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Basic guide to treating hamstring injuries in football

A basic guide to treating hamstring injuries and rehabilitation

Hamstring strains and tears are a prevalent injury in professional football, accounting for 12% of all injuries and resulting in an average of 90 days of lost playing time per club per season. Despite efforts to prevent these injuries and an improved understanding of their causes, players remain at risk.

The hamstrings are a group of muscles responsible for bending the knee and extending the hip. During running, these muscles are put under significant strain with each stride, increasing the risk of injury. While quicker players generate more force and speed, which can increase the risk of hamstring tears, these injuries can happen to anyone.

When a hamstring muscle tears, the injury usually occurs in the biceps femoris muscle on the outside of the thigh, but it can also involve the tendon and be more common in the semimembranosus muscle. The player will feel a sudden sharp pain in the back of the thigh and a loss of relative power, and depending on the severity of the injury, they may experience pain when bending their knee or on hamstring stretches.

To diagnose a hamstring injury, a scan may reveal bleeding and swelling in the area, with the size of the tear determining the extent of the fibre damage. While previously, tears were classified into three categories (mild, moderate, and severe), this outdated system has been replaced by the British Athletics Muscle Injury Classification, which divides injuries into five grades (0-4) and three sub-sections (a-c) based on MRI results and the site of injury.

The recovery time for a hamstring tear can vary widely, depending on the site of the injury. A small myofascial tear may recover in 10 days to two weeks, while mid-muscle belly or musculo-tendinous junction tears (the most common) may take approximately four weeks to heal. Tendon tears often take longer, with recovery times of more than two months.

Several factors can increase the risk of hamstring injuries, including previous injury, lack of warm-up, muscle weakness or imbalance, poor biomechanics, spinal physiology, ethnicity, age, poor flexibility, fatigue, and mechanical stress.

In terms of a football player’s rehabilitation process after a hamstring injury, the first step is to focus on compression and reducing swelling by using a bandage and regularly icing the affected area. Once swelling has been reduced, it’s important to begin loading the injury. Specifically, eccentric muscle contractions (such as the lowering part of a bicep curl or straightening part of a hamstring curl) should be introduced early on to produce favourable adaptations in the muscle and potentially minimize future problems.

After this initial stage, the rehabilitation process focuses on progressively increasing load and speed of contraction to work the range of demands that the muscle will be subject to when playing football. This includes maximal strength training (lifting heavy weights), power training (moving weights more explosively), and speed work. Throughout the rehabilitation process, objectivity is key. The team will have previous data and tests of the individual and team’s capability, which can be used to inform progression.

When it comes to hamstring injuries, it’s crucial to get the player running again as soon as possible. The hamstring muscle tends to produce large forces at higher speeds of running, so players with hamstring injuries can often begin running fairly early in the rehabilitation process (with the exception of a complete rupture). However, it may take until the latter stages of rehab for them to hit top speeds. The key is to gradually reintroduce them to increasing speed and volume of running at higher speeds.

The ultimate aim is to simulate the physical demands of training and competitive matches during the rehabilitation process. To achieve this, teams rely on GPS data to identify the frequency and volume of sprints performed by a player during training and matches. This information helps to determine the necessary intensity and duration of rehabilitation exercises needed to replicate these demands.

Overall, understanding the causes and managing the risk factors for every individual case is crucial for football players to stay on the pitch and avoid extended periods of lost playing time.

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