Hamstring injuries are a common injury in sports that involve sprinting and rapid changes in speed¹. Once you’ve suffered a hamstring injury, what do you need to do to get back up to full speed, and how long should you expect the recovery to take?

Historically, many athletes have returned to sport less than 3 weeks after hamstring injury. One of the reasons for this is that by this stage of healing, it is common to be able to run, even at moderate speeds, with no pain. However, no pain does not equal complete healing!! Sadly, it is all too easy in the case of running, or running-based sports, to begin testing the injury hamstring too early, gaining confidence due to the lack of pain, and then reintroducing sprinting too early, resulting in a much more serious or catastrophic injury.

If you’ve been reading the blog for a while, you know that I have written before about how pain is our body’s way of letting us know when we are starting to push it too much. But if we aren’t experiencing pain even though our body hasn’t fully recovered from an injury, how can we know when it is ok to return to sport and really push ourselves again?

Over the past couple of decades, hamstring injuries have seen a great deal of research. We now know that on average, athletes felt they were back at their pre-injury level 16 weeks after an injury – meaning that it really isn’t a good idea to start pushing the muscle at that 3-4 week mark when the pain begins to recede!² Also, research has shown that returning to sport too early can increase re-injury risk for up to a year after the original injury!^3,4 So, we really want to know how to return to sport safely, and how to prevent re-injury. When pain (or the lack thereof) is not a reliable guide, we need another guidepost.

Thankfully, there have been some high-quality studies conducted that not only should help improve successful return after injury, but also reduce future injury risk. A major finding is high-quality evidence⁵ that a single exercise performed in a 10-week program can reduce new injury and re-injury by 70%! (If you consider re-injury alone, the exercise program reduces risk by 85%!!) As good as these results are it is negligent for hamstring injured patients to not receive this exercise!

So what is this exercise, you ask? You may well have heard of it: the Nordic hamstring curl. A video of the exercise is shown below:

Now, this is not to say that there aren’t other exercises that should be included when rehabbing a hamstring injury, as there may be other contributing factors that have led to an overload of the hamstrings. However, nordics should be used in rehab and should also be used in the training programs of sports that have historically had issues with hamstring injuries.

For someone who has had a hamstring injury and has been progressing with the nordic program we can know readiness to return to sport using a few criteria/tests⁶: The hamstring should be painfree on palpation, painfree strength/flexibility testing, flexibility equal to the other side, and reviewing high intensity running performance. An example of a flexibility test for the hamstrings that has been shown to be helpful is the Askings H test which is shown below⁷. If you have struggled to return from hamstring injury, there is hope! Contact me via phone or email and I would be happy to chat and help you!

References:

1. Heiderscheit BC, Sherry MA, Silder A, et al. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther 2010;40:67–81
2. Verrall GM, Kalairajah Y, Slavotinek JP, et al. Assessment of player performance following return to sport after hamstring muscle strain injury. J Sci Med Sport 2006;9:87–90.Orchard J, Best TM. The management of muscle strain injuries: an early return versus the risk of recurrence. Clin J Sport Med 2002;12:3–5
3. Croisier JL, Forthomme B, Namurois MH, et al. Hamstring muscle strain recurrence and strength performance disorders.Am J Sports Med 2002;30:199–203
4. Petersen J, Thorborg K, Nielsen MB, et al. Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster-randomized controlled trial. Am J Sports Med 2011;39:2296–303.
5. Van der horst N, Backx F, Goedhart EA, Huisstede BM. Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making. Br J Sports Med. 2017;
6. Askling CM, Nilsson J, Thorstensson A. A new hamstring test to complement the common clinical examination before return to sport after injury. Knee Surg Sports Traumatol Arthrosc 2010;18:1798–803.