Not Your Hamstrings Again?

Photo by Jarrett Truscott from flickr

Hands up all of you who have had a hamstring injury, knows someone who has or have difficulty treating a patient with a hamstring injury (for the physios reading this). Clearly hamstring injuries are very common, very prone to re-injury and incredibly frustrating to treat as well.

Just ask Steven Gerrard, Glen Johnson and his other team mates at Liverpool Football club. Wasn't Fernando Torres plagued by hamstring injuries during his time at Liverpool too?

That glorious night in Istanbul. 

Speaking of Liverpool, the medical staff at the football club published a very fascinating paper (in the British Journal of Sports Medicine) on how they treated one of their player's difficult and recurrent hamstring problem.

Without disclosing any names, this player had hurt his hamstrings (5 times in 5 months), under 23 years old then, from an African/ Caribbean background, previous knee injuries, history of groin problems and poor hamstring to quadriceps strength ration. Yes, the above mentioned factors are risk factors for a hamstring injury.

The Liverpool medical staff came up with the following  treatment plan. First they corrected his functional leg length difference and his pelvis (or hip) - he saw an osteopath based in Germany for his hip.

Through some cortisone injections and nerve stretches, he had his neurodynamics addressed.

Following that they focused on his core muscles, not just any core muscle, specifically transversus abdominis and multifidus. (So if your Pilates instructor, Physiotherapist or trainer etc doesn't teach you how to activate your transversus abdominis and/ or multifidus, you're not training your core). After increasing his eccentric (or lengthening) hamstring strength, he kept his hamstring length supple with Yoga, regular hamstring stretches and low back stretches.

Since early return to running has been shown to reduce subsequent injury risk, he underwent an overload running program of the following 3 days cycle. Day one was speed running, day two aerobic base running and day 3 was off feet conditioning - bike and my favourite of course pool work.

He also had Actovegin (calf blood extract) and Traumeel injections. Cycling fans may remember Lance Armstrong used both Actovegin and Traumeel to aid his recovery. These substances are not illegal.

Well, there you have it, a complete treatment plan for hamstring injuries. You many also want to read this or another earlier post we wrote on hamstring injuries.

Reference

Brukner P, Nealon A, Morgan C et al (2013). Recurrent Hamstring Muscle Injury: Applying The Limited Evidence In The Professional Football Setting With a Seven-point Programme. BJSM. doi:10.1136/bjsports-2012-091400.

*Liverpool picture by Kevin Mustong from flickr