Recurrent Hamstring Tears – More than just a pain in the butt

Hamstring injuries are one of the most common injuries sustained, not only amongst sporting populations, but within general exercise and activity-based individuals. Although hamstring injuries are common at all levels of sports and exercise, the recurrence rate is disproportionate compared with other similar soft tissue injuries. 

Some of the more common causes that may increase the chances of experiencing more than one, or recurrent, hamstring tears are factors such as age, strength imbalances, lack of flexibility, previous injury, and the type of exercise or sport you play. Sports that require a high frequency of kicking movements, acceleration and deceleration motions, changes of direction, speeds and loads, all impact the higher likelihood of a hamstring tear. The average amount of time missed in sports due to a hamstring strain is approximately 18 days, but the actual time missed is often much greater. 

The highest risk factor for having a hamstring strain is previously having sustained a hamstring strain. The greatest incidence of reinjury occurs within the first 2 weeks of returning to your chosen sport or exercise. This highlights not only the importance of accurate diagnosis and appropriate treatment, but also the importance of sticking to the recommended treatment plan as outlined by your treating physiotherapist. 

At the initial assessment with your physio it is important to understand what your expectations are for recovery, and what specific goals or outcomes you’re striving for. It is important to note that not everyone may be returning to elite or competitive sport, so they may not have the same physical demands required for their recovery. However, the risk of reinjury remains the same, and no one likes missing out on doing the things they love due to pain and injuries. Therefore, having realistic goals within the timeframes for recovery your physio recommends, is always a great place to start. 

There are different grades of any muscle tear, often classified into 3 different categories ranging from a Grade 1 (mild strain, 3-4 week recovery) to a Grade 3 (severe muscle tear/complete rupture, 6-12 months recovery). Not all will present the same and often it can be challenging to determine the severity within the first 2-3 days. So initial treatment focuses on reducing the swelling and bleeding within the muscle strain/tear. Gentle massage and general R.I.C.E (relative rest, ice, compression and elevation) can go a long way to help speed up the recovery time. 

Weeks 2-3 often find most individual’s pain levels reducing, and in some cases can be nearly completely pain free. This is where the risk of reinjury occurs – people believe that due to the absence of pain, their injury must be fully healed. Unfortunately by this stage we have not developed enough muscle repair and added enough loads and stress to the muscle tissue to minimise the risk of another tear. So around this time the focus moves away from hands on clinical treatment, and progresses towards more exercise and strengthening based rehabilitation with your physio or exercise physiologist. 

By weeks 4-6 most minor grade 1-2 injuries are nearly completely healed depending on the severity of the initial injury – which does not always equate to a simple return to sport or exercise. As outlined earlier there are specific factors that need to be tested and trained prior to returning to full capacity – such as targeting the changes in speed, direction and loads with exercise. This is where sport specific drills and return to sport activities can be included in your rehabilitation. 

It is important to note that often there are other factors contributing to recurrent hamstring tears. Weakness of core muscle stabilisers around your lower back and gluteal region can often cause an overload or irritation of your sciatic nerve. This can often lead to poor biomechanics and refer pain into the hamstring, or alternately, cause your hamstring to become more loaded than it should be, and make it work harder to do a job it is often not designed to do. So a thorough assessment by a physio, coupled with complete treatment plan compliance, will ensure you achieve the most accurate and best experience possible when recovering from what can be a very frustrating injury, especially if it is the 2nd or 3rd time you’ve had the injury occur. 

Do not risk it – do it once and do it properly and ensure you spend more time on the field, in the gym or playing with the kids, and get back to living your best life. 

You can head to our youtube channel to watch the 2-part video series by Core Physio Partner, Joel McPhee. 

Hamstring Assessment – https://www.youtube.com/watch?v=k9Mp8pnp9lA
Hamstring Rehab – https://www.youtube.com/watch?v=0Hi8DBJvrFA