Hamstring Injuries
The most commonly injured muscle in athletes is the hamstring, frequently occurring in sports that involve sprinting, jumping, or sudden stops. This article will cover what you need to do to rehabilitate yourself after a moderate to mild hamstring injury.
Please note, If you have a hamstring injury and there is a severe amount of pain and swelling and you have problems using the muscle at all, you should seek advice from a healthcare professional to rule out a complete tear of the muscle or tendon.
The First 24 Hours
For the first 24 hours after the injury try to rest as much as possible, keeping the injured muscle in a comfortable (pain-free) position. The repair process is well underway, so you don’t want any further muscle tissue damage. You can also use a compression bandage to minimise swelling and try to keep the injured area elevated above heart level to reduce swelling.
Cold packs?
My view is that you should only apply cold packs to strained muscles on the day of the injury. Whilst cold packs can reduce pain and limit the bleeding (haematoma), there is not much objective evidence that they help with the quality or duration of the muscle repair process. They may even interfere with tissue healing if applied more than 12 hours after the initial injury.
If you do want to use them, it's generally recommended to apply ice packs for between 10 to 20 minutes at a time. You can repeat this every 1 to 2 hours as needed. Make sure to wrap the ice pack in a cloth or towel to protect your skin from frostbite. If you experience excessive discomfort or numbness, remove the ice pack immediately.
Pain relief
Following muscular injury, non-steroidal anti-inflammatories (NSAIDs) like ibuprofen are often recommended to relieve pain. Whilst they do usually provide pain relief by dampening down the inflammation, studies have shown that NSAIDs can interfere with collagen production and muscle repair. In addition, animal studies have shown that taking NSAIDs after a muscle injury can lead to smaller and weaker muscle fibres at the injury site.
My advice would be to limit NSAID use as much as you can. Paracetamol can also be used for pain relief, and interferes much less with the muscle repair process.
The next few days
For the first few days following the injury you should try to minimise the use of the injured muscle. Gentle walking is usually ok as this doesn’t stress the hamstrings too much, but no running or sport and avoid any stretching.
Should you walk if you still have pain? The advice used to be that you shouldn’t do anything that causes pain at the injury site. However, some recent research has shown that providing that the pain is minimal, then it’s probably safe to begin some gentle exercise, including walking.
What is minimal pain? It’s very subjective, but the study showed that if any pain when straightening the leg out was equal to or below a self-reported score of ‘4 out of 10’, then it was probably safe to begin gentle exercises.
The caution during the first few days is because the initial muscle repair processes start within a couple of hours of the injury and are still ongoing 4-6 days later. During this time the body will be busy breaking down the damaged tissue and laying down repairs at the injury site , and too much muscle tension or stretching may interfere with this process and reduce the final quality of the repaired muscle.
Rehab
Towards the end of the first week you may be able to start some gentle exercises to help the new muscle fibres regenerate and orientate properly. People with more minor strains may be able to start sooner, and people with more serious strains may have to start later.
As discussed earlier, traditionally it was recommended to wait until your muscle was totally pain free before commencing exercises, but recent research showed that people could begin exercising even with a small amount of pain. If you want to be on the safe side, then wait until you are pain free.
The main types of exercises recommended for hamstring injuries are progressive running exercises and eccentric hamstring exercises. These exercises are covered in more detail here
It is important to stress that every injury will be different and if you are unsure about when to start these exercises then you should seek professional guidance before attempting them.
Hamstring Injury Rehab Exercises - Progressive Running & Eccentric Exercises.
Other considerations
Along with the exercise protocols, there are other factors to consider that might optimise your healing further.
Red Light Therapy - There is strong evidence that using red light on injured tissues promotes wound healing and tissue repair. I’ve talked about the science behind red light therapy in a previous blog here. You can either purchase your own red light device or find a practitioner (like me) who uses one. Although cheaper models are freely available, I use a hand-held light from this company as well as a larger machine from this company.
Nutrition - To make sure your body has the vitamins and minerals it needs to repair and replace the injured muscle you should consider taking a quality supplement that contains the following, all of which have a role in collagen synthesis.
Vitamin C, Vitamin D3, Vitamin A, Vitamins B6 and B12, copper, zinc, magnesium.
In addition, Collagen Powder is worth considering. The body initially patches up your injured muscle with Type 3 collagen and then as healing progresses it replaces it with type 1 collagen. There is some evidence that supplementing with collagen peptide powder can help with muscle repair. My preferred product which I have been using for years is this one, which contains both Type 1 and 3 collagen
When do you go back to sport ?
Some athletes are still returning to sport too quickly, risking the same muscle getting re-injured. In particular, amateur athletes are three times as likely to re-injure themselves compared to professionals.
Studies looking at professional footballers and elite athletes have shown that following muscle injuries it takes an average of about 3 weeks before they return to full sporting activity levels.This timeframe makes sense as research has shown that it takes roughly 3 weeks for the scar tissue at the site of the injury to knit together properly and mature to anywhere near its former strength and composition.
The timing of a return to sport is still not an exact science, even for professional athletes. A 2020 study looking at hamstring injuries in professional footballers showed that the following factors were used to assess if return to play was appropriate;
No pain when palpating the injury area
No pain when the muscle was used at maximum strength
Return of full range of movement and strength
Other studies have recommended doing 2 full training sessions in your particular sport before returning to competitive play. This is so your hamstring gets used to the particular movements associated with your sport.
I would also add that you should be able to perform the most difficult running and eccentric exercises without pain together with being able to perform any movements specific to your sport.
Osteopathy
Finally, there is also a role for osteopathic treatment in the rehab process, particularly when it comes to trying to future-proof your hamstrings.
I like to assess what is going on bio-mechanically with patients who have had hamstring injuries. Sometimes without identifying and correcting underlying issues, there is an increased chance of re-injury. I assess the mobility and function of the lower back, hips, knees and feet as they can all have an effect on hamstring function. Patients with stiff hips may need work to free them up, and conversely hypermobile patients may need to stabilise their hips with targeted gluteal muscles exercises.
If you live in the East Grinstead or Forest Row area and have a hamstring injury and want help getting back to sport, then book an appointment to see me at Osteo Studio.
Cliff Russell
Registered Osteopath
