The most common muscle injury in professional football players is a tear of the hamstring muscle but this injury is not just a problem for the professional athlete and it can occur at any level of participation.
The hamstrings are a group of 3 muscles in the back of the thigh, which includes the biceps femoris, semitendinosus and semimembranosus. The hamstrings extend the hip and flex the knee but their main functional role is deceleration during running and change of direction. As a group, they are not as strong as the quadriceps muscles on the front of the thigh, with the usual strength ratio of hamstring to quadriceps being around 65%.
Hamstring strain occurs most often during high speed running when sprinting for the ball. The other way the hamstrings get injured is an overstretch injury where the muscle gets lengthened excessively during movements such as high kicks and over-reaching for tackles. It’s important to know which type of injury mechanism was involved, because overstretch injuries generally cause less pain initially but take longer to recover from.
The biggest risk factor for a hamstring injury is having had a previous hamstring injury. A player who has had a hamstring injury in the past is up to 7 times more likely to injure his or her hamstring again compared to someone who has never had a hamstring injury. The second injury often keeps them out of the game for a longer duration. Increasing age also increases the risk of hamstring injury and there are many other factors that can increase risk of injury including genetics, muscle strength and length, core stability, fatigue levels, level of competition and training loads.
Hamstring injury is usually diagnosed by clinical examination. Imaging such as MRI can help to confirm the diagnosis but is not always needed.
The majority of hamstring injuries can be managed non-surgically with a rehabilitation program. The goals of treatment are to regain pain-free range of motion and strength, and to gradually increase functional ability and performance prior to returning to play. Hamstring avulsion injuries, where the tendon pulls off the bone (usually at the top of the thigh if this occurs) may need surgical management.
The aim of a rehabilitation program is to prevent re-injury. Progression through rehabilitation isn’t time dependent, but based on achieving key functional outcomes and clinical criteria. The player should be able to complete at least a week of full training pain free prior to returning to play and should return gradually, increasing time spent on the field each week before playing a full 90 minutes. The biggest risk of re-injury is in the first 2 months of retuning to play.
Prevention of any injury is better than cure and there is increasing evidence that specific exercises can reduce the risk of injury. Nordic hamstring exercises have been shown to reduce the risk of hamstring injury by 70% and risk of re-injury by 85%. FIFA have developed an injury prevention program called the 11+, which has been proven to halve the risk of hamstring injuries amongst others.
If you have sustained a hamstring injury that has caused you to stop playing, a consultation at Shire Sports Medicine can be beneficial for you to help guide management of your condition and ensure the prevention of further complications and re-injury while aiming to get you back on the field as soon as possible.