Here at Health First Osteopathy we are proud to be working along side football clubs here in Wales with Llanelli Town and Swansea University women’s football team. In this role we encounter many injuries from Ankle sprains to hamstring pulls, to even a dislocated patella and a displaced AC joint in the shoulder (Not the nicest). But, one thing I have seen many times is a pulled hamstring, so this blog is going to explain what happens and how we go about helping those players get back to health.


How the injury happens may be different depending on when you hurt your hamstring. An acute strain can occur in training or a match with sudden acceleration, sprinting, sharp change in direction or hard breaking and sliding into a tackle (overstretching the hamstring muscle). The hamstring muscle works over the hip and knee, and as such is a two-joint muscle. It contracts to extend the hip, straightening the leg or pulling it back behind you; and it flexes or bends the knee. The hamstring is therefore constantly working throughout all stages of walking or running and jumping allowing little time for rest or recovery. It is susceptible to fatigue, which makes it vulnerable to injury. A common consequence of this is straining the hamstring in the latter half of a game as it starts to tire, especially if you are not well conditioned! A previous hamstring strain is the biggest risk factor for a future hamstring injury. A chronic overuse hamstring muscle strain can develop over time through training with a feeling of stiffness in the muscle and a deep ache at the back of the thigh or into the buttock. This is often a hamstring tendinopathy. This will be due to a cumulative effect of training, increasing load and intensity but also associated with a number of underlying factors, such as muscle imbalance including eccentric strength, pelvic and core muscle weakness, hard or wet training surface, poor flexibility, lower back pathology, poor warm-up and improper running mechanics, fitness/ fatigue. In these tendinopathy cases research has shown there are degenerative changes in the tendon rather than an inflammatory response as previously thought. Tendons have a poor blood supply and are therefore slow and stubborn to heal.


There are four muscles that make up the hamstring: semimembranosus and semitendinosus (medially – ‘inner half’ of the back of your thigh) and biceps femoris – short and long heads (laterally – ‘outer half’ of the back of your thigh). Injury could be to any one or more of them, with a tear or cumulative strain to the muscle fibres. A hamstring strain can range from mild to very severe involving a complete tear of the hamstring muscle. See the table at the bottom of this blog for details of the injuries and the symptoms.


As mentioned earlier a history of previous hamstring injury is the biggest risk factor for a future hamstring injury. If you have not had a hamstring injury previously and wish to prevent one (which is the best plan yet!) being proactive and consulting a physical therapy specialist to assess any underlying muscle weakness, or biomechanical issues would be hugely beneficial in the long run. Ensuring your hamstring is working cohesively with your glutes, lower back and buttock/pelvic muscles will ensure they are not overloaded or taking extra strain. Improving their condition and fitness will also help ward off fatigue and injury risk. A thorough warm-up has been proven to reduce hamstring injury risk, so ensure you participate in a warm-up, even if you have arrived late or are rushing to get started, take the time to adequately prepare your muscles for activity. If you have been sitting through periods of the match, warm up on the sideline again before running onto the field. Otherwise, being a disciplined, compliant patient would be key to optimal recovery. It is essential to follow hands-on treatment with a full rehabilitation programme. It may be hard to stay motivated once the pain disappears, but in order to prevent a recurrence and return to full function it is essential you work through a progressive exercise routine with your physical therapy specialist.


As seen in the table at the end, physical therapy is an integral part of treating a hamstring injury, both acute and overuse injuries. The sooner you start treatment following an injury the better the outcome. The early stages of treatment are not only aimed at reducing pain and swelling, but are also crucial to minimise scar tissue formation and ensure good muscle fibre alignment – which in the long term will ensure a stronger muscle, more resistant to injury.

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#Sport #Football #Hamstring #BackPain #Running #SportsInjury

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