When is the best time to return to sport after a hamstring injury?
4 key points that determine the success of your hamstring rehabilitation.
One of the most common injuries in running and kicking athletes, the dreaded hamstring strain can stop you in your tracks. However, there are some clear parameters you can follow to give you the best chance of returning to your sport safely.
1/ What type of hamstring injury do you have?
Like most injuries, hamstring injuries exist on a spectrum from minimal/low grade to severe/high grade. Commonly hamstring strains (tearing of the muscle fiber) are classified into 3 categories:
- Grade 1 - low grade injury, minimal muscle damage
- Grade 2 - medium grade injury, moderate muscle damage
- Grade 3 - high grade injury, significant amount of muscle damage
- Rupture - complete 100% tear of the muscle or tendon
The lower the grade, generally the quicker the rehabilitation process. Research suggests the ‘average’ hamstring injury will take 3-4 weeks to rehabilitate and return to sport with full function.
The Pollock classification of hamstring injuries (Pollock et al 2017) takes into account the location of the injury and involvement of other structures such as tendons, which assists your physiotherapist in determining return to sport timeframes.
2/ How did your hamstring injury happen?
On examination, your physiotherapist will ask ‘What happened’? This is important information, and allows your physiotherapist to make an accurate diagnosis and develop an appropriate rehabilitation plan for your specific injury.
You may have taken off quickly to sprint and felt a ‘grab’ in the upper part of the hamstring.
Alternatively, you may have had a ‘tight’ hamstring for a week and aggravated it while jogging uphill.
The rehabilitation for these two hamstring injuries will be slightly different for you to achieve the best results and return to sport/activity safely.
3/ How strong and flexible are you?
As your physiotherapist continues the examination, they will assess your flexibility and strength and compare this to your ‘good’ side. As a guide, non injured hamstrings would have less than a 10% difference in both flexibility and strength. This difference takes into account you are likely to have a dominant side.
Your physiotherapist can measure your hamstring flexibility with either a straight leg raise test, or a popliteal angle test. The location of the injury will determine if one test is more appropriate than the other.
To assess your strength, your physiotherapist would likely use a dynomometry device, which measures the force you can produce. Leading Edge Physiotherapy uses the AxIT System to measure your force production, and determine if you are ready to progress to the next stage of your rehabilitation.
4/ Sport/Activity Specific Rehabilitation
All sports and activities are different. Running while bending forward holding a hockey stick is different to running while holding a football, which is different again to sprinting on a track. Add in opposition, change of direction and kicking and you can see there are varying demands on hamstrings in different sports.
The later stages of your rehabilitation will include a return to sprinting program. This progressive program builds on your jogging to include faster pace running over a shorter distance, and acceleration and deceleration drills.
As you progress, your physiotherapist will add in backwards and sideways running drills, change of direction drills (agility), kicking drills and jumping/landing drills as appropriate for your sport/activity. Often you will be able to incorporate these drills into your training sessions during the week.
Returning to sport after a hamstring injury is often challenging both physically and mentally. Your Leading Edge Physiotherapist can expertly guide you through the assessment and rehabilitation process to ensure you return to sport safely and reduce the risk of injuring your hamstring again. To arrange a consultation to have your hamstring injury assessed by an experienced Leading Edge Physiotherapist, book online here.
Pollock N, et al. Br J Sports Med 2014; 48: 1347-1351
Luis Fernandez Astudillo
Senior Physiotherapist at Leading Edge Physiotherapy
Physiotherapist Adelaide City F.C - Senior NPL team
S&C Coach ASCA level 1