Expert Interview - Physio on Hamstring Strains

Early stage

All muscles trains are much the same in the early stages. First thing is to get an idea of how severe the injury is. The initial stages are much the same whatever the severity, but more severe injuries will require longer periods of treatment. Ice and compression should be applied straight away. Neal believes that compression is just as, if not more, important than ice. This should be for 20 minutes as soon as the injury occurs to stop the bleeding as soon as possible. Another aim is to get into the inflammation stage and out the outer side as far as possible. After this the injury is assessed to determine the severity.

Electrotherapy can work best if applied in the earlier stages. After the first 24 hours, Neal would use Ultrasound, or pulsed short wave therapy and then Laser. This would continue for the first week. Ice would also continue for the first week, and then be changed to using hot and cold alternating.

Neal recommends not massaging too early in the injury as there is bleeding so you don't want to make this worse and also it can be pretty sore to touch. After 4-5 days, he may do is very light effleurage to try to take some of the waste products away and break up the forming blood clot. Gradually the amount of massage and the pressure used is increased. This helps to develop a good quality scar - modelled into the right shape and form so that it acts like a muscle later on.

Late stage

With a hamstring strain the late stages of rehab is done out in the field. Most people can jog pain free quite quickly, but it is sprinting that tends to cause problems. Running backwards also works the hamstrings a lot so Neal includes this in his programmes.

Stretching and strengthening

Stretching would begin fairly early as long as it is pain-free - usually by the end of the first week. This helps with developing a good quality scar.

Strengthening Neal calls load. The aim is to slowly put more load through the muscle and the scar. Early stage strengthening involves isometric exercises - with no movement, followed by isotonic and isokinetic exercises and then eccentrics. These are bought in earlier at a low level, 5-6 days after injury. Manual eccentrics are performed by the therapist resisting the hamstring down from knee flexion to extension.

How long for a hamstring to heal?

Neal thinks up to 3 weeks for a grade one, between 2 and 8 weeks for a grade 2 and 12 weeks for a grade 3. Saying that, it can be quicker or it can be slower. The variation is down to lots of things including the initial treatment and the patients age and fitness etc.

It is important after an injury to carry on with maintenance work to prevent re-injury. This is where strength work is more important. It's very easy once you're back to sport to forget about the injury, but it is well known that it can take 12 months for a scar to be remodelled and work exactly like it used to before.

After a moderate or severe hamstring strain, the muscle will never be exactly the same so it is important to keep working on that muscle to build tensile strength in the muscle. Nordic curls are used continuously by Neal with his previous hamstring strain clients. This exercise tends to have the most evidence backing up it's use for injury rehab and prevention.

The other important point is that once you are back to playing the same intensity of rehab shouldn't be maintained as otherwise doing this plus training and playing can cause overload!