Hamstring injuries: We’ve outgrown our options

By Jennifer Schwartz

Editor’s note: Jennifer Schwartz is the owner of Impact Fitness DC, a professional private training company providing fitness services to female athletes, teams, individuals, and small groups in Washington, D.C. She holds a certified mastery in biomechanics with a specialization in resistance training and muscle activation techniques™, and is also a United States Soccer Federation-licensed coach with the Alexandria Soccer Association. Soccer Wire is very pleased to present Jennifer’s perspectives on biomechanics and injury prevention.

If there is one group of muscles a soccer player is aware of, it’s the hamstrings. Whether the conversation pertains to performance, flexibility, soreness or strains, hamstrings always come up.

For a soccer player, tightness in the back of the thighs is a common sensation due to lack of flexibility and a high rate of injury – or even worse, re-injury. The re-injury rates are between 12 and 31%, and an epidemiological studies reveal that the re-injury rates have remained the same since 1983.  So how has the one of the most common and complex injuries been shrouded in mystery for decades?

According to the Journal of Orthopedic Sports & Physical Therapy, this high re-injury rate suggests that commonly utilized rehabilitation programs may be inadequate at resolving possible muscular weakness, reduced tissue extensibility, and/or altered movement patterns associated with the injury.

Ouch! Even the experts leave a suggestion box of reasoning for repetitious hamstring injuries and how to treat them.

History

Current methods for treating hamstring injuries have, unfortunately, not evolved much from historical approaches. A paper published in 1906 suggested ice water and massage followed by a week of rest as the best method of treatment. Thirty years later, another paper advised that returning to strenuous activity too soon would inhibit healing and increase the possibility of re-injury. Research from 1958 suggested core muscle strengthening as a means of hamstring rehabilitation and stability.

The basis of understanding where the injuries are coming from and remedial methods of treatment are there, but most modern treatments end up causing more damage than help.

Non-steroid anti-inflammatory drugs (NSAIDS, like aspirin, ibuprofen and naproxen sodium) were acceptable medications until they began to accelerate fibrosis (i.e. the build-up of scar tissue near the injury). Plasma-rich blood injections are still used, though there is no real evidence as to their effectiveness with injury rehabilitation. And now, even a century later, very little new information has emerged because the Journal of Orthopedic Sports & Physical Therapy still recommends a three-phase treatment protocol of minimizing scar tissue, eliminating inflammation and strengthening eccentric motions in hamstrings.

Perspective

Basically, what we know is that it’s easy to be a soccer player and repeatedly strain a hamstring. But what we’d like is for this continuum of injury not to exist at all.  There seem to be two schools of thought: The perspective that this is a current norm in competitive sports, no matter what you do, and the progressive thought that prevention is truly the best prescription for longevity and performance prosperity!

An athlete who experiences a significant injury in childhood is far more likely to end up with premature arthritis or the need for joint replacement. The health of our nation echoes this with an increase in childhood obesity leading to long-term and eventually life-threatening illness. In the same way a metabolism can be permanently stunted from childhood habits, a minor injury can cause lifelong damage to the wellness and performance of an athlete.

The evidence for what ignoring your body’s limitations and ignoring signs of injury are there. One thing is certain; injury prevention efforts and education must address this problem. It’s scary to consider that what most athletes consider a minor injury, straining a hamstring, could basically be laying the groundwork for an ACL or Achilles injury/surgery down the line.

Suggestions

Knowing how muscles work and why they strain is the basis to understanding how to prevent injury. Skeletal muscle exists to control joints in a specific response to a particular demand. A strain is a response to an overload of mechanical force. If the muscle is not prepared to meet the external force through reciprocating internal joint force, the muscle sustains microscopic tears within the fibers.

The perspective of Muscle Activation Techniques™ is one that our muscular system controls our joints in much the same the suspension system of a car guides a vehicle down the road. In essence, when you understand and treat your muscles appropriately, they will withstand the effects of the road you choose to race on.

The ‘break it and fix it’ mentality of an athlete is dangerous. The truth is we shouldn’t question our muscular system’s capabilities once we’ve damaged some tissue. Sure, we can succeed mildly in athletics with injuries over the years. But it’s that break it/fix it approach that creates career-aged people who end up with herniation of spinal discs, or premature arthritis.

If one truly wants competitive edge, to be on top of their game, they need to take the approach of maintaining optimal joint and energy conditions.

[ +For helpful diagrams and a full list of works cited in this article, visit the Impact Fitness website ]