Recurrent hamstring injury is one of the most common issues we see in any field sport like football or hockey.
So why is the hamstring muscle so prone to repetitive injuries?
We’ll go through the 3 most common causes of recurrent hamstring injury and how to fix each one.
Reason 1: Inadequate rehab
It seems obvious – not preparing adequately for a return to sport makes you more prone to recurrent hamstring injury.
But the issue doesn’t lie in a lack of motivation or bailing early on rehab.
It’s a problem with not knowing WHEN your rehab is completed.
Is it when you’re pain-free? Back to normal strength? Back to running?
More often than not, rehab is incomplete because the hammy seemed fine so you stopped.
Solution 1: Better testing
Ensuring that your hamstring injury rehab is complete involves three aspects of testing.
1. Connective tissue testing
This assesses if the muscle has its length and bounce.
You can cover muscle length with a standardised muscle length test, like a sit and reach.
You can test connective tissue elasticity with a plyometric test, like a three hop for distance test.
Note that the 3 hop test also tests aspects like strength so the result isn’t purely based on elasticity.
2. Muscle strength testing
You can compare it to your unaffected side but remember that the other side has been out of action as well.
For this assessment, it depends on your equipment.
There are fancy machines that can isolate hamstrings but for most, a simple single leg barbell deadlift does the job nicely.
You’re looking to lift the same weight on both sides, with good technique for each rep.
You should be able to complete around 90% of the reps as the unaffected side over three sets.
3. Technique testing
This assesses your muscle firing patterns and coordination for any sport-specific movement that loads the hamstrings.
This might include running, jumping and kicking a ball.
This testing is to ensure that the brain is controlling the hamstring muscles effectively and not putting it at risk by being over-protective.
You’ll need another set of eyes to watch you throughout each movement, preferably someone trained in techniques like a coach (remember that a great player probably only knows their own technique and may not be a great assessor).
Perform the different techniques at game intensity (after a warm up).
You should also perform them while fatigued as that’s your riskiest time in the game.
So warm up and go through the individual techniques.
Then conduct some high intensity fitness training followed immediately by the same techniques.
Your observer is looking for altered muscle patterns, both fresh and then while fatigued.
Reason 2: It’s not a hamstrings tear
Another big reason behind recurrent hamstring injury is that it’s not actually a hamstring injury.
Seems odd but there are a number of other injuries that behave exactly like a hammy tear.
There are also a number of secondary injuries that can co-exist with a hammy tear – basically you get two injuries at the same time and the more subtle secondary injury is missed.
Most of the injuries in this category involve nerves.
You can have an irritated Sciatic nerve alongside a regular hamstring strain.
You can have a primary Sciatic nerve tension issue that behaves exactly like a hamstring tear – it’s even sore to push on!
Then there’s lower back referral. This can be due to a nerve irritation or even referred pain without nerve involvement.
Lastly there’s a few vascular (blood vessel) conditions that can cause recurrent hamstring injury symptoms but these are quite rare.
Solution 2: Confirm the diagnosis
This might be done with a second opinion or with imaging like MRI.
I wouldn’t recommend ultrasound as it lacks the detail we need to exclude some of the conditions associated with recurrent hamstring injury such as nerve issues.
MRI can be expensive but it’ll save you plenty in the long run.
Reason 3: Biomechanical issues with your technique
There are a number of biomechanical reasons why hamstring injuries occur.
It might be a longer stride length or poor pelvic control during jumping.
If that’s the case, the hamstrings are always vulnerable and recurrent hamstring injury will follow.
With each injury to the hammy, the technique issue may worsen due to strength, length or inhibition issues.
This sets up a cycle of recurrent hamstring injury that drives you nuts!
Solution 3: Technique assessment and modification
For this solution, you’ll need one, or ideally two, sets of eyes on you.
Select experienced and trained coaches rather than good players – coaches are trained in technique, players only know their own technique and they’ve never seen it from an observer’s perspective.
Start by assessing the technique that matches your injury scenarios.
If you always get injured jumping for a ball, look at your technique for that.
If it’s sprint starts, look at a variety of start positions and directions.
Then reassess each technique with fatigue – just smash out a hard 10min of cardio then re-test.
For each technique, you’re looking for errors that make you more prone to recurrent hamstring injury.
If you find those errors, design exercises and/or drills to fix them.
If you don’t find anything obvious, you can still modify technique to reduce hamstring loading.