Preventing Hamstring Tears

Given the relatively high prevalence of hamstring re-injury, it is important to consider preventative measures prior to and following hamstring strains.¹Price R, Hawkins R, Hulse MH, A. The Football Association medical research programme: an audit of injuries in academy youth football. Br J Sports Med 2004;38:466-71.^,2Feeley B, Kennelly S, Barnes R, et al. Epidemiology of National Football League training camp injuries from 1998 to 2007. Am J Sports Med 2008;36:1597-603.^,3Engebretsen A, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic risk factors for hamstring injuries among male soccer players: a prospective cohort study. Am J Sports Med 2010;38:1147-53.^,4Gabbe B, Bennell K, Finch C, Wajswelner H, Orchard J. Predictors of hamstring injury at the elite level of Australian football. Scand J Med Sci Sports 2006;16:7-13.^,5Gabbe B, Finch C, Bennell K, Waj-swelner H. Risk factors for hamstring injuries in community level Australian football. Br J Sports Med 2005;39:106-10.

Eccentric hamstring strengthening, with a slow lengthening phase of contraction, has been shown to prevent new and recurrent hamstring injuries in soccer players.⁶Brooks J, Fuller C, Kemp S, Reddin D. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med 2006;34:1297-306.^,7Heiderscheit B, Sherry M, Silder A, Chumanov E, Thelen D. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther 2010;40:67-81.^,8Askling C, Tengvar M, Tarassova O, Thorstensson A. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med 2014;48:532-9.^,9Petersen J, Thorborg K, Nielsen M, Budtz-Jørgensen E, Hölmich P. Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. Am J Sports Med 2011;39:2296-303.^,10Arnason A, Andersen T, Holme I, Engebretsen L, Bahr R. Prevention of hamstring strains in elite soccer: an intervention study. Scand J Med Sci Sports 2008;18:40-8. There is evidence that incorporation of eccentric exercises into preseason and in-season training may decrease the occurrence of hamstring injuries and prevent recurrent hamstring injuries.⁶Brooks J, Fuller C, Kemp S, Reddin D. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med 2006;34:1297-306.^,7Heiderscheit B, Sherry M, Silder A, Chumanov E, Thelen D. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther 2010;40:67-81.^,8Askling C, Tengvar M, Tarassova O, Thorstensson A. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med 2014;48:532-9.^,9Petersen J, Thorborg K, Nielsen M, Budtz-Jørgensen E, Hölmich P. Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. Am J Sports Med 2011;39:2296-303.^,10Arnason A, Andersen T, Holme I, Engebretsen L, Bahr R. Prevention of hamstring strains in elite soccer: an intervention study. Scand J Med Sci Sports 2008;18:40-8. However, eccentric exercises can be quite painful, so a gradual increase in intensity and duration of these exercises is recommended in order to avoid excessive muscle soreness and increase compliance.⁸Askling C, Tengvar M, Tarassova O, Thorstensson A. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med 2014;48:532-9.^,9Petersen J, Thorborg K, Nielsen M, Budtz-Jørgensen E, Hölmich P. Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. Am J Sports Med 2011;39:2296-303.^,10Arnason A, Andersen T, Holme I, Engebretsen L, Bahr R. Prevention of hamstring strains in elite soccer: an intervention study. Scand J Med Sci Sports 2008;18:40-8.​​​​​​​

Given the relative risk factors for hamstring injury and re-injury, it's prudent for athletes to develop a balanced conditioning program that incorporates:

• Flexibility
• Eccentric strength training
• Neuromuscular control (balance and coordination)

A conditioning program with these elements may help prevent initial and recurrent hamstring strains. Further research into potential benefits and longitudinal effects of eccentric training are ongoing.

Conclusion

Hamstring injuries are extremely common occurrences in all levels and types of athletic activity. Acute hamstring strains and tendon injuries can be severely debilitating for anyone. Proper and prompt management of these injuries can improve outcomes, speed return to play, and decrease re-injury rate. Eccentric exercises offer a promising way to treat and prevent recurrent injuries and further research into potential benefits and longitudinal effects are ongoing. Proximal hamstring avulsion-type injuries warrant advanced imaging and possible surgical fixation. It is important to individualize treatments and consult with a physician or qualified clinician for each patient, each injury, and each sport.