How to manage a Hamstring strain

How to manage a Hamstring strain

I just strained my Hamstring (HS). What do I do?

DAY 0. That’s now man!

1) Ice:

Fill up a bag with ice or grab the frozen peas from the freezer, sit down and jam the ice under your hammy. Stay there for 15 – 20 mins and then remove. Allow the skin to get back to normal temperature and then repeat the icing. Do this as much as you can in the first 24-48 hours

2) Compression:

At your earliest convenience, source a compressive garment. Most Physio’s will stock tubular form or tubi-grip that can be cut off a roll and shouldn’t sting you like the Pharmacies will. If that is difficult to source, get yourself a firm, wide elasticized bandage (not crepe) that you can wrap on (from the bottom up) nice and firm without cutting off the blood supply to your foot. This can stay in situ and remove only for showers and sleeping for the first 48-96 hours.
3) Relative Rest:

Now’s not the time to do the groceries, walk the dog or hit the clubs. Only walk as much as you absolutely need to do to get around and perform day-to-day activities. If you are unable to walk pain free, source some crutches (and use them!)

DAY 1-2

4) Active Stretches:

In a seated position (up very straight), gently squeeze your quadriceps to straighten your knee until you just feel something in your hamstring. DO NOT PUSH BEYOND THIS. You will notice you are able to straighten much further on your unaffected leg. If you feel no difference – make sure you are definitely upright – poke your bum out, sit up tall and ensure there is an arch in your lower back. Try again.

Repeat the straightening and bending of the knee through a pain free range slowly for 2 mins. After 2 mins, hold the knee extension at your pain free threshold for 20-30 seconds and release. Repeat the whole process for 10-15 mins (4-6 times). If your hamstring is still quite sore, the process can be performed with the thigh once again sitting on an ice pack.

Perform active mobility stretches with sustained holds up to 3 x per day and for as long as it takes for you to get a pain free, full range of leg extension the same as your opposite side. This will improve every day until ~Day 5-10 depending how severe it is.

NB: ‘Stretch tears’ (sustained by overstretching the hamstrings passively eg. at the end of a long kick) may be more sensitive to this procedure. You may need to delay it a day or two and just be patient, respecting your pain level always with the Active Stretch procedure.

DAY 3-4 (By now you should have consulted your Physio, especially if you are new to HS injury).

5) Isometric Gluteal Squeezes

Lay on the edge of your couch with your affected leg hanging off, foot flat on the floor. Gently push the heel straight down, building tension in the buttock. Grab your butt cheek and feel it squeeze, filling up in your palm. Hold for 3 seconds and repeat for 10-12 reps. Total dosage for this drill is 3 x 10-12 (3s holds) 3-4 x/day. This can be performed daily, right in to the second week if you choose.

6) Glute Bridges

Glute Bridges starts in crook lying with your heels quite close to your buttock. Squeeze your buttock slowly, driving the hips up in to the bridge position. You must be 100% symptom free in the injured HS. If not, delay this drill until it is. Dosage: 3 x15-20, 3 x/day.

These drills generally put your HS in a very shortened position we call active insufficiency. This means they are at a mechanical disadvantage and generally don’t contract (thus allowing you to isolate your butt and give your HS more rest to heal).

These drills are good enough to get you through the first week or so post injury. By now the HS tear should have moved through the inflammatory phase and immature scar formation is beginning to bridge that tissue defect. Controlling load through the reparative phase as well as addressing any risk factors that predispose you to straining can be tricky and specialized. So too is the conditioning training that sets you up for a incident free return to sport, since the requirements for a sprinter could be quite different to a basketballer for instance. Consulting a Physio from this point is definitely worthwhile to ensure the best result for your particular circumstance as well to reduce your risk of sustaining a recurrent strain.

Chris Dillon, Sports Physiotherapist

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