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Hamstring Injuries – Risk Factors

Continuing on from the newsletter discussing the anatomy and incidence of hamstring injuries, the next natural question to answer is:  Am I at risk?

Am I at risk for a hamstring injury?
Certain people are more at risk for hamstring injuries: those who are participating in running, sprinting and kicking activities, those who do not warm up well, those who are tired and those who are trying to play beyond their ability. The biggest factor in predicting a hamstring injury is having injured your hamstring in the past.
Imagine a recreational pitch sportsperson who is tired from a night out after a long week at work sitting at the desk….maybe during the week they didn’t do much exercise.  That person is now rushing to get to a game, they are running late, they don’t get into the full warmup, and they start to play.  Oh, and they’ve hurt their hamstring previously, but feel fully recovered.

They would be a higher risk for an injury than anyone else who had exercised, warmed up, and had some rest…especially if they didn’t have an injury in the past.

What Can I do?

Avoiding injury (and then re-injury) is the best thing you can do! Be well conditioned for the sport you’re playing by doing functional training and don’t skip your warmup.  If you’re in a sprinting sport, that means your training should include sprinting and not endless running on the track – muscle recruitment is different in that scenario and you want to train your system to recruit muscles in the way you need to use them.  You want to be sure you do lots of dynamic stretching as part of your training routine, and get plenty of rest and allow yourself recovery time between intensive game weekends.
How are hamstring injuries approached?
There are a wide variety of approaches by different therapists and the approach is also dependent upon the severity of the injury.  There is conflicting evidence about the best approach to take, but generally speaking approaches to rehab tend to look a bit like this:
  • First 48-72 hours:  ice, compression and non steroidal anti inflammatories (though some suggest waiting at least 48 hours to start these as they also interfere with the natural healing process that inflammation kicks off.


  • Through the first week it is often suggested that active movement of the knee continues so as to avoid adhesion and promote proper early healing tissue orientation. (Imagine fibres of muscle laying side by side, with a cut across them. You want them to heal end on end slowly so the sides can work together, not as a large blob which won’t work very well).  This part is relatively simple: just keep moving a bit!


  • When pain free movement is achieved, gentle isometric exercises (exercise where the joints are not moving) often begin, and are reduced if pain is re-experienced.  This helps prevent atrophy.  Low weight bearing/no impact cardiovascular work (like biking) can be started.


  • Gradually the person can begin to do concentric (ONLY) exercises and when comfortable, stretching can also begin.  Very gently, eccentric exercise can begin. (Remember, eccentric movement is hardest on muscles so this comes last).  Once this phase begins, a slow gentle start back into regular exercise can begin and be followed by a slow reintroduction to your sport.


  • Depending on the severity of the injury, you may be guided through this process over a few weeks…..but it can take up to six months and you will find yourself going ‘backwards’ through rehabilitation if you rush it and re-injure yourself. So take it easy!


  • During the course of this process, an osteopath can help with very gentle soft tissue work and will also place some emphasis on any adaptation issues that have arisen and will also focus on maintaining mobility.  Exercises that may maintain some functional fitness for your sport could be tried as long as they do not rush the hamstring rehab process itself.


  • Don’t diagnose yourself!  Get assessed!

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