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In fast paced sports such as football, hamstring injuries tend to be common occurrence, affecting a large number of professional athletes both on the pitch and during training. As Football has progressed to become more competitive over the years, players spend longer in games running and sprinting, meaning hamstring injury rates have risen over the last decade. This type of injury happens when players are sprinting, stretching, or kicking the ball.

England are now through to the finals of the UEFA European Women’s Championships with just one match away from winning the tournament. Luckily, they have not sustained any significant injuries that have resulted in players becoming injured and missing matches. 

We spoke to Dr Bruce Paton, ISEH and University College London Hospitals (UCLH) Consultant Physiotherapist and Dr Ricci Plastow, Lower Limb Consultant at UCLH, to ask them some of the most ‘Googled’ questions surrounding hamstring injuries to help people have a better understanding of this type of injury.

Both Dr Bruce Paton and Dr Ricci Plastow have vast expertise in managing athletes and the general population with hamstring injuries and are currently writing up the international consensus, a guideline on how to treat hamstring injuries with fellow ISEH physicians, Dr Noel Pollock and Professor Mat Wilson.

To begin, Dr Bruce Paton shares key insights about how common hamstring injuries are and the severity of them, sharing key advice regarding how to manage this type of injury to how recognise the difference between a pulled hamstring and a torn hamstring.

Why are hamstring injuries so problematic?

Hamstring injuries are particularly problematic as they tend to recur and once a player has had one injury, they can often get subsequent injuries which are often worse than the initial injury.
 
Are hamstring injuries common?

Hamstring injuries tend to be very common and can affect many players in running, kicking and pivotal sports such as football. Due to the frequency of hamstring injuries and as a consequence time taken out of play, this unfortunately makes them the greatest time loss injury in football.
There has been a lot of research into prevention, but as football has evolved to become more competitive and players are spending longer in games running and sprinting, injury rates have risen, rather than falling over the last decade. However latest research suggests rates may not be rising like previously, as we learn more how to manage this type of injury and keep players from getting injured.
 
What should you not do with a hamstring injury?
 
Those with a hamstring injury will often need some time out of running / sprinting but it depends on severity of the injury and this can often be from 1-2 days to 6 weeks.
In some high grade (especially tendon) injuries, people can experience a re-tear if sprinting is introduced too early.
 
How to tell the difference between a pulled hamstring and a torn hamstring?
 
The difference between a pulled hamstring and a torn hamstring relates to the severity of the injury - some injuries result in no tissue damage on the scans meaning those who have this type of injury will recover very quickly.

The more severe injuries are result in larger tearing. There tends to be more bruising in these injuries and they can take longer to recover from.
It is important to note that the back of the joints in the pelvis can send pain down the back of the thigh, mimicking a hamstring injury
 
Can symptoms be managed at home? When should someone seek medical help?
  
Symptoms of a hamstring injury can often be managed at home – but additional help is often needed if the patient experiences any of the following:
 

  • bruising / or large amounts of pain 
  • loss of power or strength
  • symptoms such as pins and needles or numbness (which can mean nerve could be involved near an injury site as the sciatic nerve sits very close to the hamstring attachment onto the pelvis)

 
If the injury does not start to recover, it is important to have the muscle checked by seeking medical help.
 
If the injury is located high up the hamstring near the pelvis attachment on the ischial tuberosity (sit bone), it can be more consequential and should be checked by a medical professional (again, especially if bruising or pain is experienced).
 
It can be worth having an assessment to ensure that all the factors in the injury are addressed – and to make sure that it doesn’t happen again. Sometimes the hamstring can heal but if symptoms are experienced and not treated, it can increase the risk of the injury recurring. 
 
Hamstring injury recovery: how long does a hamstring injury take to heal?
 
Low grade hamstring injuries can heal within several days to 1-2 weeks, which will then see them return to sport/activities.  Larger injuries can take between 2 and 6 weeks for players to return to sport.
 
For tendon type injuries, it can take much longer because tendons take longer to heal –this can take 6-12 weeks before athletes are ready to return to sport. With these injuries, running and sprinting too early can cause re-injury; strength work can be important early.
 
Some larger injuries may result in a change in the hamstring muscles permanently, and this may be one of the reasons for the high recurrence rates in these injuries. For these athletes, some type of regular prevention exercise is important. 
 
Dr Ricci Plastow provides further expertise and advice by answering the below questions on hamstring injuries.
 
Hamstring injuries: how best to recover?
 
The initial recovery of a hamstring injury should include the 'RICE’ approach, meaning:
 

  •  Rest
  •  Ice
  •  Compression 
  •  Elevation.


Physiotherapy is key to rehabilitate the muscle back to normal function. The healing tissue will need protection initially and then milestone-based rehabilitation to prevent scar tissue and stiffness developing.
 
Hamstring injury grades – please share insight on the set timelines regarding recovery?
 
The British Athletic Muscle Injury Classification (BAMIC) allows us to grade these injuries to allow rough guidelines on recovery. Simplifying the classification into mild, moderate, and severe injuries allows timelines of 3 weeks, 6 weeks, and 12 weeks for each grading.
 
What is the treatment for a hamstring injury? 
 
As 80% of hamstring injuries involve muscle only, this would require physiotherapy rehabilitation. The more severe type injuries involving tendon may need surgical repair if complete avulsion of the tendons from the ischial tuberosity or knee joint distally.
 
Can a hamstring injury cause sciatica? 
 
Hamstring injuries can cause sciatica type symptoms if severe enough to allow scar tissue to surround the sciatic nerve. Haematoma can form around the nerve which lies only 1cm away from the proximal tendon attachment to the pelvic bone. This can be an indication to perform surgery.
 
Make an appointment at our dedicated facility in Central London:
 
At The Institute of Sport, Exercise and Health, we offer a specialist hamstring testing / treatment service, aiming to test the hamstring muscles in multiple ways especially in the actions that are important for running and pivoting for football.  Our specialists use equipment for measuring strength as well as EMG for measuring muscle activity during typical hamstring exercises, and in running. Our level of expertise in this type of injury enables us to find the deficits in the hamstring and address them in rehabilitation. 
 
We aim to measure the whole leg and trunk muscle function to identify all the other possible factors that have led to the injury and factors that may increase the risk of reinjury; with the aim to rehabilitate the injury to ensure that it doesn’t happen again and provide education of prevention types of exercise we think are important.
 
At our facility, we see a lot of athletes with severe injury who require surgery and our team have a vast experience with rehabilitation for these injuries. In addition, we also have experienced radiologists who can use Ultrasound and MRI to diagnose exactly which muscle / portion of muscle has been affected in the injury. 
To enquire about a private appointment, please contact our team by calling +44 (0)20 3447 2800  or by emailing info@iseh.co.uk. For appointments via the NHS, please contact your GP in the first instance.