“Hammer time”- a narrative on hamstrings
Paul O’Connell after rupturing his hamstring in the Rugby World Cup in 2015- I witnessed it first-hand in Cardiff
“Let Clancy take the warm-up”…
That’s how it started. Here we are in the Oblate hall, my teammates and I of Coolmine about to play in a basketball league cup final in Dublin, Ireland. Coach lets me take the guys through a vigorous mobility, activation and prep session prior to layup drills and the other usual suspects. As I’m demonstrating a single leg Romanian dead lift whilst walking from the three point line to the baseline I feel the pull in my left hammy- my good friend Kev sees me wince a little. The irony of it all. The young physio tweaks the muscle himself in the warm-up- I still played ok and we won, just. We laughed about it afterwards and that experience won’t be forgotten.
Pause a minute… and think about some athletes who have strained or significantly pulled their hamstring over the years and what impact it had on their respective career, physical and mental wellbeing; Michael Owen was never as explosive after he ruptured his hamstring. It ended Paul O’Connell’s career in Cardiff against France in the rugby world cup. Chris Paul in the NBA lost that first step speed, Daniel Sturridge, a player of pace, ended up losing much of that pace. The Tipperary hurling defender Cathal Barrett missed a Munster hurling final pulling the muscle, Bernard Brogan, the Dublin Gaelic football star has suffered with this injury. I could write down 1 million examples, maybe more. And that’s just within the sporting world.
Despite increased knowledge of hamstring muscle injuries, the incidence has not diminished. We know that not all hamstring injuries are the same. We know that certain types of injuries require physiotherapy, prolonged rehabilitation and steady return to play pathways; some more severe injuries necessitate surgery, especially for those injuries when the tendon insertion into the buttocks or ischial tuberosity is ruptured, or snapped explosively. I have treated these catastrophic injuries in clinic and they take a long time to rehab- I’ve seen this extreme example with windsurfers, snowboarders, ballerinas and cricket players.
In spite of all the research and additional understanding of the hamstring muscle group (three muscles form it- semimembranosus, semitendinosus, biceps femoris) over the past 30 years, the sports medicine fraternity have not reduced the potential of first-time injuries, and the re-injury rate is still extremely high. If you strain this muscle it is very likely that it will happen again in the future; I can speak from personal experience. My left hamstring has suffered 3-4 strains through the last 15 years since the original injury. While research published over the past couple of years has led to an increased understanding of these challenging and complex injuries, we still have a long path to pave in relation to the best practice management of hamstring muscle injuries.
In relation to the rehabilitation of an injury to this muscle group, there are many things to consider- anatomical site of the tear, extent of damage, mechanism of injury, acute care and management, and so forth. Mid-belly strains along the posterior thigh are pretty common and usually occur in stretching episodes or change of pace moments in time. Picture that sprinter pulling up mid-run and clutching the back of the thigh…next comes the grimace and limp. Depending on which hamstring portion one does injure, strengthening may be focused on hip extension or more so on knee flexion, or bending - it depends.
There is no doubt that prevention is the key here - it is gold. Never mind those dreaded reoccurring strains, but performance, power and speed won’t be impacted. Let’s not forget that hamstrings support the anterior-crucial ligament (ACL). They prevent significant anterior tibial translation or when the shin bone displaces forwards- strength in the hamstring can influence these forward shear forces during knee loading.
Exercises that bias hip-hinging patterning such as deadlifts, Romanian deadlifts, glute-ham raises and kettlebell swings are vital; focussing on developing strength and contractile power when the knee is bending and straightening is also imperative- swiss ball leg curls, machine leg curls, heel slides, kickbacks, etc. You are then conditioning the hamstring muscle group at all points. It needs to be targeted on a stretch and also when they are shortening. Research the Askling protocol for more information on this.
Eccentric Nordic curls are considered the benchmark for strengthening these muscles - check out the FIFA 11+ warm-up to see where you could include these in your sessions. Pro teams use nordboards to test the capacity of this type of strength; razor curls are the next frontier- they are hardcore!. High speed running, stop-start acceleration and deceleration, and broad jumping are all advanced exercises to develop that capacity, power and endurance required to help minimise the potential for a strain or rupture.
As MC Hammer once said “can’t touch this!” - focus on developing your hamstring muscle group in all departments. If you look after them well then hopefully injury can’t touch them.