The hamstrings are formed by three muscles and their tendons. The hamstrings arise from the ischial tuberosity, or sitting bones, at the bottom of your pelvis. They run down the back of your thigh and their tendons cross the knee joint and attach onto each side of the shin bone (tibia). The hamstrings are involved in hip extension (moving the leg backwards) and knee flexion (bending the knee).
Acute hamstring injuries are common and generally present with localised pain following rapid acceleration or deceleration movements, such as when sprinting, and frequently occur in sports such as football, skiing, and hockey, to name a few. Acute injuries can also occur when the muscle is stretched too far Whereas chronic/persistent hamstring injuries present with a stealthy onset of unrelenting pain made worse with sports activities and sitting – often found in runners.
It is very important to treat and rehabilitate hamstring injuries correctly; incorrect or improper healing makes re-injury more likely. For the first 3 to 5 days (in the acute phase), the general consensus is to control swelling, pain and bleeding. The POLICE method is often used. POLICE stands for Protection, Optimal Loading, Ice, Compression and Elevation.
Following this acute phase, there was previously some ambiguity among treatment protocols until the introduction of Askling and colleagues’ 2013 research. In this paper, Carl Askling and colleagues used 75 elite Swedish football players to compare two different hamstring rehabilitation protocols called the C-Protocol and L-Protocol. They then assessed outcomes of return to play and re-injury. The L-Protocol focused on eccentric loading of the hamstrings while the C-protocol consisted of conventional hamstring rehabilitation exercises. Participants in the L-protocol (outlined below) were able to return to sport significantly faster than those in the conventional group (mean 28 days vs 52 days). Their research into which protocol was best for chronic injuries was inconclusive, but the researchers were able to surmise that rehabilitation protocols consisting of eccentric exercises are more effective in returning athletes to their sports following hamstring injury.
Additionally, it is recommended that hamstring injury rehabilitation protocols should be preferentially based on strength and ﬂexibility exercises that primarily involve exercises with high loads at long muscle–tendon lengths.
The L- Protocol Exercises
These exercises are a great starting point. Head over to our clinics for this and much more in the way of hamstring treatment, rehabilitation and general advice. We can also use hands on manual therapy of the hip and spine in combination with exercise therapy to help you recover and rehabilitate fully.
Good luck and keep active!
Physioimpulse Chartered Physiotherapists