Hamstring injury

Hamstring injuries are the most common thigh injuries in footballers. Once footballers have had a hamstring injury, the risk of recurrence is high. Rehabilitation can take a long time. Prevention is therefore always better than cure.

The hamstrings are a group of three muscles at the back of the thigh. These muscles run from the ischial tuberosity to the lower leg, crossing both the hip and the knee. They therefore influence both joints. Their main function is to flex the knee, and they also support extension of the hip.

Football and hamstring complaints

Hamstring injuries are notorious among footballers. They are common, and recovery can take a long time. Football is mainly known for the so-called acute hamstring injuries, meaning that it suddenly "shoots" up the hamstrings. This can happen when setting off into a sprint or when kicking a ball.

How hamstring injuries occur

Two types are distinguished:

Type 1: Sprint-related hamstring injury
An acute muscle injury that occurs during sprinting. There is acute pain in the middle of the hamstring. Type 1 causes a direct decrease in hamstring function, which often makes it impossible to continue playing. However, the rehabilitation time is much shorter than with Type 2.

Type 2: Stretch-related hamstring injury
An acute tendon injury that occurs when the hamstrings are suddenly stretched. In football, this can happen, for example, during a slide or tackle. Tendon injury occurs rather than muscle injury. Tendon injuries require a longer recovery time than muscle injuries because tendons have a poorer blood supply than muscles.

This explains why the rehabilitation time for Type 2 is much longer than for Type 1. With a Type 2 injury, there is only a less acute limitation. This does, however, increase the risk of aggravating the injury because play often continues after sustaining this injury.

Recovery from hamstring injuries

A hamstring injury typically requires three or four weeks of recovery time. For recurring injuries, the recovery time is much longer.

In the first 48 hours, rest and ice (cooling) are most important. This promotes recovery and prevents excessive growth of scar tissue. Too much scar tissue increases the risk of recurrence. In the first 48 hours, pain-free exercises are also advised. A muscle contraction promotes blood flow, which aids recovery. This balance between rest and load is important.

Stretching after an acute hamstring injury is only permitted after 48 hours, and then gently and in a controlled manner. Strength training also plays an important role. It should focus on the strength of the hamstrings and also on the other muscles around the hamstrings, such as the gluteal and thigh muscles. These support the function of the hamstrings.

Physiotherapy for hamstring injuries

Guidance by a physiotherapist or sports physiotherapist is recommended for hamstring injuries. After a hamstring injury, you may load fairly quickly, but in the right way. When the load is increased too quickly or too intensively, the chance of recurrence rises.

In the first week, especially with Type 1, there is rapid pain reduction. This is deceptive because the healing process is only in the first phase. This means that the hamstrings are pain-free but still very weak. The risk of recurrence is therefore very high.

Treatment by a (sports) physiotherapist consists of advice, stretches, muscle mobilisation, coordination, and strength exercises. A physiotherapist also examines the spine and pelvic region. Movement restrictions here can be a cause of hamstring injuries.

Return to football

It is difficult to determine when football can be resumed after a hamstring injury. This may also explain why hamstring injuries recur so often. In the first weeks after resuming football, the risk of recurrence is greater. The sensitivity to an acute hamstring injury remains but gradually diminishes over weeks. Football is often resumed earlier.

There are some criteria that must be met before football can be resumed. An important criterion is completing the progressive running schedule provided by the (sports) physiotherapist. Strength, coordination, and jump performance must also be equal on the left and right.

Preventing hamstring injuries

Preventing a hamstring injury is most important. Once you have had a hamstring injury, the chance of recurrence is much greater. An exercise programme focusing on strength, coordination, and flexibility after an acute hamstring injury or with longer-standing hamstring complaints helps to strengthen the leg again. This reduces the chance of a new hamstring injury.