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Hamstring strains and how physiotherapy can treat them

Hamstring strains (a.k.a. “doing a hammy!”) are one of the most common injuries seen by Northern Beaches physiotherapists. Hammy strains are most prevalent in sports that use a combination of dynamic movements like sprinting, Australian Rules football (AFL), soccer, dancing, surfing, rugby league and other activities where quick eccentric contractions, when the leg is being straightened and the hamstring is working hard, occur frequently such as slowing the leg down after kicking a ball.[1] In AFL hamstring strains are the most common injury with a rate of 6 injuries per club per season combined with the highest rate of re-injury at over 30%.[2] Musculoskeletal physiotherapists know that it is perfectly normal for two people to tear exactly the same muscle but recover at different speeds. Recovery time is dependent on the grade of the injury with a grade 1 injury possibly healing in only a few days, while a grade 3 injury could take months and, in extreme cases, even require surgery.

“My hamstring is ok but derogatory and sexist comments aren’t”

Most hamstrings will have torn well before this point so all can admire the incredible strength and flexibility of Tayla Harris during the AFLW 2019 season.

What are the hamstrings and what do they do?

The hamstrings are a group of muscles and their tendons at the back of your upper leg. They are made up of three different muscles: the biceps femoris, the semitendinosus and the semimembranosus.[3] You use your hamstrings for all kinds of things: walking, running, dancing and jumping. They enable you to flex your knee and extend the hip at the beginning of each step you take. Your hamstrings play a large role in many movements of the legs and hips which is why physiotherapists have spent so long studying them and how to reduce the occurrence and length of injuries.

How do hamstring injuries occur?

Like most injuries, hamstring strains or injuries can be classified as being caused by either primary or secondary factors.

  • Primary factors include:
    • Poor timing coordination in the hamstring (the swing phase of the leg in sprinting)
    • Lack of strength and stiffness in the hamstring
    • Muscle imbalances
    • Increased neural tension through the sciatic nerve
  • Common secondary factors include:
    • Overstriding or poor pelvic control when running
    • Fatigue
    • Improper warm-up to prepare hamstring muscles
    • Lower back problems
    • Prior hamstring injuries

What are the symptoms of a hamstring strain?

The nature of hamstring strains means that symptoms can vary greatly between injuries. Mild hamstring strains could present as tightness or a mild ache in your hamstring. While a severe strain can be extremely painful, with some people describing it like being shot in the back of the leg even making it impossible to walk or even stand. If you have any of the following symptoms get in to see your Dee Why physio ASAP:

  • Hamstring tenderness
  • Pain or difficulty running, walking or standing
  • Pain in the back of the thigh or lower buttock
  • Bruising or swelling
  • Sudden severe pain while exercising, with a popping sound or snapping feeling

How physiotherapy helps treat hamstring strains

If you have had a hamstring injury your best course of action is to consult with a physiotherapist that has an expert knowledge of sporting and musculoskeletal injuries. Due to the high rate of reinjuring your hamstring, there is no substitute for high quality initial care and rehabilitation. Physiotherapy helps patients with a hamstring injury to speed up the healing process and ensure the best outcome. They will be able to assess and treat your strain and help you to minimise their recurrence in the future.

  • Acute or initial phase of a hamstring injury

Your physio will likely recommend the trusty RICE (Rest, Ice, Compression, Elevation) method for the first few days. This will help to reduce swelling and minimise pain. I like the saying ‘the early bird gets the worm’ and when it comes to intervention for hamstring injuries the early bird getting treatment always recovers quicker and more effectively. An expert sports physio will also get you loading your hamstrings in a variety of different ways, even in the early stages!

  • Your physio will then comprehensively assess:
    • Your range of motion
    • The strength and mobility of your lower back
    • Your gait
    • Your flexibility
    • If possible, your running, jumping and sporting techniques

How to prevent another Hamstring Strain

If you’ve ever had a hamstring strain I can pretty much guarantee you won’t want another one, they certainly don’t tickle. Dealing with a hamstring injury once it’s already happened is much harder than preventing it. Here are some tips:

  • Stretch before and after physical activity
  • Increase the intensity of your physical activity gradually
  • If you feel pain, stop exercising (it’s not all ‘no pain, no gain’)
  • Stretch and strengthen hamstrings as a preventative measure

Whether you have recently suffered a hamstring injury and are in need of immediate physical therapy or you have suffered a hamstring injury in the past, a physiotherapist is able to assess and recommend the best activities and stretches to help speed along your recovery and reduce the likelihood of experiencing further strains.

 

[1] Sutton G. Hamstrung by hamstring strains: a review of the literature*.J Orthop Sports Phys Ther. 1984; 5(4):184-95.

[2] Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, season 1997–2000. Br J Sports Med2002;36:39–44.

[3] Schunke M., Schulte E., Schumacher. Anatomische atlas Prometheus: Algemene anatomie en bewegingsapparaat. Nederland: Bohn Stafleu Van Loghum, 2005.

Person reaching finish line

Final preparations for the Sun Run & Cole Classic

In just over two weeks time, the Sydney Morning Herald Sun Run & Cole Classic kicks off again just across the road from your friendly neighbourhood Dee Why Physio. Let’s hope the Northern Beaches has a little less in common with the surface of the sun by then. Started in 1983 at Bondi Beach by the keen ocean swimmer, Graham Cole after returning from competing in Hawaii at the Waikiki Roughwater, the event has grown into a weekend starting with a 10km run. With its roots heavily invested in the belief that anyone could train and challenge themselves with dedication to swim a reasonable distance through the surf, the Cole Classic swim rewards each finisher with a memento of their achievement.[1]

Today the event is also a huge contributor to fundraising for a host of charitable causes such as, Kids Cancer Project, Cure Brain Cancer Foundation and Beyond Blue. As of today they have raised $65,000 of their target of $200,000 for 1100 different charities! Congrats guys and gals!!

Over to you. Hopefully you’re putting the final touches on your training regime and preparing yourself for the races, physically and mentally. But, I won’t judge if you’ve left your prep a little late… Being a Northern Beaches physio, I’ve seen it all when it comes to preparations and mis-preparations for runs, swims and everything in between. Don’t get caught out by failing to prepare, especially when extreme heat is involved. Follow these tips below to help prepare, and make sure your Sun Run is a fun run without any sink in your swim.

10 kilometres isn’t that far when you think about it

Ideally you want 12 weeks to prepare for a 10km run, but if you’ve only got 2 weeks… well damn, that’ll do! I know what you’re thinking: “how can I pack 12 weeks’ worth of training into two”? The answer is… don’t. No seriously, ask my cousin who decided to run a marathon without any prep. He was cactus for months afterwards. Going hell for leather is a quick way to end up with all kinds of overtraining injuries that you’d be on your way to your musculoskeletal physiotherapist to sort out. To avoid being fatigued and sore on the day of the run, don’t do any more than a handful of full length runs at race pace. Ease into your longer runs and focus on your breathing, technique and intervals of race pace running without overdoing it.

Undergo a biomechanical assessment with your physio

This is doubly important if you are starting from relative scratch. Having a musculoskeletal physiotherapist go through your body’s movements in depth will pick up on any areas of weakness that may indicate an injury is more likely. A further benefit of undergoing an assessment with your physio is that they will be able to assess your running and swimming style to help you get the most efficiency out of each movement.

Time to taper

If you’re not part of the “how can I prepare for a 10km race in 2 weeks” crew, it’s time to taper off from all that awesome training you’ve been doing. As a general rule runners should look to decrease their workload by 30-50% in the last 7 days before a race. Avoid throwing in any crazy new exercises to your routine too. If you haven’t been taking jazzercise classes and doing Romanian deadlifts daily, now is not the time to start. Don’t stop moving altogether though, keep up the light runs and stretching to keep your body active and moving.

Break up your training swim distances

You don’t need to swim 5km every training session. In fact, swimming this distance a few times in the safe environment of a pool will likely be all the confidence you will need to know in yourself that you can swim that distance on the day. Swimming 5km can be boring and repetitive, not to mention a great way to cause yourself a rotator cuff injury if you’re not used to it. Break up your training swims into more manageable pieces; a 1km swim session can be completed in 10x100m, 5x200m, 500m+200m+200m+100m… you get my drift.

Use the RICER method if you are feeling some soreness post race

Rest properly, but please resist the temptation to down too many celebratory alcoholic beverages. If you must go out, keep hydrating, don’t party too hard because you need to let your body recover.

Ice – this will help constrict the blood flow to sore areas and help to reduce inflammation and soreness. If you feel up to it, you can always take an ice bath.

Compression of the legs and arms will help flush out the lactic acid that has accumulated. Wearing compression gear will work great for this. Pairing compression and icing will ensure they work symbiotically and will shorten your recovery period.

Elevate your legs as you lie in bed thinking about how accomplished you feel.

Referral to your local sports injury expert if the soreness is over 5/10 or if the pain last more than 3 days (hint: you are on their website 😉)

The main thing is to make sure that you are comfortable, confident and prepared for whichever race you are participating in. Seeking the advice of a Dee Why physio with expert knowledge in preparation and recovery for these types of events is the best way to make sure you’re going in full armed with everything you need to crush your goals on race day.

 

[1] https://sunruncoleclassic.com.au/history/

person playing tennis

Physiotherapy tips for those suffering Tennis Elbow

Going by name alone, you wouldn’t expect to see Tennis Elbow too far from centre court. But the reality is that lateral epicondylitis is currently causing thousands of painters, plumbers, carpenters and computer programmers alike plenty of pain and discomfort around the country. In fact, only 5% of tennis elbow cases are actually linked directly to tennis, most new cases are due to heavy computer use.  Talk about false advertising! Maybe it should be renamed for the 21st Century – Computer Elbow. Tennis elbow is one of the most common overuse injuries seen by musculoskeletal and sports physiotherapists. With many cases leading to joint compression, nerve inflammation, increased stress on the arm and pain when gripping and lifting things … due only to not getting it treated earlier!

Tennis Elbow pain is commonly focused where the forearm meets the elbow joint on the outside of the arm (not to be confused with Golfer’s Elbow which normally affects the inside of the arm). Excessive use of wrist extensors (those muscles that work all day when you have your hand on your mouse or raised keyboard) and forearm supinators can cause small tears to develop on the elbow end of the extensor carpi radialis brevis (ECRB) muscle. When this pain first starts to occur is when your local physio should hear about it, but the reality is that many people just grin and bear the pain, only causing more problems in the long run. With these tips you will be able to help stave off tennis elbow or cut down the length and intensity of your pain considerably.

Stop and recover

If you are currently experiencing pain, holding an ice pack (please wrap it in a chux or a towel… ice burns are awkward to explain!) against your sore elbow for a few minutes several times a day can help ease it. Tendons calm down slowly. Tennis elbow can last from anywhere between weeks and years, depending on how you manage it. The simplest way to recover from tennis elbow is to cut back on the movement/s causing it. This can be hard for those of you who perform this movement every day for work. You may need to modify your movements, focusing on using other muscle groups effectively. Tennis elbow CAN (though rarely) get better without treatment. Rarely! If you are at the point where your elbow has been experiencing ongoing pain, in the long term you statistically have a longer recovery period and more chance of recurrence than someone who undergoes a physiotherapy rehabilitation program[1]. A musculoskeletal physiotherapist has expert knowledge on recovery and prevention methods.

Have a coach or physio check out your form

For the 5% who do get their tennis elbow on the court, having your coach or a local sports physiotherapist with a tennis background observe and critique your technique and movements could help reduce the strain on your tendons. Incorrect technique can unequally distribute the power in the swing of a racquet to rotate through and around your wrist; creating a movement through the wrist instead of the elbow joint or shoulder. This can increase pressure on the tendon and cause irritation and inflammation, leading to tennis elbow. A sports physio will be able to observe these movements and offer advice on how to make adjustments to minimise this strain. Another simple thing to check is the size of your grip. Those playing with a fat overgrip are at a higher likelihood of developing elbow pain!

Make ergonomic adjustments to your workspace

If you are a heavy computer user, making some adjustments to your computer workstation may be all you need to kick the dreaded “computer elbow”. Keyboards are a large contributor to these issues, with many people raising the back of the keyboard so that it slopes downwards. Doing so cocks your wrists into an extension; causing the extensor muscles of your forearm to contract, extra pressure on your wrists and fast-tracking your way to pain. A gel pad is a good defender against this problem for both the keyboard and mouse, as is a comfortable chair with an ergonomic design.

Stretching and strengthening exercises

Musculoskeletal physiotherapists recommend and will take you through a number of stretches and strengthening exercises designed to help prevent a recurrence of pain. An effective stretch involves simply extending the painful arm with your palm down, bending your wrist so your fingers point toward the floor, with the other hand pull your fingers back toward your body. You will feel the stretch along the outside of your forearm. 30 seconds on. Rinse and repeat. Strengthening the wrist with a simple home exercise known as the ‘towel twist’ is also an effective preventative measure. Hold a loosely rolled-up towel with one hand at each end, twist the towel by moving your hands in opposite directions like you’re wringing out water. Give it 10 good twists holding for a few seconds in one direction and then 10 in the other.

Your Dee Why physio will ask you a number of questions on your first visit, try to note:

  • When your symptoms began
  • If any motion or activity makes the pain better or worse
  • Any recent direct injuries
  • What medications or supplements you take

This allows us to help build a profile of the injury and lets us get stuck into creating your personalised recovery program. If any of the above sounded like you, click the buttons above to book an appointment or just give us a call!

 

[1] Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Nynke Smidt, Daniëlle A W M van der Windt, Willem J J Assendelft, Walter L J M Devillé, Ingeborg B C Korthals-de Bos, Lex M Bouter – “At longterm follow-up, our findings suggest that physiotherapy becomes the best option, followed by a wait-and-see policy.”

 

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