Hamstring Injuries: We Should Be Looking at More Than Just the Hamstring

Hamstring injuries are common in running and field-based sports, and they can be frustratingly recurrent. One reason for that is that hamstring rehab often becomes too narrow. People focus on the sore muscle itself but not enough on the broader factors that may have contributed to the injury.

At our physio clinic in Marrickville, we regularly see hamstring injuries in runners, footballers and active adults across the Inner West. One of the more important parts of assessment is working out whether the hamstring is the whole story, or just the structure that has become symptomatic.

The hamstring does not work in isolation

The hamstring sits within a broader system that includes:

• the pelvis
• the lumbar spine
• the glutes
• the calf complex
• the ability to tolerate high-speed running

If there is an issue elsewhere in that chain, the hamstring can end up taking more load than it is ready for.

What else should be considered?

1. Lumbopelvic control

The pelvis and trunk provide a base for the hamstring to work from. Poor control here can change how force is transferred and may increase the demand on the hamstring during running and acceleration.

2. Glute strength and contribution

If the glutes are underperforming, the hamstrings often end up doing more work with hip extension. That does not mean the glutes are always 'off', but it can mean the posterior chain is not sharing load well.

3. Sprint exposure

A lot of hamstring injuries occur at high speed. If someone has not been exposed to enough high-speed running, then asks the hamstring to tolerate it suddenly, that is often where trouble starts.

4. Neural contribution

Sometimes posterior thigh pain is not purely a local hamstring issue. Lumbar referral or neural sensitivity can mimic or contribute to symptoms, particularly where there is a history of back pain, pins and needles, or symptoms that feel less like a classic strain.

What rehab should usually include

Good hamstring rehab often involves more than rest and basic curls. It may include:

• progressive hamstring strength work
• lengthened-position loading
• single leg control work
• glute and trunk strengthening
• running progression
• high-speed running exposure where appropriate

For a runner, this may also involve reviewing cadence, training progression and recent load spikes.

Why recurrence is common

Hamstring strains often settle enough for people to jog, gym and function reasonably normally. That does not mean they are ready for sprinting, kicking, fast accelerations or reactive movement. Returning too early or without enough high-speed exposure is one reason recurrence rates remain high.

The key point

If you injure your hamstring, it makes sense to treat the hamstring. But it generally does not make sense to stop there.

A broader assessment often gives a clearer picture of why it happened and what needs to improve to reduce the chance of it happening again.



Links: Running Assessment | ACL Rehab | Sports Injuries