The Treatment of Hamstring Injuries

In our combined experience the number one injury suffered by football players are hamstring injuries. There are a number of reasons why football players suffer hamstring injuries. Here are the top 3 reasons

Muscle weakness

Askling et al (2003) evaluated whether a preseason strength training programme for the hamstrings- emphasising eccentric overloading – could affect the occurrence and severity of hamstring injuries during the subsequent football season. Thirty elite Swedish footballers were divided into two groups; one group performed additional specific hamstring training, whereas the other did not. Eccentric overloading of the hamstrings1-2 times a week for 10 weeks resulted in significantly less hamstring injuries and significant increases in strength and speed in these players.

CLINICAL SIGNIFICANCE: hamstring strengthening exercises reduces hamstring injuries.

Sherry and Best (2004) found a rehabilitation programme consisting of progressive agility and trunk stabilisation exercises (planks, side bridging and bridging) was more effective than a programme emphasising isolated hamstring stretching and strengthening (prone knee bends and TB hip extensions) in promoting return to sports and preventing injury recurrence in athletes suffering an acute hamstring strain – however the strengthening programme was quite poor in design and would not offer significant overload to strengthen the hamstrings.

CLINICAL SIGNIFICANCE: hamstring strengthening exercises should be combined with trunk stabilisation exercises.

Muscle tightness

Muscle tightness is frequently postulated as an intrinsic risk factor for muscle injury. To investigate this Witvrouw et al (2003) measured the flexibility of the hamstring, quads, adductor and calf muscles of 146 Belgian footballers prior to the start of the season. These players had no history of muscle injury in the lower extremities in the previous 2 years. Players with a hamstring or quadriceps muscle injury were found to have significantly lower flexibility in these muscles before their injury compared with the uninjured group.

CLINICAL SIGNIFICANCE: hamstring and quadriceps flexibility testing can identify players at risk of developing hamstring and quadriceps muscle injuries.

Neural tightness

Turl and George (1998) investigated the presence of adverse neural tension (slump test) and hamstring flexibility (using the active knee extension in lying test) in 14 male Rugby Union players with a history of grade 1 repetitive hamstring strain. Comparison was made to an injury-free matched control group. Results indicated that 57% of the group with repetitive hamstring strain had positive slump tests, suggesting the presence of adverse neural tension. None of the control group had a positive slump test. There were also no differences in flexibility between groups or between those demonstrating a positive or negative slump test.

CLINICAL SIGNIFICANCE: neural tightness plays a role in hamstring re-injury and needs to be addressed in the rehabilitation programme.

If you are an athlete that suffers hamstring injuries book in to see one of our expert sports physiotherapists or reading personal trainer today to get your problem resolved.

Serious Head Injuries in Elite Sports

Last week during the England versus Wales RBS Six Nations match we saw another incident of badly managed head injuries. It was clear to see that George North was knocked unconscious during the game and at the time I couldn’t believe that he was allowed to carry on. However I watched an interview with the Wales Doctor the following day and he clearly did not see that George North had been knocked unconscious and when he arrived at the player on the pitch he was conscious and managed to pass the concussion assessment and thus play on.

I know a lot of you play sport or have kids that play rugby and I have treated some of your kids as well. It’s not just rugby where you need to manage head injuries, any sports where there can be a collision with another player or with an implement such as a cricket ball or hockey ball you need to pay attention to potential head injuries.

If a player has lost consciousness for any period of time they must be removed from play immediately and monitored over the next hour.  If they still have signs of concussion after an hour or so they should be taken to A and E.

Signs of concussion would be a persistent headache, dizziness, nausea, drowsiness or any combination of the aforementioned. If a player has not lost consciousness they need to be screened for concussion. A basic pitch side concussion assessment would consist of five questions such as:

  1. What day is it today
  2. How did you get here today?
  3. Who are you playing?
  4. Which half is it?
  5. What is the score?

If a player passes all of these questions and shows no signs of concussion then they should be allowed back on the field of play. If they fail any of these questions and / or display signs of concussion they need to be removed from the field of play and monitored for the next hour.

Even if signs of concussion resolve within an hour they should be sent home but they should not be left alone for the next 24 hours in case symptoms worsen again. If after 24 hours all signs and symptoms have cleared up they need to be managed back into play. They should not be allowed to go straight back into a sport or game.

They may need to do some light gym work or some light supervised training first before being allowed back into full contact play. I hope this helps as I know many schools and sports teams do not have medical experts on hand and if you have these guidelines with you can make sensible decisions about whether you want your child participating in sport if they have had a head injury.

The Obesity Time Bomb

With the nation getting ever fatter and the burden this will have on our health and economy, the government and health care professionals alike are urging us to lose weight and become more active. But there are so many different diet books and weight loss programmes on the market and so much conflicting information in the press that it can sometimes be quite confusing about what to do. Then there are only selfie posting personal trainers and fitness competitors on Facebook posting completely unrealistic things to do to lose weight and get in shape, such as eat chicken and broccoli eight times a day and train twice a day. 99% of us simply can’t do that.

From an evolution perspective humans are designed to be lean, muscular and highly active. Just look at animals in their natural environment where there is no human interaction – you very rarely see overweight animals (apart from those that store fat before hibernation) and you never see obese animals.

Alarmingly the House of Commons Health Committee Report on Obesity estimated the economic cost to the nation of people being overweight and obese to be £6.6 – £7.4 billion. At a time where our economic future looks bleak we need to realise that it is no longer acceptable to let ourselves become overweight or obese.

Nor is it acceptable to put the responsibility of our health care on to others such as the government and the National Health Service (NHS). We need to take responsibility for the decisions we make in our lives including the decisions that affect our health. Of course there are genetic and environmental factors that contribute to our body shape and our health – but no one gets obese just from having “bad” genes. People only get overweight or obese from what they choose to eat on a daily basis and from lack of exercise.

You can take a big step towards improving your health, wellness and body shape by joining our fitness class or reviewing turbulence training workouts in your own time; however exercise alone will not get you the results you desire. You have to combine exercise with healthy eating.

Just as you need to train hard (intensity) and you need to do it often (consistency) – you also need to eat well and do it consistently. But, it doesn’t need to be chicken and broccoli eight times a day. You just need to implement a few healthy options, such as get your five a day, eat a healthy amount of protein, and cut out all the starchy and junk carbs. This little bit of advice will go a long way.

Common Leg Injuries in Soccer Players

When rehabilitating the quadriceps, they respond to a much greater variation in reps. Experts at the  famous reading physiotherapy clinic say this means using a variety of exercises such as step ups, squats, knee extension, squats, split squats and lunges. You also need to use a large variety of reps brackets for these exercises. So this means training anywhere from using singles to sets of 50 reps. For example.

Also to re-build an injured or atrophied quads you have to use protocols that produce a lot of lactate, and you have to use heavy-load protocols. This could mean do 2 minutes of continuous squats with a heavy loads, or for anyone who is not quite as highly conditioned it could be 2 minutes of step up with 10kg dumbbells.

Remember, any training protocol is only as good as the time it takes you to adapt to it, therefore change you exercises and reps brackets often.


 Hamstrings have two major functions – knee flexion and hip extension, thus you must train both functions of the hamstrings:

The knee flexion component of the hamstring is usually trained by all variations of the leg curl: seated, prone, kneeling, and standing using a machine; Swiss ball hamstring curls, Nordic drops or theraband prone knee bends. This function of the hamstring is usually best trained using high loads, explosive concentric and slow eccentric tempos and low reps. For example you could do 5 sets of 5 leg curls or Nordic drops. This will create a lot of muscle soreness so you only need to do heavy work like this every few days.

The knee Hip extension component of the hamstring uses exercises such as Romanian deadlifts and good morning; back Extensions, and reverse hyperextensions.  This function of the hamstring can be trained using moderate loads and higher reps scheme, such as 3 sets of 15 Romanian deadlifts.

Fitness Tips for Team Sports

When you play on a sports team, you need to make sure that you are in good shape. If not, you could end up letting your teammates down. If you want to have a chance to play on a regular basis, you need to take steps to maintain a high level of physical fitness.

Just going to practice on a regular basis is usually not enough to stay in shape. You also need to make sure that you spend time exercising on your own. At practice, the goal is usually to improve your skills and work on plays, not to maintain your endurance or strength.

Focus on both strength and stamina during your workouts. If you neglect one area at the expense of the other, you will end up unbalanced. This means doing both strength training and cardio work so that you can be in great shape.

However, it is also important not to push yourself too hard too fast. Doing so will increase the risk of injury, which means that you will not be able to play at all. Pay attention to what your body tells you, and lower the intensity of your workouts if you need to.

Do not do too much in the days leading up to a game, either. You do not want to wear yourself out by working too hard so that you do not have anything left for the game. You need to make sure that you are ready to play at a high level throughout the contest.

Give your body time to rest and recover after a game. Do not just jump right back into intense workouts. Take a day or two to recover before you start working out again. This way, you can make sure that you are always ready to give it your all during a game.