Hamstring injuries are extremely common in elite soccer. In fact, it is estimated that 11-16% of all soccer-related injuries (in elite levels) are due to hamstring issues (1).
By far, the most common presentation we see in our chiropractic and physical medicine clinic in Carol Stream, Illinois is incomplete rehabilitation of a hamstring injury. Many, many times we get a referral from another healthcare provider (or even a coach whose player “can’t get back to normal”) after weeks and months of rehabilitation. It’s not that the other healthcare providers are provided poor treatment, it’s that they either:
- 1Didn’t treat enough - the most common indicator for a nagging hamstring to not properly recover.
- 2Didn’t identify the right trigger!
- 3Didn’t expose the hamstring BACK into the athlete’s specific training and competition atmosphere.
So, in order to walk you through how we view hamstring rehabilitation, we first have to identify the 3 ways soccer players can prevent (or at the very least MITIGATE) the risk of a hamstring injury.
We’ve all seen it; a player taking off a lengthy sprint only to pull up and casually switch into the shuffle and hobbling of a textbook hamstring injury. How do we know it was a hamstring problem? They place their hand on the back of the thigh - right over the dodgy hammy in question!
While it is quite rare, there is sometimes an audible noise that occurs in severe hamstring injuries. Most hamstring injuries, however, are going to be mid-belly or at the tendon attachment sites.
Here’s where we start…
1. Redefine the Problem
Needless to say, a hamstring injury can be quite frustrating for a soccer player. They never occur at a convenient time and they have a tendency to linger longer than one might expect. Well, the view from the medical side of hamstring injuries is quite a similar story. With the re-injury rates significantly higher for this injury compared to others, medical providers have been left questioning if they are addressing the right problem.
After carefully combing through the data on hamstring studies, it appears that we’re not alone. With many traditional medical providers opting to follow the Rest, Ice, Compression and Elevation (RICE) Method for hamstring injuries, it appears to not be working out all that well. (See my previous 3-part article series about why you should forget the RICE Method if you are a soccer player).
In fact, try this… in a separate web browser type in “hamstring treatment” or “how to recover from a hamstring strain?” and see what comes up.
Isn’t it frustrating to see that the major medical institutes are promoting such misinformation about the recovery strategies of soft-tissue injuries like a hamstring strain?
It tells me that these well-respected major medical institutes do not have a clue when it comes to treating musculoskeletal injuries. They have plenty of helpful medical information on their websites but many of them simply do not do enough to keep the medicalization of common injuries out of the medical system.
By focusing all of their efforts on solely the hamstring, we’ve found that many other healthcare providers are guilty of tunnel vision. They see a soccer player come in for an apparent hamstring issue and they …. Only look at the hamstring!
Mistakes Healthcare Providers Make When Treating Hamstring Injuries in Soccer Players
We have found that the abdominal, posterior chain and hip range of motion play a MUCH bigger role in dealing with hamstring injuries than most other offices.
In fact, just last week we had a college soccer player in our office go through a simple hip range of motion exercises. He was unable to do our entry level flexibility, mobility and tissue extensibility tests. Do you think it would benefit him to be able to isolate his hip motion for the long term health of his hamstring? We think so
Imagine how much more robust and resilient this guy can be out on the field if he has a full range of motion in his dominant hip joint. It’s really exciting when you think about it. We get to problem solve with athletes and be a part of their journey towards redefining their limitations. They are no longer limited to getting back to where they started, they have more potential than they originally thought!
2. Load it, Don’t Baby it!
By far, the biggest risk factor of developing a hamstring injury is a past hamstring injury. Having said that, the research is quite clear about progressively loading the hamstring, in both an eccentric (lengthening) and concentric (shortening) fashion in order to properly rehabilitate the injured site.
What’s more, is that the more thorough the rehabilitation of the hamstring, the most athleticism the athlete should achieve by the end of the treatment plan. For many of our high school, college and professional soccer players we work with, the hamstring is best loaded while PLAYING. Playing the game of soccer demands full capacity of the whole musculoskeletal system, not just the hamstring complex. Our goal is to get soccer players to the point where they can rely on a strong, robust and resilient hamstring without there being any fear of specific movements, strides or strikes.
We do this in our clinic by constantly loading the hamstring and the entire body in a progressive way. First we protect the hamstring, but once we are able to, we love to have the athlete doing simply movements to get that hammy moving again.
Once the hamstring adapts to the stresses we’ve applied to it in a treatment session, we progress to the next level. And again, and again, and so forth. This is the essence of progressive overloading. We are constantly pushing the hamstring into positions it will get into (under load) in a given soccer training session or game.
For the soccer coaching reading this article, I’m sure this makes sense. After all, is there anything more frustrating than when you get a player who has been “cleared to play” but is not match fit NOR are they even ready to participate in competitive drills?
That’s the difference between a complete rehabilitation program and a symptom rehabilitation program. One focuses on the player's hamstring symptoms, the other focuses on getting the player BACK on the field with an improved capacity like never before.
3. Expose it; Don’t Fear Moving it!
One of the most entertaining and revealing aspects of soccer player rehabilitation is their inability to do the basics exceptionally well. The professionals we work with can do the basics really well, which is one of the main reasons why they are professionals. Surprisingly, though, many middle school, high school and college soccer players cannot stand securely on one leg. Do you think, in a sport like soccer where nearly 60-70% of the time spent in running and kicking is one one-leg, soccer players should be decent at standing on one leg? We think so, too.
One of the areas where we feel we do a better job than more healthcare offices (remember, most advice given from traditional medical offices is to rest, ice and take a muscle relaxer), is by exposing soccer players “lowest hanging fruit”. We refer to this as the smallest changes which yield the greatest results. Many times, by sharpening up the basics of human movement - such as balance, coordination, agility and dissociation of limbs - we can produce a strong and robust athlete who can be rest assured they have prepared their body for the test of competition.
My friend and colleague, Tim Gabbett, PhD (who did the original study on “Workload Management”) famously put it this way: “It’s not the demands of the sport which injured you. It’s what your body was NOT prepared to face that did.”
"I couldn’t have said it any better myself."