Our hamstrings may be the most commonly injured muscle group when it comes to playing rugby. In fact, the hammies account for between 6-29% of all injuries reported in AFL and rugby union, as well as soccer, basketball, cricket and sprinting. When it happens to our kids and teenagers during a game of rugby, whether it’s social or competitive, it’s important to understand what has happened and why – so we can say and do the right things to help prevent them from experiencing this again in the future. 

Today, the Sole Motion sports podiatry team have sat down to share all about hamstring injuries, why they’re a common injury in rugby, and how we can do our part to help the kids prevent them in the future.

 

First thing’s first: Tell me about the hammies

The hamstrings are the group of three muscles that run down the back of your thigh and just below your knee. They’re called the biceps femoris, semitendinosus, and semimembranosus – and together, their job is to help you bend your knee and extend your hip (if you’re not sure what we mean by hip extension, picture yourself standing up, bending one knee and holding your foot by your buttocks. Now pull the knee backwards so your foot moves even closer to your backside. In this position, your hip is in extension).

 

And how do the hamstrings become injured?

While it’s often referred to as a hamstring injury by health professionals, the reality is that your little rugby star may well have injured just one of the three muscles by overextending the muscle group – that is, stretching it past a point that the muscle group can naturally extend to and safely handle. About 75% of the time, this is going to be your biceps femoris muscle. In all honesty, this differentiation doesn’t matter a great deal at the conservative (non-surgical) level of care as the recommended treatment principles are the same for all three muscles. And most of the time, this level of care is sufficient to ensure effective healing and repair.

 

In rugby, the most common actions that will cause the overextension of the hamstrings are:

• Kicking the ball
• Running
• Sustaining a tackle in a position that forces the hamstrings into overextension

 

While overextension is the case with the majority of hamstring injuries, we wanted to take a moment to emphasise the very important role of having your child professionally assessed if they do sustain this injury. This is because, alternatively, they may have developed a longer-standing inflammation of their hamstrings from repetitive overuse (usually also related to poor training techniques, warm-ups or foot biomechanics) – or worse, an avulsion fracture involving the hamstrings, which takes much longer to heal and requires a completely different approach to treatment.

 

Your child may have an increased risk of hamstring injury if

There are a few well-documented risk factors that make a person more vulnerable to hamstring injuries. These include:

 

• A previous hamstring injury – often one that hasn’t been rehabilitated properly and to full strength
• Sudden acceleration and deceleration – like when you’re running and stopping to pass, catch and gun it for the goal line
• Poor flexibility – both in the form of not focusing on improving flexibility over time, as well as not doing an adequate warm-up before the game
• Biomechanical motion – this is influenced largely by the way the muscles, joints, bones and ligaments naturally work together, as well as the effects on the biomechanics by their chosen footwear

 

For us oldies, increasing age is also a known risk factor – though this doesn’t apply to our little ones! Other risk factors of note are poor muscle strength – as muscles that tire easily don’t do their job and absorb shock as well, overpowering quads (the opposite muscle group at the front of the thigh) and poor technique development in rugby.

 

What do hamstring injuries feel like?

If your child has injured their hamstrings during a match, they’ll describe a sudden sharp pain, usually immediately after a kick or during running. They may describe hearing a popping sensation, and if the injury is severe, they may start having difficulty walking. Overall, their range of symptoms may include:

• Pain when bending or straightening their affected leg, including sitting or walking up hills or stairs
• Sharp, stabbing pain 
• Tenderness at the back of the thigh
• Tightness in the muscles with movement restrictions
• A popping sensation at the time of injury
• Inflammation immediately after the injury
• Bruising as the inflammation subsides
• Weakness in the injured leg
• Difficulty walking on the affected leg

 

The full range of symptoms can range from mild to severe depending on the severity of the injury. Even if the injury is mild, it’s important to rest and let the muscles recover so they don’t worsen. This may mean sitting out the rest of the game – which as disheartening as it may be, is much better than sitting out the rest of the season!

 

Yes, podiatrists do diagnose hamstring injuries

Before you ask, yes, diagnosing hamstring injuries – as well as helping your little ones return to the field as efficiently as possible, is absolutely something we do – and we love doing it. To make a diagnosis, we run a comprehensive biomechanical examination, and have a good chat with you and your child about their symptoms, current pain, injury history and more.

We’ll then grade their injury based on their symptoms – grade one is a mild strain, grade two is a partial tear (yep, ouch!) and grade three is a complete tear of one or more of the hamstring muscles. If we suspect that the injury is of a serious nature, we’ll refer your child for some medical imaging.

 

How are hamstring injuries treated?

The good news is that conservative therapy is sufficient to offer significant repair for the majority of hamstring injuries. Initially, you’ll want to help manage your child’s pain and inflammation so they feel more comfortable. This is done brilliantly using the acronym ‘peace & love’ from the Running Clinic:

• Protection – avoid activities and movements that increase pain during the first few days after the injury
• Elevation – elevate the injured limb higher than the heart as often as possible
• Avoid anti-inflammatories – avoid taking anti-inflammatory medications as they reduce tissue healing. Avoid icing
• Compression – use an elastic bandage or taping to reduce swelling
• Education – your body knows best. Avoid unnecessary passive treatments and medical investigations and let nature play its role
• Load – let the pain guide your gradual return to normal activities. Your body will tell you when it’s safe to increase your load
• Optimism – condition your brain for optimal recovery by being confident & positive
• Vascularisation – choose pain-free cardio activities to increase the blood flow to the repairing tissues
• Exercise – restore mobility, strength and proprioception by adopting an active approach to recovery

 

After the initial pain has subsided, the physical therapy begins. This will be based on the results of our biomechanical assessment, and may include:

• Strengthening weakened muscles, like the hamstrings themselves
• Correcting any biomechanical problems that contributed to the injury
• Working on proper techniques for running and rugby to reduce the risk of future injury
• Stretching tight muscles that may have contributed to the injury
• Increasing core stability

 

Mild injuries can heal completely within a couple of weeks, while more severe injuries may take months. Either way, full rehabilitation is key to future injury prevention – both in the hamstrings and potentially other areas of the lower limbs, too.

 

Is your young rugby star experiencing pain or other problems during the game?

We love helping kids do the things they love and feel great doing it! We’re parents too – so totally get it. To book in with our experienced podiatry team, call us on 1300 FX FEET or book your appointment online here.

 

 

References

https://sportmedbc.com/article/hamstring-strains

Hagel B. Hamstring injuries in Australian football. Clinical Journal Sport Medicine. 2005;15(5):400

https://therunningclinic.com/runners/blog/archives-anglaises/peace-love-new-acronym-for-the-treatment-of-traumatic-injuries/