THE SPORTING HAMSTRING PART 2: RETURN TO SPORT
There is a lot involved in the decision making process around return to sport / play following any injury. However, injuries with high recurrence rates such as hamstring injuries require a little more care and consideration…
WHAT DOES THE EVIDENCE SAY?
- Players returning to sport are at greater risk of re-injuring their hamstring during the first three weeks back from injury.
- A player taking longer than 24 hours to achieve pain-free walking is four times more likely to need more than 3 weeks to return to competition compared to players walking pain-free within 24 hours of injury.
- Players with a past history of a hamstring strain on the same leg in the preceding season and unable to walk pain free within twenty four hours, have a significant chance of taking four or more weeks to return to play.
- Players with a lateral hamstring strain and a past history of a hamstring strain are at a greater risk of suffering a recurrence in the first three weeks of returning to competition
THE GRADING SYSTEM
|Grade 1||~ 3 weeks||
|Grade 2||~4-8 weeks||
|Grade 3||~3 months||
RETURN TO SPORT CRITERIA
The rehabilitation process for hamstring injuries is highly individualised, with physiotherapists and injured athletes working together to address all modifiable risk factors, whilst ensuring their bodies are prepared with exercises that are both sport and conditions specific (eg. speed, agility, flexibility, endurance).
As a result, working on time frames alone is an inadequate measure of readiness for sport. But at what point is each individual safe to return to sport? How strong do they have to be? How flexible? How confident?
There is yet to be a clear consensus developed for a safe return to sport criteria, however testing should address the following:
Although the grading system can give individuals a rough time frame for return to sport, physiotherapists need to:
- Address the key factors that have contributed to their injury (see part 1),
- Prepare athletes to a standard that meets clinical and functional criteria
- Successfully simulate match/sport conditions
- Carefully consider their injury history and the evidence available as predictors of re-injury
The high recurrence of hamstring injury indicates that there is a need for further research in this field, in particular, a clear set of return to sport criteria and rehab milestones that can guide therapists in their decision making, and set clear goals for the injured individual.
What the available literature does tell us, is that hamstring injuries and their rehabilitation are highly individualised. Individuals need to work closely with their physio to tailor their rehabilitation and return to sport requirements specifically to their needs.