The Parent – Child Relay, the Hamstring Graveyard

To truly understand someone's life you must walk in their shoes and so it was at the end of the parent child relay race I found myself with what would be traditionally described as a grade 2 hamstring tear (Mueller-Wohlfahrt et al., 2012). This definition is currently up for discussion but more on that later. Now when it comes to tearing a muscle I’m certainly not alone and unsurprisingly I was not alone on that day either. To treat patients is one thing, to be one is a whole different story. So I thought I should answer some questions on my predicament. What is the definition of my injury? How do I best treat a hamstring injury? Where do we go from here? How do I stop this from ever happening again?

Over the years muscle injuries have been given a grade to describe their severity. With grade one being the less severe injury and grade four being a complete rupture. In more recent times with the advent of scanning technology there has been further discussion on how we should grade a muscle injury. In my case I would fit the category of a grade 3B Hamstring injury. This means I have a moderate partial muscle tear.  As described in the definition I suffered a stabbing sharp pain with noticeable tearing at the time of injury. I also experienced a ‘snap’ followed by a sudden onset of localised pain (Mueller-Wohlfahrt et al., 2012). For hamstring strains this definition can be further elaborated by the way I suffered the injury. Askling and his colleagues propose there are two types of hamstring injuries the first resulting from high-speed running the second from pronounced stretching such as high kicking (C. M. Askling, Malliaropoulos, & Karlsson, 2012). As I’m no dancer and I was running at the time, my hamstring injury is classed as a Type 1 strain from high-speed running. That’s certainly the first and only time high-speed running and I will be mentioned in the same breath!

The way we treat acute muscle injuries has advanced over the last few years with some compelling evidence that the right rehabilitation program can ensure a quicker return to activity. The tried and tested Rest, Ice, Compression and Elevation (RICE) remains our advice in the initial 48 hours, despite some recent controversy, which I won’t go into here. Another key component in the first 48 to 72 hours is to reduce pain to stop muscle inhibition associated with pain (Brukner, 2015). Following this period, Askling and his colleagues have given us a rehabilitation protocol that has evidence to suggest it reduces the time taken to return to sport after hamstring injury. These include “The Extender”, “The Diver” and “the Glider” (Carl M Askling, Tengvar, & Thorstensson, 2013). Used five days after injury these exercises can reduce the length of time off sport and lead to improved recovery. I’ve started the protocol and am looking forward to the results.

How do I stop this happening again?

To begin with some of the risks of hamstring injury are compelling. They include previous history of hamstring injury, history of serious knee or groin injury, muscle weakness, poor flexibility, muscle fatigue, lack of warm up and increased age (Verrall, Slavotinek, Barnes, Fon, & Spriggins, 2001). Interestingly I fall into a couple of those categories including previous hamstring injury, no warm up and increased age, unfortunately being past your mid 30’s is old in the athletic population. Further evidence exists to promote the use of eccentric muscle strengthening. In other words strengthening the hamstrings as they lengthen. When this type of strengthening program was added to a pre-season program in soccer players the number of hamstring strains was significantly reduced (C. Askling, Karlsson, & Thorstensson, 2003).  In summary, while I can’t change my age or previous injury once recovered, I can work on eccentric strength training, improve my flexibility and remember to warm up before competing.

I look forward to completing my rehabilitation and returning to running with the knowledge that when I’m next asked to run with my children in a race, I won’t be limping away scarred from the experience. I hope this little tale proves valuable for all the other Dads and Mums out there. As always I welcome feedback.

 

References

Askling, C., Karlsson, J., & Thorstensson, a. (2003). Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scandinavian Journal of Medicine & Science in Sports, 13, 244–250. doi:10.1034/j.1600-0838.2003.00312.x

Askling, C. M., Malliaropoulos, N., & Karlsson, J. (2012). High-speed running type or stretching-type of hamstring injuries makes a difference to treatment and prognosis. British Journal of Sports Medicine, 46(2), 86–87. doi:10.1136/bjsports-2011-090534

Askling, C. M., Tengvar, M., & Thorstensson, A. (2013). Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med, 47, 953–959. doi:10.1136/bjsports-2013-092676

Brukner, P. (2015). Hamstring injuries: prevention and treatment—an update. British Journal of Sports Medicine, 49, 1241–1244. doi:10.1136/bjsports-2014-094427

Mueller-Wohlfahrt, H.-W., Haensel, L., Mithoefer, K., Ekstrand, J., English, B., McNally, S., … Ueblacker, P. (2012). Terminology and classification of muscle injuries in sport: The Munich consensus statement. British Journal of Sports Medicine, 342–350. doi:10.1136/bjsports-2012-091448

Verrall, G. M., Slavotinek, J. P., Barnes, P. G., Fon, G. T., & Spriggins, a J. (2001). Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging. British Journal of Sports Medicine, 35, 435–439; discussion 440. doi:10.1136/bjsm.35.6.435