Managing hamstring injuries

Hamstring injuries are one of the most common injuries in sports. Time lost from competition can be substantial, and there is a high risk for re-injury.

One of the reasons that the hamstring is so susceptible to injury is that it crosses both the hip and knee joints. During running, the hamstring works to decelerate the knee at ground contact and then assist the glutes to accelerate the hip into extension. This change in function is believed to be one of the reasons that the hamstring is injured.

Risk factors for injury include a previous hamstring injury and weakness in the hamstrings.
Currently, there is a lack of systematic research on effective hamstring prevention, treatment and rehabilitation programs. Stretching has not been shown to decrease injury risk, and our current knowledge on prevention has been primarily performed on soccer athletes utilizing Russian/Nordic hamstring exercise as an eccentric training technique. This exercise has been effective in reducing the rates of hamstring strains in soccer athletes. However, due to the eccentric action of the exercises, it does cause DOMS (delayed onset muscle soreness), so starting a program should be progressed accordingly. While not studied for prevention, Romanian deadlifts activate the hamstrings eccentrically, and they can be an adjunct to a prevention program.

If a hamstring is strained, the location can affect the time lost from competition. Proximal hamstring injuries, avulsions where the muscle pulls off the bone and larger lesions all increase the time to heal. If you have access to a physician doing corticosteroid injections, this can assist in decreasing the healing time without an increased risk for re-injury.

Rehabilitation of hamstring injuries follows the same guidelines as other rehab programs including decreasing pain and inflammation; restoring range of motion and neuromuscular control; strengthening and progressing to higher speed and higher functioning sport specific drills. A more holistic rehab program focusing on core stability, hip strengthening and neuromuscular control is more effective than an isolated strengthening and stretching program in return to sport and re-injury rates. Adding in eccentric exercises in the late strength phases can assist with injury prevention as well as incorporating agility and running drills to improve proprioception and stride mechanics.

While the evidence for the most effective treatment of hamstring injuries continues to be developed, we know that eccentric training is beneficial at preventing initial strains and recurrent strains. The added benefit of eccentric hamstring strengthening is that they can also help decrease ACL injuries in certain populations.
What have you found to be effective in preventing and rehabbing hamstrings?