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The truth about hamstring injuries and how to avoid them

One of the most common injuries that you can suffer if you play a sport that involves running is a hamstring injury. This is what you should look out for

Manchester City star Kevin De Bruyne suffered a serious hamstring injury this season.
Manchester City star Kevin De Bruyne suffered a serious hamstring injury this season. (Reuters)

When the Everton striker Dominic Calvert-Lewin picked up yet another injury last season, the club sent a team of specialists to check the mattress and bed he slept on to figure out why he was getting injured so often. At Manchester City, manager Pep Guardiola said that a team of doctors monitor striker Erling Haaland 24x7 because they cannot risk him picking up an injury. Male international footballers play a lot through the year, and the stakes, including financial ones, are very high. So, getting to the root cause of injuries and taking steps to prevent injuries is a top priority and, usually, immediate. 

But what about injuries to players in women’s football, which is growing at a phenomenal pace? Still not enough is being done to get to the root of the problem. Majority of the women footballers in Europe continue to play in boots designed for either kids or men. The grounds that women play on aren’t the same top quality that men play on either. All of these are injury risks to any footballer. 

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Anterior cruciate ligament (ACL) tears continue to affect top female footballers in their prime, and there is still little clarity on why women suffer more ACL injuries than men. Some of the biggest names in women’s football were missing from the just concluded Women’s World Cup due to ACL tears. Studies show that the relative risk of ACL injury in women is 3 to 8 times greater than men. Former players and experts point out that if men suffered so many ACL tears, clubs and stakeholders would have done a lot more to figure out the problem. 

As women start playing a lot more games, they are susceptible to other injuries as well. Thus far, hamstring injuries used to be more common among men than among women players. But that is changing at the elite level; incidence of hamstring injuries among both men and women is almost similar now. A Uefa research project, the Women Elite Club Injury Study, found that hamstring injuries are “the most common injury subtype in women’s elite-level football players, constituting 12–16% of all time-loss injuries.”

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Hamstring strains occur most often during maximal sprints, explains Vaibhav Daga, head of sports science and rehabilitation and a sports medicine consultant at Kokilaben Dhirubhai Ambani Hospital in Mumbai. “There are two types of hamstring injury mechanisms: one is ‘high speed running’ and the other is ‘stretch injury’. They are very common in sports that involve running at high speeds. On average, a squad of 19-22 players would typically suffer 3-4 hamstring injuries per season,” he adds, quoting the Uefa study that was published in May this year. The aim of this study is to assess opinions on preventable risk factors for hamstring injuries. The Football Research Group has also continuously carried out an injury surveillance study on male elite football, the Uefa Elite Club Injury Study, since 2001.

The Premier League season has just returned and already there are two high profile players out with hamstring injuries — Manchester City’s Kevin De Bruyne and Chelsea’s Reece James. Daga says that if the hamstring muscles are not well conditioned or if there is an imbalance in the muscles around the hip or knee joints, the hamstring can be vulnerable to an injury. “These injuries can also be caused by extrinsic factors such as the playing surface and the type of football shoes to name a few,” he adds. 

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The Uefa study also found that most factors that led to hamstring injuries among women footballers were extrinsic in nature and not because of the players themselves. The two biggest factors were the lack of communication between medical staff and coaching staff, and the increased load on the footballers, who nowadays play matches 2–3 times a week. Coaching methods were also to blame including a lack of regular exposure to high-speed football actions during training.   

A hamstring injury is graded based on its severity. Recovery from the injury depends on the grade of injury a player suffers. “In Grade 1 strains, only a few fibres of the muscle are injured. That takes around 2-3 weeks to heal. Grade 2 injury is one where 50% of the fibres in the muscle are hurt. Recovery in these cases requires 4-6 weeks. A complete tear of the hamstring muscle constitutes a Grade 3 injury. It may require surgical repair. Recovery can take 8- 12 weeks,” explains Daga. The best way to prevent a hamstring injury, according to Daga, is to do a proper warmup and follow a structured strength and conditioning programme that increases the eccentric strength of the hamstring muscles and improves joint mobility of hips and knees. 

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The best way to speed up recovery from a hamstring injury is to follow a proper guided and supervised rehabilitation programme. One must respect the signals the body sends about pain or strain during activities like running or various exercises during the rehab. “One must remember not to over-strain or over-stretch the injured muscle in the rehab phase. This will help to protect any further injury. Finally, start playing only when you feel confident and can sprint without any pain as recurrence of hamstring injuries is very common,” says Daga. 

Shrenik Avlani is a writer and editor and the co-author of The Shivfit Way, a book on functional fitness.

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