Field hockey was re-introduced as an Olympic sport back in1928. Participation levels have risen steadily and now it is played in 132 countries. As a team sport it is second only to football.
With the introduction of ‘water based’ pitches and a change in some key rules, the game has become faster and more physical than ever. Unfortunately, this has resulted in a rise in both the number and severity of injuries.
Although hockey is classified as a non-contact sport there is potential for direct trauma. Acute injuries may result from contact with a stick, the ball, another player, the playing surface or the goal.
However it is soft tissues injuries that still account for the vast majority of problems that will typically require physiotherapy management.
Hockey can be an aggressive game, requiring rapid movement, agility and sudden bursts of speed. When these stresses are put on the body repeatedly, injury can occur, particularly during those stages of the game when muscles are already weary.
Hockey also involves a lot of bending low down while running at speed and reaching or stretching for the ball to push on or make a tackle. This can increase the workload on the leg muscles significantly.
Hamstring injuries are very high ranking for hockey players. These are a group of three muscles running down the back of the thigh, from the pelvis to just below your knee. They are extremely important muscles, responsible both for flexing the knee and extending the thigh behind the body when we run. They also help to stabilise the knee when slowing down and changing direction.
Hamstring injuries can be extremely painful, they carry a long recovery period and can be notorious for recurring if they aren’t managed correctly.
Additionally because players are often anxious to get back playing again, they can be tempted to return too early and as a consequence there is often a high rate of re-injury.
Factors that are thought to increase the risk of hamstring injury include:
- muscle fatigue
- inadequate muscle strength
- muscle imbalances
- poor flexibility/joint range
- poor running biomechanics.
- poor control of lumbo-pelvic and trunk muscles
- previous injuries (particularly to the lower back and knee on the same side)
- inadequate warm-up
Signs & symptoms of hamstring injuries:
This can vary greatly depending on the severity of the injury. Typically, a sudden sharp pain will be felt at the back of the thigh when running. This will then be accompanied by some loss in strength of the muscle usually due to discomfort when the muscle contracts. Bruising and swelling may also occur, sometimes the bruising is very colourful! In more severe cases the thigh may be very tender to touch. In serious cases you may feel a ‘popping’ sensation at the time of injury and be unable to walk on the leg afterwards.
Diagnosing a hamstring injury
Once a hamstring injury is suspected, it is important to gain a proper diagnosis from an expert. The clinical tests physiotherapist’s use are often very accurate and unless the injury is thought to be serious an MRI scan or ultrasound scan need not be required.
The severity of injury is usually graded on a scale of 1 to 3 which can then often be used to predict a ‘potential return to play’ date.
Grade 1 – a mild muscle pull or strain
Grade 2 – a partial muscle tear
Grade 3 – a complete muscle tear
The length of recovery time will depend on the severity of the injury – a minor muscle pull (grade 1) may take a few days to heal, whereas as grade 2 or 3 injury will more likely take weeks or months to recover.
Treatment will vary considerably depending on the severity of the injury.
Typically, a period of rest, ice, compression and gentle movement exercises are used within the acute phase (first 3 days post-injury) to reduce tissue bleeding and inflammation.
Once the tissue re-modelling stage begins (usually 3 days post-injury) physiotherapy management should then begin:
How can physiotherapy help?
As well as being able to give you an idea of the severity of your hamstring injury, your physiotherapist shoulder be able to identify any contributing factors. These can be characteristics such as lower back stiffness, nerve irritation, poor soft tissue flexibility and muscle strength, all of which will need to be addressed as part of your rehabilitation programme.
- Soft tissue techniques can be very useful in helping to break down scar tissue and encouraging good blood flow to the injured muscle.
- Manual therapy can help to prevent surrounding joints such as the hip and lumbar spine from stiffening up.
- Ultrasound, acupuncture and taping can also be very useful in the early stages to help promote the healing process.
- Gentle, controlled stretching (usually 3-4 days post-injury) to break down scar tissue and help restore normal muscle length is essential
- Functional rehabilitation
- Subsequent strengthening of the hamstrings, as well as other surrounding muscle groups (gluteals, quadriceps, core muscles) is critical for a successful return to sport. Any biomechanical disadvantages such as leg length discrepancy, poor pelvic control, and abnormal foot biomechanics may also need to be considered.
- Neuromuscular re-education (NMR) to restore stability and functional movement patterns that typically occur in hockey (e.g. ball striking, lunging to tackle, acceleration /deceleration and change of direction).
- Home exercise programmes which will include elements of all of the above (strengthening, stretching and stabilisation exercises) and
- Guidance on stages of recovery and when it is safe to return to playing hockey again.
In summary, accurate diagnosis is essential in the first instance, followed by a systematic approach to rehabilitation. Even with optimal treatment however, the recurrence rate during the remainder of the season is estimated to approach 30%. You must therefore be patient, listen to your physiotherapist and convert your weakness into strength!