Fantasy Impact
A hamstring strain is the most common lower body sports injury, subsequently providing us a massive sample size for most positions. With that, we see some interesting positional trends shown in the data tables below.
Running backs miss the most games due to a hamstring strain; however, their production, when they return, is only marginally impacted. Meanwhile, wide receivers are the most impacted from a hamstring strain, evident by lousy production in the first game back from injury.
To summarize the data below, yes, hamstring strains are a pain in the butt, however, it does not always lead to a ruined season.
Athletes Who Have Had Hamstring Strains
Quarterbacks
| Quarterbacks | Games Missed | PPG Prior to Injury | PPG 1st Game After Injury | PPG Games 2-3 After Injury | PPG Games 4-6 After Injury |
|---|---|---|---|---|---|
| Kyler Murray (2022 week 10) | 1 | 20 | 26.2 (+6.2) | N/Aψ | N/Aψ |
| Russell Wilson (2022 week 6) | 1 | 15 | 14.8 (-0.2) | 13 (-2) | N/Aψ |
| Tyrod Taylor (2021 week 2) | 6 | 14.9 | 8.9 (-6) | 17.7 (+2.8) | 2.3 (-12.6)* |
| Daniel Jones (2020 week 12) | 1 | 16.4 | 3.1 (-13.3) | 15.2 (-1.2) | 22.5 (+6.1) |
| Marcus Mariota (2017 week 4) | 1 | 12.1 | 14.2 (+2.1) | 12.1 (0) | 13.4 (+1.3) |
| Average | 2 | -2.2 | -0.1 | -1.7 | |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Points | 2/5 (40%) | 2/4 (50%) | 3/3 (100%) |
Running Backs
| Running Backs | Games Missed | PPG Prior to Injury | PPG 1st Game After Injury | PPG Games 2-3 After Injury | PPG Games 4-6 After Injury |
|---|---|---|---|---|---|
| Jaylen Warren (2022 week 11) | 1 | 5.6 | 2.9 (-2.7) | 7.8 (+2.2) | |
| Damien Harris (2022 week 5) | 1 | 13.6 | 1.5 (-12.1) | 8.3 (-6.3) | N/Aψ |
| Justice Hill (2022 week 4) | 2 | 4.1 | 0.6 (-3.5) | 2.6 (-1.5) | 2.1 (-2) |
| Dontrell Hilliard (2022, week 1) | 1 | 8.9 | 4.9 (-4) | 7.1 (-1.8) | 3.9 (-5) |
| Leonard Fournette (2022 week 1) | 0 | 19.3 | 8.7 (-10.9) | 12.2 (-7.1) | 17.9 (-1.4) |
| Brandon Bolden (2022 week 1) | 1 | 8 | 3.1 (-4.9) | 2.7 (-5.3) | 0.2 (-7.8) |
| Elijah Mitchell (2022 preseason) | 0 | 14.9 | N/Aψ | N/Aψ | N/Aψ |
| Miles Sanders (2022 preseason) | 0 | 9 | 17.5 (+8.5) | 7.5 (-1.5) | 15.6 (+6.6) |
| Leonard Fournette (2021 week 15) | 3 | 19.1 | 27.2 (+8.1)ρ | N/A | N/A |
| Damien Harris (2021 week 13) | 1 | 14 | 28.3 (+14.3) | 16.3 (+2.3) | N/A |
| Rashaad Penny (2021 week 11) | 1 | 1 | 6.7 (+5.7) | 15.9 (+14.9) | 20.4 (+19.4) |
| Ty Montgomery (2021 week 8) | 1 | 1.4 | 0.2 (-1.2) | 3.5 (+2.4) | -0.1 (-1.5) |
| Christian McCaffery (2021 week 3) | 5 | 24.4 | 12.6 (-11.8) | 21.3 (-3.1) | N/A |
| Austin Ekeler (2021 preseason) | 0 | 14.1 | 11.7 (-2.4) | 18.9 (+4.8) | 22 (+7.9) |
| Kareem Hunt (2020 week 12) | 0 | 12.1 | 7.2 (-4.9) | 15.2 (+3.1) | 11 (-1.1) |
| Matt Breida (2020 week 12) | 2 | 3 | 8.6 (+5.6) | 8.5 (+5.5) | 7 (+4) |
| Ty Montgomery (2020 week 11) | 5 | 2.5 | 0 (-2.5) | 6.1 (+3.6) | 2.4 (-0.1) |
| Carlos Hyde (2020 week 7) | 3 | 7.3 | 16.5 (+9.2) | 3.3 (-4) | 7.7 (+0.4) |
| Austin Ekeler (2020 week 4) | 6 | 14.2 | 18.4 (+4.2) | 14 (-0.2) | 12.8 (-1.4) |
| Le’Veon Bell (2020 week 1) | 3 | 11.6 | 7.2 (-4.4) | 4.6 (-7) | 5 (-6.6) |
| Miles Sanders (2020 preseason) | 1 | 16.8 | 18.6 (+1.8) | 10.7 (-6.1) | 15.7 (-1.1) |
| Derrick Henry (2019 week 15) | 1 | 22.6 | 39.1 (+16.5) | 26 (+3.4)ρ | 13.1 (-9.5)*ρ |
| Darrell Williams (2019 week 13) | 4 | 3.6 | N/A | N/A | N/A |
| Chase Edmonds (2019 week 8) | 3 | 12.2 | 0 (-12.2) | 0.5 (-11.7) | -0.1 (-12.3) |
| Devin Singletary (2019 week 2) | 3 | 12.3 | 2.6 (-9.7) | 17.2 (+4.9) | 8.9 (-3.4) |
| Rashaad Penny (2019 week 2) | 3 | 4.1 | 5.9 (+1.8) | 2.8 (-1.3) | 6.1 (-2) |
| Spencer Ware (2018 week 14) | 4 | 7.1 | N/A | N/A | N/A |
| Lesean McCoy (2018 week 14) | 1 | 9.3 | 3.4 (-5.9) | 10.6 (+1.3) | 13.7 (+4.4) |
| Ronald Jones (2018 week 8) | 4 | 5.3 | 0.2 (-5.1) | 0.2 (-5.1) | 3.6 (-1.7) |
| Melvin Gordon (2018 week 6) | 1 | 21.5 | 18.8 (-2.7) | 21.8 (+0.3) | 13.5 (-8) |
| Leonard Fournette (2018 week 4)μ | 4 | 13 | 25.4 (+12.4) | 23.3 (+10.3) | 12.4 (-0.6) |
| Dalvin Cook (2018 week 4)μ | 5 | 13.5 | 12.9 (-0.6) | 7.8 (-5.7) | 20.1 (+6.6) |
| Dalvin Cook (2018 week 2) | 1 | 14.1 | 2 (-12.1) | N/Aμ | N/Aμ |
| Marlon Mack (2018 week 2)μ | 3 | 5.7 | 9.8 (+4.1) | 29.8 (+23.7) | 10.3 (+4.6) |
| Leonard Fournette (2018 week 1) | 2 | 14 | 4 (-10) | 23.3 (+9.3) | 12.4 (-1.6) |
| Marlon Mack (2018 preseason) | 1 | 5.7 | N/A | N/A | N/A |
| Average | 2.2 | -1.1 | +0.5 | -0.4 | |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Points | 12/33 (36%) | 21/33 (64%) | 22/30 (73%) |
Wide Receivers
| Wide Receivers | Games Missed | PPG Prior to Injury | PPG 1st Game After Injury | PPG Games 2-3 After Injury | PPG Games 4-6 After Injury |
|---|---|---|---|---|---|
| Tee Higgins (2022 week 14) | 0 | 14.8 | 13.8 (-1) | ||
| Tee Higgins (2022 week 13) | 0 | 14.8 | N/Aμ | N/Aμ | N/Aμ |
| Courtland Sutton (2022 week 13) | 2 | 6.5 | 8.9 (+2.4) | N/A | N/A |
| Devin Duverney (2022 week 11) | 0 | 5.7 | 5.4 (-0.3) | 3.7 (-2) | |
| DeAndre Hopkins (2022 week 11) | 0 | 15.2 | 13.6 (-1.6) | ||
| Kadarius Toney (2022 week 11) | 3 | 5.6 | 1 (-4.6) | ||
| Desean Jackson (2022 week 9) | 1 | 2.3 | 8.4 (+6.1) | 3.2 (+0.9) | |
| Russell Gage (2022 week 7)μ | 4 | 6.9 | 2.1 (-4.8) | 15 (+8.1) | |
| Keenan Allen (2022 week 7)μ | 2 | 12.5 | 9.9 (-2.6) | 15.6 (+3.1) | |
| Deebo Samuel (2022 week 7) | 1 | 13.2 | 6.1 (-7.1) | 12.4 (-0.8) | N/Aψ |
| Tyler Lockett (2022 prior to week 6) | 0 | 15.2 | 2.7 (-12.5) | 10.7 (-4.5) | 13.7 (-1.5) |
| Christian Watson (2022 week 5) | 2 | 4.1 | 1.7 (-2.4) | 18.1 (+14) | 21 (+16.9) |
| Marvin Jones Jr. (2022 week 5) | 1 | 10 | 7.7 (-2.3) | 3.7 (-6.3) | 5.2 (-4.8) |
| Nelson Agholor (2022 week 5) | 1 | 6.6 | 0 (-6.6) | 0.4 (-6.2) | 7 (+0.4) |
| Juju Smith-Schuster (2022 prior to week 5) | 0 | 6 | 4.8 (-1.2) | 23.1 (+17.1) | 8 (+2) |
| Laviska Shenault (2022 week 4) | 2 | 7.3 | 1.3 (-6) | 2.9 (-4.4) | 6.4 (-0.9) |
| Jahan Dotson (2022 week 4) | 5 | 11.6 | 1.9 (-9.7) | 0.6 (-11) | |
| Christian Watson (2022 week 2) | 1 | 3.8 | 8.8 (+5) | N/Aμ | N/Aμ |
| Sammy Watkins (2022 week 2) | 4 | 3.8 | 4.6 (+0.8) | 1.4 (-2.4) | 2.1 (-1.7) |
| Kadarius Toney (2022 week 1) | 6 | 4.4 | 2.2 (-2.2) | 8.5 (+4.1) | N/Aμ |
| Keenan Allen (2022 week 1) | 5 | 12.5 | 2.1 (-10.4) | N/Aμ | N/Aμ |
| Chris Godwin (2022 week 1) | 2 | 15.1 | 9.4 (-5.7) | 10.9 (-4.2) | 8.6 (-6.5) |
| Rondale Moore (2022 prior to week 1) | 3 | 4.1 | 2.2 (-1.9) | 8.8 (+4.7) | 11.5 (+7.4) |
| Velus Jones Jr. (2022 preseason) | 3 | N/A | -2 | 3.9 | 1.4 |
| Marquise Brown (2022 preseason) | 0 | 6.2 | 12.3 (+6.1) | 15.4 (+9.2) | 15 (+8.8) |
| Michael Thomas (2022 preseason) | 0 | 10.1 | 20.2 (+10.1) | 11.5 (+1.4) | N/Aψ |
| Kadarius Toney (2022 preseason) | 0 | 8.1 | 2.3 (-5.8) | N/Aμ | N/Aμ |
| Russell Gage (2022 preseason) | 0 | 12.9 | 2.3 (-10.6) | 12 (-0.9) | 3.8 (-9.1) |
| Mike Evans (2022 preseason) | 0 | 12.2 | 15.6 (+3.4) | 17 (+4.8) | 10.1 (-1.9) |
| Tee Higgins (2021 week 17) | 1 | 17 | 1.5 (-15.5)ρ | 13.2 (-3.8)ρ | 24 (+7)*ρ |
| Mike Evans (2021 week 15) | 1 | 12.8 | 12.7 (-0.1) | 23.1 (+10.3)ρ | N/A |
| Julio Jones (2021 week 15)μ | 0 | 7.5 | 1.2 (-6.3) | 14.3 (+6.8) | N/A |
| DJ Moore (2021 week 14) | 0 | 9.1 | 9.8 (+0.7) | 6.2 (-2.9) | 13.5 (+4.4)* |
| Curtis Samuel (2021 week 14) | 4 | 6.6 | N/A | N/A | N/A |
| Julio Jones (2021 week 9)μ | 3 | 8.5 | 5.3 (-3.2) | 0.6 (-7.9) | 14.4 (+5.8) |
| DeVante Parker (2021 week 8)μ | 4 | 9 | 8.7 (-0.3) | 7.4 (-1.6) | 4.4 (-4.6) |
| DeAndre Hopkins | 3 | 12.9 | 10.2 (-2.7) | 7.9 (-5)* | N/A |
| Julio Jones (2021 week 7)μ | 1 | 8.5 | 5.5 (-3) | 2.7 (-5.8) | 7.8 (-0.7) |
| Sterling Shepard (2021 week 6) | 1 | 15.2 | 4.5 (-10.7) | 3.1 (-12.1) | N/A |
| Julio Jones (2021 week 6)μ | 0 | 9.6 | 4.8 (-4.8) | 5.4 (-4.2) | 0.6 (-9) |
| Sammy Watkins (2021 week 5) | 3 | 7.2 | -0.8 (-8) | 3.8 (-3.4) | 4 (-3.2) |
| Terry McLaurin (2021 week 5) | 0 | 15.1 | 4.8 (-10.3) | 13.4 (-1.7) | 11.6 (-3.5) |
| Amari Coooper (2021 week 4) | 0 | 10.5 | 13.5 (+3) | 15.1 (+4.6) | 5.6 (-4.9) |
| DeVante Parker (2021 week 4) | 3 | 7.4 | 12.5 (+5.1) | 11.8 (+4.4) | 2.9 (-4.5) |
| AJ Brown (2021 week 3) | 1 | 14.1 | 5.3 (-8.8) | 18 (+3.9) | 12 (-2.1) |
| Sterling Shepard (2021 week 3) | 2 | 15.6 | 12.6 (-3) | 4.1 (-11.5) | 2.5 (-13.1)* |
| Chase Claypool (2021 week 3) | 1 | 8.7 | 21.5 (+12.8) | 5.4 (-3.3) | 9.1 (+0.4) |
| Marquez Valdes-Scantling (2021 week 3) | 5 | 6.1 | 2.9 (-3.2) | 12.5 (+6.4) | 9.6 (+3.5) |
| Julio Jones (2021 week 3) | 2 | 11.4 | 7.4 (-4) | 5.2 (-6.2) | 2.7 (-8.7) |
| Tre’Quan Smith (2021 preseason) | 5 | 5.4 | 1.6 (-3.8) | 8.8 (+3.4) | 10.7 (+5.3) |
| Tyreek Hill (2020 week 16) | 1 | 25.4 | 15.9 (-9.5)ρ | 16.5 (-8.9)ρ | N/A |
| DeVante Parker (2020 week 14) | 2 | 9.5 | 17.1 (+7.6) | N/A | N/A |
| Deebo Samuel (2020 week 14) | 3 | 10.6 | N/A | N/A | N/A |
| Julio Jones (2020 week 13)μ | 4 | 14.1 | N/A | N/A | N/A |
| Tee Higgins (2020 week 13) | 0 | 13.2 | 7.4 (-5.8) | 11.8 (-1.4) | N/A |
| Julio Jones (2020 week 11)μ | 1 | 13.9 | 12.4 (-1.5) | N/A | N/A |
| Michael Thomas (2020 week 6) | 2 | 15.3 | 7.6 (-7.7) | 9.3 (-6) | 11.5 (-3.8) |
| Sammy Watkins (2020 week 5) | 5 | 6.5 | 5.8 (-0.7) | 5.9 (-0.6) | 7 (+0.5) |
| Julio Jones (2020 week 4)μ | 1 | 16.3 | 29.7 (+13.4) | 15.5 (-0.8) | 9.4 (-6.9) |
| Chris Godwin (2020 week 3) | 2 | 15.2 | 7.3 (-7.9) | 12.5 (-2.7) | 13.6 (-1.6) |
| Desean Jackson (2020 week 3) | 3 | 8.5 | 6.1 (-2.4) | 8.9 (+0.4) | 10.3 (+1.8) |
| Mike Williams (2020 week 3) | 1 | 8.5 | 25.4 (+16.9) | 9.7 (+1.2) | 10.2 (+1.7) |
| Julio Jones (2020 week 2) | 1 | 17.2 | 5.2 (-12) | 21.7 (+4.5) | 15.6 (-1.6) |
| Henry Ruggs III (2020 week 2) | 2 | 8.1 | 18.8 (+10.7) | 3.7 (-4.4) | 2.8 (-5.3) |
| Devante Adams | 2 | 15.2 | 6.1 (-9.1) | 27.5 (+12.3) | 16.8 (+1.6) |
| Jamison Crowder (2020 week 1) | 2 | 9.5 | 13.9 (+4.3) | 15 (+5.4) | 5.4 (-4.2) |
| Golden Tate (2020 preseason) | 1 | 12.2 | 7.2 (-5) | 5.1 (-7.1) | 3.9 (-8.3) |
| Brandon Aiyuk (2020 preseason) | 1 | N/A | 3.1 | 15.6 | 9.5 |
| Kenny Golladay (2020 preseason) | 2 | 12.8 | 14.7 (+1.9) | 13.4 (+0.6) | 14.4 (+1.6)* |
| Mike Evans (2020 preseason) | 0 | 12.7 | 6.7 (-6) | 16.6 (+3.9) | 11.9 (-0.8) |
| Chris Godwin (2019 week 15) | 2 | 14.4 | N/A | N/A | N/A |
| Scotty Miller (2019 week 15) | 2 | 3.3 | N/A | N/A | N/A |
| Mike Evans (2019 week 14) | 3 | 16.8 | N/A | N/A | N/A |
| Adam Thielen (2019 week 9)μ | 4 | 14.3 | 4.5 (-9.8) | 0.2 (-14.1) | N/A |
| Will Fuller (2019 week 7) | 3 | 13.2 | 17.5 (+4.3) | 5 (-8.2) | 5.8 (-7.4) |
| Adam Thielen (2019 week 7) | 1 | 14.3 | N/Aμ | N/Aμ | N/Aμ |
| Keenan Allen (2019 week 7) | 0 | 14.8 | 8.8 (-6) | 9.1 (-5.7) | 14.6 (-0.2) |
| T.Y. Hilton (2019 week 3) | 1 | 14.8 | 5.7 (-9.1) | 11.4 (-3.4) | 4 (-10.8) |
| Breshad Perriman (2019 week 4) | 2 | 5.9 | 0 (-5.9) | 7.5 (+1.6) | 6.2 (+0.3) |
| Terry McLaurin (2019 week 3) | 1 | 17.9 | 6.6 (-11.3) | 12.8 (-5.1) | 6.7 (-11.2) |
| Randall Cobb (2018 week 9) | 3 | 9.5 | 4 (-5.5) | 8.7 (-0.8) | 8 (-1.5) |
| Randall Cobb (2018 week 3) | 3 | 12.4 | 6 (-6.4) | 4.5 (-7.9) | 7.1 (-5.3) |
| Will Fuller (2018 preseason) | 1 | 3.7 | 21.3 (+17.6) | 14.9 (+11.2) | 5.5 (+1.8) |
| Sterling Shepard (2017 week 13) | 0 | 10.9 | 1.7 (-9.2) | 17.5 (+6.6) | N/A |
| Juju Smith-Schuster (2017 wek 11) | 1 | 13.8 | 3.7 (-10.1) | 15.5 (+1.7) | 21.3 (+7.5) |
| Jamison Crowder (2017 week 8) | 1 | 3.6 | 10.1 (+6.5) | 17.4 (+13.8) | 8.7 (+5.1) |
| Kenny Golladay (2017 week 3) | 5 | 11.1 | 7.4 (-3.7) | 6.6 (-4.5) | 4.8 (-6.3) |
| Corey Davis (2017 week 2) | 5 | 9.9 | 3.8 (-6.1) | 4.5 (-5.4) | 4.2 (-5.7) |
| Average | 1.8 | -2.7 | -0.4 | -1.3 | |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Points | 21/80 (26%) | 35/73 (48%) | 35/63 (56%) |
Tight Ends
| Tight Ends | Games Missed | PPG Prior to Injury | PPG 1st Game After Injury | PPG Games 2-3 After Injury | PPG Games 4-6 After Injury |
|---|---|---|---|---|---|
| Darren Waller (2022 week 5)μ | 8 | 6.5 | 12.3 (+5.8) | ||
| Dawson Knox (2022 week 4) | 1 | 4 | 11.2 (+7.2) | 6 (+2) | 7 (+3) |
| Kyle Pitts (2022 week 4) | 1 | 6.7 | 9.4 (+2.7) | 9.5 (+2.8) | N/Aψ |
| C.J. Uzomah (2022 week 1) | 1 | 4.7 | 0.5 (-4.2) | 1.1 (-3.6) | 2.6 (-2.1) |
| Darren Waller (2022 preseason) | 0 | 8 | 9.9 (+1.9) | 8.9 (+0.9) | N/Aμ |
| Kyle Pitts (2021 week 17) | 0 | 8.3 | 1.8 (-6.5) | N/A | N/A |
| Albert Okwuegbunam (2021 week 4) | 3 | 5.1 | 4.9 (-0.2) | 6.9 (+1.8) | 2.7 (-2.4) |
| Logan Thomas (2021 week 4) | 6 | 10.9 | 4.6 (-6.3) | 12.3 (+1.4)* | N/A |
| Zach Ertz (2021 week 1) | 0 | 4.5 | 1.1 (-3.4) | 11.2 (+6.7) | 8.9 (+4.4) |
| Hayden Hurst (2020 week 6) | 0 | 6.8 | 9.8 (+3) | 8.8 (+2) | 3.4 (-3.4) |
| OJ Howard (2019 week 6) | 2 | 4.7 | 12.7 (+8) | 0.8 (-3.9) | 8.2 (+3.5) |
| Logan Thomas (2018 week 14) | 1 | 1.7 | 0 (-1.7) | 0 (-1.7) | N/A |
| Evan Engram (2018 week 11) | 2 | 7.1 | 9.2 (+2.1) | 12.9 (+5.8) | 16.5 (+9.4) |
| Zach Ertz (2017 week 8) | 2 | 13.9 | 1.8 (-12.1) | 12.4 (-1.5) | 10.2 (-3.7) |
| Jordan Reed (2017 week 8) | 9 | 9.4 | N/A | N/A | N/A |
| Average | 2.3 | -0.3 | +1.1 | +1.1 | |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Points | 7/14 (50%) | 9/13 (69%) | 7/11 (64%) |
Anatomy of a hamstring strain
The hamstring is a group of three muscles that attach from the back portion of the hip to the back portion of the knee. Therefore the hamstring helps control motion at both the hip and knee joints. The muscles are named the biceps femoris (with two heads, long and short head), the semitendinosous, and semimembranosous.1 The hamstring attaches to a part of the hip called the ischial tuberosity, which can often be the location of the injury.1
These muscles collectively work to forcefully move the thigh bone backward (such as running or squatting) and bend the knee. Perhaps, more importantly, the hamstrings function as a break for the leg when running, particularly sprinting at high speeds. The hamstrings will work eccentrically (contracting forcefully while stretching) during the end of the swing phase of sprinting to begin to prepare the foot to contact the ground.
Injuries to the hamstring will typically occur at a region called the musculotendinous junction, where the muscle merges into the tendon or in the muscle belly itself. A challenge to recovering from hamstring injuries is the hamstring tendons have a poor blood supply, making them slower to heal.1 Like most soft tissue injuries, hamstring strains have a grading system to classify the severity and are listed below.1,2
- Grade I: Very minimal tissue damage, some pain, little to no loss in strength or range of motion.
- Grade II: More notable tissue damage, more pain, decreased strength and range of motion.
- Grade III: Complete tear with severe pain and loss of strength and range of motion.
MRI is often used to diagnose hamstring injuries and their severity. As expected, a larger hamstring injury and an injury to the tendon that attaches to the ischial tuberosity (mentioned above) often lead to a more prolonged absence from sport.2,3
Cause of hamstring strains
The hamstring strain is the most common muscle injury in sports, and the incidence of injury is more frequent in the later portions of each half as players become fatigued.1,4 Injury can occur from repetitive minor injuries that build over time or one instance of a more significant force through the muscle or tendon that is strong enough to cause injury.3
The biceps femoris long head is the most common muscle injured in a hamstring strain and most frequently occurs during sprinting. The second most common cause of injury is the follow-through during kicking.1,4 During sprinting, the hamstring contracts eccentrically to act as a brake to decelerate the leg in preparation for contacting the ground.3 This puts high amounts of force through the hamstring muscle while it is in a position where it is being stretched to its maximum length. This combination of maximal contraction while being maximally stretched can lead the muscle vulnerable to injury.
When an athlete increases their sprinting speed from 80% of max speed to 100% of max speed, the force through the hamstring increases by 1.3x, with most of this force occurring through the biceps femoris long head muscle, explaining why it is most commonly injured out of the three hamstring muscles.3,4 There is also some evidence that the hamstring contracts very hard when the foot first hits the ground, and this may also be when the hamstring strain occurs in some cases.4
A previous hamstring strain and other lower-body injuries such as ankle sprain or fractures may increase the risk for re-injury. Previous hamstring injuries, in particular, increase the risk for re-injury by 2.7x, and this re-injury usually occurs at the same part of the muscle that was injured.3 This makes a return to playing challenging to gauge.
hamstring strain Rehab Process
The goals for rehab following a hamstring injury are to allow the injured portion of the muscle or tendon to heal, regain the lost range of motion, prevent weakness in the hamstring and other muscles in the lower body, and regain any strength, endurance, or speed lost.1
Initially, when the player is experiencing quite a bit of pain and loss of function, treatment is geared around reducing pain and swelling. For example, this is achieved by relative rest, ice, compression, elevation, soft tissue work, which may include massage techniques or dry needling, and electrical stimulation for pain control.1 During this phase, it is also essential to identify factors that may have led the athlete prone to a hamstring injury. Examples would be weaknesses in the core or glutes or stiffness in the hips or ankles.1 These can be addressed during this time.
As the athlete’s pain begins to subside, they can start to work on stretching the hamstring and progressively strengthening.1 Strengthening begins with isometric exercises, where the muscle contracts but the joint does not move. The athlete will typically do isometrics for a few days to weeks and, when tolerable, can progress to concentric strengthening (muscle contracts and joint moves) and eccentrics (muscle contracts forcefully as it is stretching). Examples of concentric exercises are when you are curling your legs on the leg curl machine, and the eccentric phase is when you slowly allow the weight stack to straighten out your legs (the controlled manner is what makes the muscle contract as it is stretching).
During this intermediate phase, it is critically important that the athlete continues to work on glute and core strengthening and ankle and hip mobility if needed.1,3 When the glute and core muscles are weak or not working correctly, the hamstring muscles tend to compensate and overwork, which can influence injury. Some recent studies emphasize earlier use of eccentric exercises as long as the athlete can tolerate it without too much pain.3
Returning to running, cutting, and jumping is a significant part of returning to playing football. There is no clear consensus among rehab professionals on ideal return to running protocols, and it is dependent on how the athlete is progressing through rehab. One suggestion written by rehab professionals working in professional football recommends returning to light jogging (25-50% speed) as soon as the athlete can tolerate walking with minimal pain.3 When this light jog is tolerable, they can progress to 80% speed. When 80% is performed without pain, the athlete can slowly progress to 100% speed; however, this progression to 100% should not be rushed as over 80% speed, the force through the hamstring increases quite a bit.3 Alternative ways to progress running include using anti-gravity treadmills to reduce the effects of gravity.
| Rehab Phases | Treatments | Criteria to Enter Phase |
|---|---|---|
| Early Phase | Rest, ice, compression, elevation, NSAIDs. Soft tissue work, dry needling, electrical stimulation (pain control). Ankle and hip mobility Glute and core strength Gentle hamstring isometrics | N/A first phase |
| Intermediate Phase | Soft tissue work, dry needling Ankle and hip mobility Glute and core strength Hamstring concentrics and eccentrics Hamstring stretching Initiate running program | Little to no pain with hamstring isometrics. Little to no pain with walking (for initiating running program). |
| Sport Specific | Full weight lifting Progress to 100% speed running Agility, plyometrics Position specific drills | No pain with hamstring eccentrics. No pain with running up to 80% speed. |
There are limited studies on NFL football players’ time missed, re-injury rates, and performance disparities from pre-injury compared to post-injury. However, there are numerous studies on this data for professional European soccer. In European soccer, players average missing about 18 days due to a hamstring injury (equivalent to 2-3 weeks of NFL season).5 In these studies, the re-injury rate is about 17.5%, and nearly half of players show a decline in performance measured by maximal speed.6 While soccer and football are two different sports, this data may translate to football as we all know how pesky hamstring injuries can be.
Tom Christ, PT, DPT, OCS
References
- Sueki D, Brechter J. Orthopedic Rehabilitation Clinical Advisor. 1st ed. Maryland Heights, MO. Elsevier Inc.; 2010.
- Sevensson K, Alricsson M, Eckerman M, Magounakis T, Werner S. The correlation betweehn the imaging characteristics of hamstring injury and time required before returning to sports: a literature review. J Exerc Rehabil. 2016;12(3):134-142.
- Hickey J, Opar D, Weiss L, Heiderscheit B. Hamstring Strain Injury Rehabilitation. J Athl Train. 2022;57(2):125-135.
- Huygaerts S, Cos F, Cohen D, et al. Mechanisms of Hamstring Strain Injury: Interactions Between Fatigue, Muscle Activation, and Function. Sports. 2020;8(65).
- Ekstrand J, Krutsh W, Spreco A et al. Time before return to play for the most common injuries in profesional football: A 16-year follow-up of the UEFA Elite Club Injury Study. Br. J Sports Med. 2020;54(7):421-426.
- Whiteley R, Massey A, Gabbett T, et al. Match High-Speed Running Distances Are OFten Suppressed After Return From Hamstring Strain Injury in Professional Footballers. Sports Health. 2021;13(3):290-295.