Introduction

The Running Injuries: Hamstring Masterclass, taught by Jo Brown and Brooke Patterson, provides a complete overview of the assessment and management of Hamstring injuries in the running population. This position statement provides clinically relevant, actionable information that may be useful to health professionals.

Part 1: Background of Hamstring Injuries in Runners

The three most common types of hamstring injuries in runners are strains, proximal tendinopathy and referred posterior thigh pain. Hamstring injuries have a relatively high recurrence rate and a large financial burden on sporting clubs with lots of time out of sport.

• Depending on the type (type 1 or 2) of hamstring injury, the mechanism of injury, clinical presentation, pain location and rehab journey will be varied.
• The rehab program should be patient goal orientated, criteria based, early exposure to high speed running and with regular subjective and objective testing.
  

Part 2: Assessing Hamstring Injuries

When treating runners with hamstring injuries, there are lots of factors to consider such as possible prognostic indicators. The subjective and objective interview must be performed thoroughly to assess possible causes of the hamstring pain and to assess the lumbar and SIJ for a possible referral source.

• Subjective assessment should cover the possible mechanism of injury, any change in recent activity, immediate function after injury, aggravating factors, location and size of pain, prior injury and previous level of running.
• Objective assessment should include gait analysis, trunk movements, squat, flexibility assessment, palpation, strength, bridging progressions, special tests including the slump and a lumbar spine examination.
  

Part 3: Management of Hamstring Injuries in Runners

Management for hamstring injuries should be criteria driven and specific for each individual patient, depending on their goals. There are 4 distinct phases which are acute, sub-acute, return to full training and lastly a return to competition/play. The program should commence with early isometrics and then a graded loading program with exposure back to functional activity.

• The Askling protocol consists of the extender (flexibility), gliders (hip extension) and divers (pelvic control).
• Introduce high speed running, running drills and nordics as soon as possible, assessing for good pelvic control and monitor closely for patient’s response.
• Returning to sport clearance includes the same palpation on both sides, pain-free max isometric testing, negative Askling H-Test, triple hop test within <10% between both legs and ≥ 30 single leg bridges.
• The Puranen-ORAVA test includes hip flexion hamstring stretch and a loading component which is helpful to diagnose proximal hamstring tendinopathy.
  

Part 4: Preventing Hamstring Injuries in Runners

For hamstring injury prevention, explaining to the patient why they should do prehab is absolutely necessary for their adherence. The injury prevention program should consist of a variety of exercises, targeting both the hip and knee plus high speed running with good technique 1-2 x per week.

• While keeping the hamstrings strong is crucial for injury prevention, the clinician should also assess training balance and recovery, general physical conditioning, lumbopelvic hip stability and focus on movement quality.