by Andrew Leipus in Cricinfo
Overwhelming feedback so far shows there are a lot of ESPNcricinfo
readers out there currently suffering cricket injuries and they want
some help. There are volumes of research out there but over the next few
articles I will broadly discuss some guidelines on what I commonly see
in practice, and provide some information that might be useful. Of
course, it goes without saying that all injuries are unique and wherever
possible you need to seek professional advice.
I have just read that my old captain of many years, Sourav Ganguly, has pulled a hamstring
which kept him out of the Syed Mushtaq Ali Trophy quarter-final
recently. Whilst this was unfortunate for Bengal, what was of interest
was his comment that he will be fine by the time the IPL starts. This
leaves him around two weeks in which to recover and complete his rehab.
But the IPL also presents an interesting challenge to players, in that
often they are coming off long seasons or a Test series. The increased
intensity and speed of play during a Twenty20 is potentially a risk for
the players, and where time allows, they should be gradually increasing
their training intensity during the pre-camp.
Sudden transition from
standing around during Test cricket to explosive T20 is an injury
waiting to happen and players need time to prepare adequately. I hope
Sourav can recover in time. Unfortunately, hamstring strain injuries are
a challenge for both the players and support staff, given their high
incidence rate, slow healing, and a tendency to recur.
There is a continuum of muscle impairment that can occur in sport,
ranging from simple muscle cramping or soreness to the worst-case
scenario, of a complete rupture. We like to classify the degree of
injury as a grade 1, 2, or 3, as it gives us an idea of how quickly we
can get the player back to sport again. The greater the damage, the
longer the rehabilitation period for restoration of full function.
Hamstring strains are quite common in cricket and can occur when
overloaded eccentrically, like if the hamstring attempts to control a
rapidly flexing hip/trunk or an extending leg, or both. This can happen
during bowling, running between wickets or sprinting in the outfield, so
every player is a potential victim. When the load applied or expected
to be controlled by the muscle exceeds its capabilities, especially when
on stretch, the muscle fibres tear or get damaged.
In terms of self-diagnosis, if you experience hamstring muscle soreness
after a long day in the field or following training in the gym, the
problem is unlikely to involve disruption of muscle fibres and will
probably heal in a day or two. Many players experience this feeling
after long days in the slips during a Test match. But a massage or ice
bath in the evening will always help them recover by morning.
Actual muscle strains, however, always are accompanied by an acute onset of pain.
A sudden, sharp "grabbing" behind the thigh is generally an indicator
of a strain. Feeling pain or a swelling under your thigh when sitting is
also quite indicative. The more intense the pain, generally, the higher
the grade of injury.
The delineation between strong cramping and a mild strain is often
difficult to diagnose, especially when the player is fatigued and
dehydrated. This poses problems now that substitute runners are not
allowed. Regardless, a grade 1 will probably let you continue playing,
albeit with some discomfort, a grade 2 or 3 will bring you off the
ground, limping. If this acute "grabbing" or "tearing" sensation isn't
experienced and the hamstring pain arrives insidiously, there is a good
chance the pain is being referred from surrounding areas like the lower
back or pelvis. The management for this sort of injury is very
different. There are many other possible sources of hamstring pain,
often co-existing. This often results in a player return to sport
remarkably quickly, since no muscle is actually injured at the time.
The initial management of all strains begins with protecting or
offloading the muscle - applying an ice compression for 15-20 minutes
every hour or two for a couple of days (commonly longer). A lot of
people start to exercise too early post-injury, and in my experience
sometimes it's better left alone, to allow for the natural healing
processes to begin. A good rule of thumb to follow is not to do anything
that hurts - it is common sense but not always followed, and leads to a
premature return to sport, getting injured again, and even more time
out of the game.
After a few days, when walking is easier, aim to gradually restore full
range of movement, develop good alignment of scar tissue and regain
optimal strength, since injured muscle becomes inhibited or weak almost
immediately. Active stretching is useful in regaining movement - when
sitting, use the quads to straighten the knee and provide a gentle
hamstring stretch. It's much more preferable to static stretching at
this stage. Soft-tissue massage is also beneficial to normalise muscle
tone and soften the healing scar tissue.
| A lot of people start to exercise too early post-injury, and in my experience sometimes it's better left alone, to allow for the natural healing processes to begin. A good rule of thumb to follow is not to do anything that hurts | |||
A good sports physio will address these issues and examine for any other
contributing or driving factors that may be modifiable, such as muscle
imbalances, weakness, poor flexibility or dysfunctional movement
patterns. In other words, they will look for reasons, biomechanical or
otherwise, why the injury possibly occurred and try to correct or
improve them.
After this, a progressive amount of training load is needed to
strengthen the injured and weakened muscle without injuring it again.
Some of the better traditional exercises prescribed early in
rehabilitation don't require any equipment and include hip bridging off
of a bench, squats, lunges, deadlifts and single-leg standing windmills.
Hamstring curl machines found in gyms certainly have their place in
rehab but are a luxury not a necessity. Stationary cycling is also
beneficial for maintaining cardio fitness and initially provides a low
load to the hamstring. Access to a spin bike is useful if it has a
weighted fly-wheel, since this will introduce an eccentric load to the
hamstring. Eccentric loading has been shown to be a critical component
to full hamstring rehabilitation.
Jogging can be reintroduced gradually, initially as sideways movements,
which places less stress on the hamstrings. As pain-free contraction and
full range of motion are regained, drills such as 80-metre run-throughs
are common, like 20m of gradual acceleration leading into 40m of steady
pace, followed by a deceleration over the next 20m. The distances and
intensities of the acceleration and steady pace are gradually increased
from session to session as the injured muscle adapts to increasing
loads. Progression is based on the ability to complete each session
successfully and wake up the next day without pain or stiffness. The
ultimate goal is rapid acceleration into a full sprint, and for cricket,
rapid changes of direction.
At some stage during this programme, cricketing skills will be
reintroduced. For example, once lunging is comfortable it is quite
reasonable to begin easy net sessions. Similarly, bowlers coming off
hamstring strains need to begin "walking through" their actions,
progressing to controlled medicine-ball throws and gradually bowling off
a short run.
As mentioned at the start, there is no recipe. What you need instead is a
structured and flexible progression of loading the injured muscle and
the reintroduction of the necessary skills to avoid the development of
altered movement patterns associated with the injury. The loads can be
increased as the muscle becomes stronger, as can the progression of the
gym programme to include more dynamic functional training and
plyometrics/power training.
In terms of returning to play, don't be one of the many people who
equate a lack of pain or stiffness with being fit. Prevention of
re-injury starts with thorough rehabilitation of the current injury.
Incorporating a dynamic warm-up before playing is the norm nowadays and
static stretching is uncommon (although there still is a place for it).
Bowling actions need to be reviewed carefully by the coach to ensure
there is no altered movement - bowlers often don't finish their actions
completely when recovering from a hamstring strain, and avoid short or
full deliveries as they require a slightly longer delivery stride.
Ultimately, the best functional testing is seen under match conditions.
Muscles tend to tighten when weak or fatigued and the best practice for
this is to play a match, often at a lower grade than usual, in order to
better control the efforts.
As you can see, there is a lot to cover in management of the "simple"
hamstring strain and this has just been an introduction. But the best
piece of advice I can give for prevention of hamstring strains is to be
physically well conditioned. The more functionally strong the muscle,
the less likely it is to fail.