How to Prevent and Recover from Acute Hamstring Injuries



Hamstring injuries are common with sports, particularly with sprinting (from 80% to 100% sprint effort), changing direction and movements that involve stretching the muscle such as kicking and tackling. With sprinting, often overload in training which can be increase speed, distance or fatigue can increase the risk of injury. Studies have found that increase in load over a week, compared to loads that are built over 4 weeks are associated with a greater risk of hamstring. So it’s critical to have your training loads monitored and progressed appropriately to minimise the risk of hamstring injury.

Hamstrings are made up of 3 muscles: biceps femoris, semimembranosus and semitendinosus. Not all hamstring injuries are equal and some may take longer to recover than others. Hamstrings injuries can be divided into the muscle belly tears, tendon tears; or tendinopathy.  Research has found that slow stretch type injuries such as kicking ball, central tendon injuries, and injuries close to the pelvis ( where the hamstring attaches to the bone) take longer to recover. Biceps femoris injuries also have a higher recurrence rate.


Risk Factors for Hamstring Injuries

There are a number of risk factors for increasing the risk of an initial hamstring injury including:

  • Previous injury – major knee injury i.e. ACL reconstruction, history of osteitis pubis
  • Increasing age
  • Ethnicity – Black African or Caribbean and Australian aboriginal
  • Higher level of competition
  • Later stages of football matches
  • Hamstring muscle strength imbalance profile

Recurrent injury risk factors include:

  • History of hamstring muscle injury
  • Larger volume size of injury as measured on MRI
  • Grade 1 injury

Timeframes for recovery are based on your presence of risk factors, the type of injury, age, load, previous strength and biomechanics. It is important to have assessment and diagnosis done by your physiotherapist to determine timeframes of recovery for your individual injury.


Rehabilitation for Hamstring Injuries

Correctly rehabilitating your hamstring is essential to successful return to sport and minimising the risk of recurrent hamstring injury. Your rehabilitation program needs to be tailored to the type of injury, sport and previous strength and biomechanics. After an injury, pain can cause inhibition of your muscles, leading to decreased strength, particularly eccentric strength, which refers to strength when the hamstring is stretched or lengthened. There are a series of exercises and progressions that need to be prescribed by your physiotherapist to safely guide you through your rehab without risk of re-injury.

Progressive agility and trunk stabilisation, including a running technique programme improves neuromuscular control, which studies have shown to decrease the rate of re-injury. Your programme needs to include exercises and movements that are sport specific to mimic the load your hamstrings undergo during training and games.

Hamstring strengthening is key and is progressed based on resistance, volume, muscle length and velocity. There are a number of exercises available, we have videos of an example of hamstring exercises, but it is crucial you get a diagnosis and prescription of exercises based on your injury and risk factors.

Four common hamstring strengthening exercises are demonstrated below.

There are ways to decrease the risk of hamstring injury including:

  • Adequate warm up
  • Hamstring strength and conditioning, which takes time and effort
  • Managing load appropriately
  • Preparing your strength and load prior to your season of sport
  • Avoiding large rapid increases in high speed running volumes.
  • Trunk and agility training

The Evolution of Sitting



Chairs have evolved to be more comfortable and ergonomic to allow us to sit for long periods of time, however, our bodies have not evolved to sit for prolonged periods. As technology has become integral to many of modern society, our sitting time has dramatically increased compared to that of our parents and grandparents. The research is mounting and the statistics prove that our health is suffering from being bound to a chair.

Sometimes sitting becomes second nature and we may not even realise that we are being glued down by our seats. Consider a typical office worker and how much of their waking hours involve sitting from the moment they wake up and until they are in bed.

Here is an example of such a pie chart with someone who works a typical 40 hour week at the office.


With our example pie chart, it demonstrates approximately 70% of the waking day sitting, but some of us may need to commute longer, work longer hours, or spend a bit more extra time winding down in the evening.


Do you sit too long throughout the day?

If you sit for 7 hours a day or more, your are twice as likely to develop type 2 diabetes and cardiovascular disease, and are 13% more likely to develop cancer. Even after you have adjusted the data for additional moderate-to-vigorous physical activity, you still have an increase risk of these adverse health outcomes.


These are the grim facts of sitting and we need to focus on developing strategies to reduce our sitting time to improve our health.


Training For a Marathon: Practical Tips to Avoid Injury




Increase load gradually

Remember the general rule of thumb is to increase your total running volume by 10% per week. This is important to avoid injury, as it takes time for the body tissue (muscles, tendons, bone) to adapt to increases in running load. Failure to do so can often result in injuries such as Tendinopathy (eg. Achilles tendon), bony stress reaction (eg. shins), or anterior knee pain!

To track your mileage effectively I would recommend keeping a training diary eg. (Tues 5km, Thurs 8km, Sunday 14km = Total 27km for the week), or most people are training with GPS watches / Smartphone Aps which makes is easy to track running volumes online.

Listen to your body!

Pay attention to any alarm bells such as recurring pain/fatigue. Remember the body will elicit pain for a reason! It is normal to experience some muscle soreness perhaps the day after a run (especially when starting out), but if you have persisting pain, or definitely pain that worsens during a run – it is likely worth a visit to your physiotherapist to diagnose the problem & get on it top it before it becomes a serious issue and prevents you hitting the road.

There are plenty of options that runners can do pre-run to both improve performance & prevent injury. In my experience, runners are usually great at throwing on the shoes & hitting the pavement straight away, but often neglect any supplementary strength/activation work!

Strengthening your lower-body & core lets you handle the 3-4x bodyweight that is absorbed with every step as you run. In addition, doing some simple strength work; not only will you be less injury-prone, but also more efficient & potentially faster! Win-win!

Below are 5 simple gluteal & core exercises designed to be both easy & quick to punch out 10-mins before your run. No need to rush out and join a gym; these can be done at home, or in the park before starting. Only equipment that may be useful is an elastic band (Theraband) to add in some resistance & really get your gluteals firing up!

Happy running!

Video exercise guides

  1. Arabesques
  2. Knee to chest, into a falling Lunge
  3. Crab Walks + Theraband resistance
  4. Monster Walks + Theraband resistance
  5. Plank Series

Tips for Rehab After Knee Surgery



How should I prepare?
Before the surgery, have a good chat with your surgeon about the amount of time you will need off work. Make sure you’re made aware of any rehabilitation requirements, for example any post op restrictions, how quickly you need to see the physio, or any exercises you should begin (or avoid!) straight away. Also discuss your own personal goals and get a rough idea about when you will be able be able to get started with your recreational activity of choice, whether that be the odd run around the block, or the half iron man 6 months from now!
It’s also worth noting that prehab is the best rehab: the stronger your knee can be leading up to the surgery, the better results you will get afterwards. If you can, get your physiotherapist at Rolleston Central Physio to make you up a program prior to going under the knife for best preparation!


What should I do immediately after surgery?
The knee will be swollen and painful following any type of surgery. Regular icing, elevation of the leg and use of a compression bandage will assist in settling down oedema as soon as possible.

The knee is somewhat predictable in its post op behaviour, whether you’ve had an ACL reconstruction, minor arthroscopy or knee replacement. Your stabilising quadriceps muscles have a tendency to switch off in the presence of any pain or swelling, which can lead to rapid wasting (atrophy) of your thigh muscles. This in turn can lead to feelings of instability, weakness and poor tracking of your patella. To address this quickly, you can start an exercise called ‘quads setting,’ which aims at getting your quads muscles activated so that they can do their job controlling your knee!

To do this, lie on your back and straighten your operated knee as much as possible. You can place a towel under your heel to help if you like. Then tighten the muscles at the front of your thighs, and press the back of your knee to the ground. Hold for 3-5 seconds, then relax. Repeat x 10 repetition, 3-4x per day.

Swelling and pain will also cause your knee to stiffen up and lose its range of movement. Starting some range of motion exercises (bending & straightening the knee, within your pain limits) early on will ensure that you regain your movement again quickly. Take note that some surgeons may request splints or movement restrictions for a portion of the post-op period, so be sure to follow your post op guidelines for this.


When should I see the physio, and what will physiotherapy involve?
We usually recommend seeing a physio within the first week to ten days following any joint surgery, as long as you are working on your swelling management, range of movement and quads setting exercises at home in this time – otherwise you may want to see them sooner. Your sessions will include some soft tissue massage and joint mobilisation, however the most emphasis will be placed on your home exercise or Pilates rehab program. This will address your specific weaknesses and often include strengthening of not only your thigh muscles but also those of your hip and core.

As you become stronger, your program will include sports specific drills, in order to progress you right on through to your recreational goals!

Lunges are commonly used for lower limb rehabilitation, particularly when returning to running or sport. 


 If you have any questions or would like some advice, feel free to give us a call at the clinic, or come in to see one of us today!

The Five Best Things You Can Do For Your Health


The Five Best Things you can do for your Health, from the perspective of a Physiotherapist.


Just the process of moving your muscles increases blood flow and gets endorphins flowing. There is so much available to read about the “best forms of exercise to lose weight” or the “best form of exercise to cross train” but if we change our attitude from our workout being something that has to be inserted into a weekly timetable towards incorporating incidental movement or exercise into our day, health becomes an overall state of mind rather than something that emotes the image of lugging a gym bag in the dark at 6am. The attitude permeates your overall lifestyle and your body will feel fitter, stronger and lighter.


Get a stand-up desk or make your job involve movement

Many of us sit at a desk for more than 40 hours per week and there has been increasing literature on the detriment of sitting. From a medical perspective research has shown sitting to increase the rate of cancer and other chronic diseases but from a physio perspective, the results are much more instant. Do you know if we see a client who has had a heavy desk-based week, we can often see a noticeable decrease in the range of rotation of their neck and upper back?

Hip flexors are really commonly affected by sitting as you can imagine the shortened position they adopt in sitting can stiffen them up considerably. This then poses a problem if the “sitter” then wants to run or do other upright activity that requires lengthened or loose hip flexors. We can do retraining work with you to teach you how to sit in a good position, using your core muscles, but we wouldn’t expect any muscle in the body to hold a static position for 8 hours per day. So therefore, try not to sit so much!

Avoid serious damage to your health and start sitting at your desk better. Download Your Ergonomic Checklist for Work.


Cross Train

By this, I don’t mean that everyone has to do 3 runs and 2 Pilates session per week, although that would be a good start. What I mean is that your body will benefit a lot by taking the time to consider the style of exercise you are currently doing and then see if you can come up with other ideas of how you can expose your body to different types of movement.

For example, running every day is a fantastic form of exercise. However if that is all you do, your calves, hamstrings and hip flexors may become excessively tight resulting in cumulative injury. Throwing in a stretching session or some yoga will keep your body balanced and prevent niggles from forming. If you like to cycle, consider that it’s a sitting down exercise. If you also sit at a desk at work, you might find your sitting hours exceed your standing hours. Throw in a brisk walk with the dog and you’ll find the opposing (or antagonist) muscles get a workout. Get in touch with us if you would like professional advice on assessing your current exercise regime or creating a plan for cross training.


Eat Well

I’m no Dietician, but I’m a big believer in eating well. Not only does it work for me on a purely scientific basis but I also believe that by making good food choices, it motivates you in other areas of your health. Don’t worry about the fad diets, just stick to the basics by reducing processed food and refined sugar and drink lots of water!


Make Goals

Whether it be to take the stairs three times per day, or stretch your hamstrings twice per week…. We all know the SMART acronym, so just make sure you make the realistic and achievable. If you’re struggling, set yourself a reward for good behaviour.

Running Drills – Tips to make your style more efficient



With most teams gearing up for pre-season, and the athletics track season already underway.. here are a few hot running drills to help with your technique, make your running style more efficient, and hopefully speed up your times!


These 3 drills are more geared towards speed or power running – ideal for touch, tennis, or your distance runner looking to add an extra kick to burst uphill. Ideally they should be done pre-training during a 10-minute mobility warm-up session, to help fire up the right muscles and get the appropriate carryover into your session.

The three YouTube videos we’re going to take a look at basically follow two key concepts:
SWING LEG = Triple Flexion (speed and movement pattern of the Swing leg)
STANCE LEG = Triple Extension (power/drive from gluts & calf of your Stance leg).


Running Drill 1 – High Knees

Key Tips:

  • Start tall, weight on balls of your feet.
  • Drive knee forward (swing leg), aim to keep foot directly under the knee, with toes up.
    Aim for the foot to land directly under the body.
  • Overstriding is inefficient – as it leads to a ‘braking force’ at heel strike.
  • Think ‘be fast’ with the swing leg – leg in the air is wasted time (forward propulsion comes from foot contact with the ground).
  • Stance leg – get up onto ball of your foot/toes.


Running Drill 2 – ‘A-Skip’

Key Tips:

  • Very similar to High Knees drill, but adding in a skip. This makes the drill slightly more complex, but functionally it is closer to running. You need to focus on & implement the components worked on from drill 1 (High Knees).
  • Start to think about being more explosive & driving through your gluts + calf on the Stance leg to propel yourself up off the ground (skip)!


Running Drill 3 – Back lunge into Triple Extension Drill

Key Tips:

  • This drill incorporates both Triple Flexion & Triple Extension, but is more geared towards the extension/drive component.
  • Controlled step-back into a backwards lunge, then explode forward (driving through glut & calf), stepping the Swing Leg up onto a 60cm box.
  • Your stance leg should finish up on the ball of your foot.
  • Stay upright through your trunk.
  • Aim to perform 2 sets of 5-reps, but really focus on the quality of movement & being explosive.

Support Your Mind for Better Workouts


We all want to do our best while we train.

When you end your workout or finish up a competitive sports match knowing you could have put more into your performance, that slight twinge of guilt is never too far behind. That mysterious internal voice is already saying: “You could have pushed harder”.

Yet, how do you power through your workout when your body doesn’t feel as strong as it did yesterday or last week? How do you push through those patches where your goal feels a little too far from reach?

Your mind is your powerhouse

Making it to the next step in your fitness journey comes down, in part, to mental focus.

Developing techniques to help get your thinking right, means your body can follow. Professional athletes and personal trainers know this. They also know small gains or “wins” are the progress markers you should use to propel yourself forward. Especially when injuries set temporary limits.

Beyond fine tuning your mental focus, you still need to listen to your body. Reducing or even completely quieting physical distractions lets you pay attention to what matters most: your breathing, your movement, your goal.

So, how you do you support your mind for better focus which creates better performance? We’ve got some tips to help get you started:


Mind over matter: 5 tips for better sports performance


1) Start setting realistic goals.

Remember: what matters is you. Setting goals means working toward a fitness goal you feel comfortable with. A goal you can achieve based on your ability, time, and effort. Stop competing with your mate or that “really fit” guy or girl at the gym.

Sir Edmund Hillary, New Zealand mountaineer, got it right when he said: “It’s not the mountain we conquer but ourselves”.

While having a goal to reach for is a great start, most fitness coaches and sports psychologists will tell you the best way forward is to break your training down into manageable pieces.

Think about it like this: you aim to complete an endurance event in a set amount of time. This number represents your personal best. And you want to tackle the biggest challenge on offer — a triathlon made up of a 1500m swim, a 40km mountain bike ride, followed by a 10km run.

Signing up for this event and “ just going for it” may leave you feeling disappointed later. While your fitness level may be high, your goal is focused solely on the final outcome: setting a personal record. Second, you’ve left out many important stepping stones or smaller goals that will help you focus on making incremental performance improvements.

Map out a realistic plan. Build towards completing such a challenge 1 kilometre at a time. Use those small wins to help you gauge your training progress.

For example, a small training win for the mountain biking portion of the event might be riding sets at 50 to 65rpm with high pedal force. Your goal is to focus on the feel of each correct pedal rotation instead of simply pushing downward on the pedals.

You may also strive to improve your swimming skills. Another small win would be perfecting how you swim paces so you know how fast you’re swimming distances. Further, swimming consistent times is a milestone to achieve before focusing on bettering your speed.


2) Try visualisation and positive self-talk

Carl Lewis, Olympic track and field athlete once said:

“My thoughts before a big race are usually pretty simple. I tell myself: Get out of the blocks, run your race, stay relaxed. If you run your race, you’ll win… channel your energy. Focus.”

Using visualisation or imagery can help you fine tune mental focus for better performance.

As the understanding about the impacts of mental training for sports has increased, so have the number of professional athletes using visualisation. The New York Times has reported on Olympic athletes using this practice to help them cope with distractions or unexpected events when they need to perform. Visualisation is also thought to create more consistent performance for these pro athletes.

Visualising success means achieving it.

According to Steven Ungerleider, PhD and author of “Mental Training for Peak Performance (2013)”, the better the visuals, the better your result. As you picture the steps you’ll go through to achieve your goal, use words that capture the rest of your senses — touch, smell, and sound.

When you hit the gym, are you thinking about which weights you’ll use or how many reps you’ll complete? What about the quality of your technique? How will your feet, knees, back and shoulders be positioned? What does a successful lift feel like? Can you smell the chalk you’ve put on your hands? Can you hear the weights clank together as you add more weight? Are you thinking about finishing your training session, feeling like a better, stronger version of yourself?

Visualisation also helps keep emotions in check, so you can overcome or control emotions like anxiety.

If thinking about 10 repetitions of a movement seems overwhelming, only think about completing one repetition to the best of your ability (this ties back to breaking down your goals). Make each rep as strong as it can be. What matters is you give it your all while staying focused on your task.

Words hold power, too.

We’ve all got an inner monologue going on. Yet, have you ever stopped to fully consider WHAT sorts of things you say to yourself? Positive self-talk is a great way to build your self-confidence and remove limits you’ve created for yourself.

Stop telling yourself, you can’t or you’re not up to the task at hand. Instead, use self-talk to boost your concentration and focus by using words that help you focus on what needs to be done.

Use words that help you focus on the present, such as “lift” or “jump” and use words that capture the mood of successful performance like “sprint” or “drive forward”. There may also be times where positive phrases are needed to help you with endurance — so, tell yourself to “stick at it” or “push on”.

If you tell yourself you’re the best, you behave like the best. So, when you talk to yourself, use words that are positive and repeat phrases that you find motivational.


3) Stay in the moment

The ability to remain in the present holds incredible power for improving your performance — and your life.

If you can remain focused on what you need to do, right now, you’re on your way to success. Ignore the ringing cell phone and finish your set of repetitions. Block out the cheers of onlookers as you score points for your team.

If you let yourself get distracted by what happened just before your workout or what you’re going to have to do after your workout, your attention is somewhere else. And your performance will dip.


4) Take stock and breathe deeply

How does you your body feel? Are you carrying tension in areas where you should be relaxed? Are you feeling pain beyond the “good pain” of using your

Knowing what’s normal for you and what’s not is the first step. If you’re feeling good, stay focused on your movement. Complete one strong rep with good control, then move on to the next one.

Remember to breathe.

Taking 10 minutes before training to centre yourself can help you focus for better performance. Breathing exercises reduce tension, allow you to shift your focus away from negative thoughts or stress, and naturally lead into visualisation and/or positive self-talk. You can also choose to do some stretching or listen to music for relaxation — it’s about what works best for you.

Armed with a sense of calm and the mental focus created by adding these steps to your pre-training routine, you may surprise yourself by powering through the most demanding moments of your workout.

As Kayla Imrie, New Zealand Olympic kayaker, said: “If it was easy, everybody would do it. Trying to make it to the top is never going to be an easy job. There’s always going to be highs and lows.”

You have to find a way to push through tough moments to get to your goal.


5) Remove distractions with the right gear

Wearing the right clothing makes a huge difference.

As Muhammad Ali once said: “It isn’t the mountains ahead to climb that wear you out; it’s the pebble in your shoe’.

If you go for a run and mother nature offers up wind and rain, what keeps you feeling warm and dry? The right gear.

Sportswear that keeps your body feeling comfortable contributes to better mental focus. This may sound odd, but if you think about the number of times you’ve had to adjust your clothing during your workout or you felt too wet and too uncomfortable to keep going, you’ll know this is true.

These physical distractions prevent you from staying focused on your goal. They stop you from pushing as hard as you can.

A zero-distraction workout is a great workout — one with unparalleled mental focus.

Next time, skip the cotton tee that holds sweat or the hoodie that keeps you just a bit too warm. Wear sports clothing that wicks sweat away to keep you dry, supports your body’s natural cooling process, and allows you to bend and flex however you need.

Put your mind to work

If you decide to get out of bed in the morning and go for a run, your body has to follow. If you choose to wear sports clothing that will keep you comfortable, you’re preparing to focus. If you can visualise running for 5 km despite a little wind and rain, you’re on your way to success.

If you use your focus to give it all you’ve got during your last 1km, your legs will carry you one step closer to your goal.

How Do I Avoid Injury? Prevention Is Always Better Than A Cure

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It’s the time of year most team sports are into pre-season training, summer  fitness regimes are taking off and excitement is high for new opportunity.

Players may be returning from long injury lay-offs, runners hitting the track following their winter and of course, cricket and tennis are in full swing.

This also means it’s the time of year that a lot injuries occur!

Whether it’s an athlete returning to their sport or someone in the middle of a long season, I regularly get asked as a physio, ‘how do I best avoid injury’?

The answer to this involves a lot of factors but a great place to start is to identify your injury risks and preparing well for your sport.

Although accidents happen and we can never guarantee an injury won’t occur, what we do know is that different sports are more susceptible to different injuries due to their differing physical demands. For example, we tend to see overload injuries such as Achilles and Patella tendinopathies in runners and teenagers, shoulder impingements in swimmers, ankle sprains in jumping sports like basketball and netball, hamstring and groins strains in Rugby and of course the dreaded ACL injury with our Basketballers, Netballer’s and Footballers.

The good news is we know that the risk of a lot of these injuries occurring can be reduced by implementing preventative strengthening and improved neuromuscular control programs.

As mentioned above, a lot of sports are prone to the devastating ACL injury and given it’s long rehab and unfortunately low rate of return to previous level of sport amongst athlete’s who have undergone an ACL reconstruction, it’s become the ‘poster injury’ in sports medicine.

As research shows that 50%-70% of non-contact ACL injuries are preventable, this makes it a great example of how identifying your injury risks and implementing an injury prevention program can help you stay on the park longer.

We know through research that most at risk are girls aged between 14-18 and men aged 19-25, teenagers with recent growth spurts, previous ACL injury, athletes who are increasing their training load and the athlete who has increased their level of competition.

You can quickly see why these young girls, who are going from semi-professional sports players, are regarded as high risk for injuries!

Continuing with our example of ACL risks, our research shows young females are at more risk of ACL injury compared to young males and this is thought to be due to a smaller attachment site of the ACL, increased hip angle which biomechanically increases loading through the knees and a decreased ratio of quads to hamstring strength. What this often results in is a decrease in control through the knee when jumping, landing, twisting and turning. The mechanism for ACL injury!

Now the point I’m making here isn’t that it’s all doom and gloom for adolescent female athletes, it’s how important efficient biomechanics and strong neuromuscular control are to avoid injury. Not just for ACL injury, but all injuries.

So what can we take away from this?

Whether you’re an elite athlete, weekend warrior or returning to the running track, we’re all susceptible to injuries but they can be prevented!

By identifying what injuries you’re likely to be exposed to and understanding your biomechanics, implementing an injury preventative program to improve biomechanics and neuromuscular control, you can reduce your chance of becoming another injury stat and improve performance.

Remember, Prevention is always better than a cure!