The Puzzle of Recurrent Hamstring Strains: A Physiotherapist's Perspective

By Daniel Hickey 
Physio at Rehab Rooms Physio Clinic

Introduction
Hamstring strains are among the most frustrating injuries, made even more challenging by their tendency to recur. As a physiotherapist, I see people from all walks of life—young hockey players, teenagers excelling in GAA, and middle-aged runners chasing personal bests and so forth. Regardless of their background, the frustration of a hamstring strain is universal.  

To me, recurrent hamstring strains are like solving a Rubik’s Cube—a complex and maddening puzzle that demands patience, strategy, and persistence. My role as a physiotherapist is to help patients piece it together. Having experienced the devastation of repeated hamstring injuries myself, I truly understand how overwhelming it feels when the pieces just don’t seem to fit. 

A Personal Struggle with Recurrent Strains 

In my late teens and early twenties, I had the privilege of playing at the highest level with the Kerry U20 football team. During this time, I fell victim to recurrent hamstring strains, which ultimately led to two hamstring surgeries. These injuries sidelined me from the game I loved and forced me to endure the long, gruelling journey of recovery.   
 

The challenges weren’t just physical; they tested me mentally as well. I vividly remember the isolation of rehab, the countless hours spent rebuilding my strength and confidence, and the creeping doubt about whether I would ever return to full fitness.   

Despite the pain and setbacks, these injuries ignited a passion within me. They fuelled my determination to understand why hamstring injuries happen, how they can be prevented, and—most importantly—how to ensure recovery is both complete and lasting.   

Why Are Hamstring Strains So Tricky?   

Hamstring injuries are rarely straightforward. The function of the hamstring is to bend the hip and extend the knee – in sport, that happens at speed – kicking, high speed sprints, sudden decelerations, quick changes of direction. They can get an awkward stretch like an overreach for a ball or a high kick. While they are common across all age groups, the reasons they happen—and the recovery challenges—can vary widely.   

Research shows that previous injury, age, and activity type all play a role in recurrence. For example, teenagers and older adults may have different risks, while sports like GAA, rugby or hockey demand explosive movements that place unique stresses on the hamstring. 

What makes hamstring strains particularly complex is their tendency to recur, often because underlying factors—such as muscle imbalances, neuromuscular control, or even psychological readiness—aren’t addressed.   

Common mistakes that we sometimes see include: 

• Patients just stretching or overstretching the hamstrings. 

• Patients doing strength work but not the correct strength work to match the demands of the sport / hobby. 

• Hamstrings can be deceiving and often once patients don't feel pain, they do not respect the natural healing process of hamstrings. As a result, they return to activities that place too much of a load on the hamstrings too quickly.   

A Philosophy Rooted in Experience and Evidence   

My approach to hamstring rehabilitation is shaped by my personal struggles, but it’s powered by science. Research from leading experts in the field, such as studies on hamstring strain mechanisms and recovery, guides the decisions I make in the clinic every day.   

1. Individualised Assessment   

No two hamstring injuries are the same. That’s why my first step is always a thorough evaluation, considering not just the injury itself but also factors like running mechanics, muscle strength, and the patient’s goals. 

2. Tailored Rehabilitation   

I firmly believe that rehab should fit the individual, not the other way around. A teenage athlete preparing for return to play will have a very different rehab plan from a weekend runner who wants to stay active without pain.   

3. Progressive Strengthening and Prevention   

Building strength, is one of the keys to recovery. But rehab doesn’t stop when the pain goes away—it’s about preparing the hamstring to handle the demands of real life, whether that’s sprinting on the pitch or running 5Ks on the weekend. 

Transferring Skills from my own research  

My work as a researcher has significantly enhanced my understanding of these complex injuries. Currently pursuing my PhD at UCD, I am exploring innovative ways to leverage technology to monitor patient outcomes and recovery trajectories more effectively. In the clinic, we place a strong emphasis on evidence-based assessments and re-assessments. One of the key tools we utilise is a handheld dynamometer, which allows us to accurately measure and reassess patients' strength levels. This objective data plays a crucial role in guiding our rehabilitation strategies and informing safe and effective return-to-activity decisions. 

To Anyone Dealing with a Hamstring Injury   

My goal, as a physiotherapist, is to help every person who walks into the clinic not just recover but come back stronger and more resilient than before. Whether you’re a young athlete, a recreational runner, or someone who just wants to move without pain, solving the puzzle of a recurrent hamstring strain is always possible—with the right tools and support. 
 

What to Do Next 

At Rehab Rooms we believe that successful treatment is down to accurate diagnosis and assessment, which leads to successful treatment outcomes. With this in mind…why not book online by clicking here or call us at 01 430 5634 to schedule a time that works for you!