NFL week 1 – the return of physio Chris and hamstring strains!

Screen Shot 2015-09-15 at 12.52.05 AMAfter 9 months of moving jobs and houses, spreadsheeting other interesting things (e.g. my taxes), hitting up Coachella for the fourth year, and running around on a soccer field, I am happy to announce that this blog back in action! Please, ladies and gentlemen, hold your applause for the end. Now let’s make like Beyoncé and blow the dust off this ol’ bad boy!

The start of a new NFL season means the resurrection of learning about your favourite injuries while joyfully laughing at my witty jokes. No, seriously. If liquids aren’t being snorted out your nose on numerous occasions throughout reading this, I need to step up my game.

Vegas bookies and beer-bellied sports fans alike rejoiced on September 10 when the football season kicked off. And similar to last year, injuries were happening left, right, and centre. Sort of like Oprah’s hectic giveaway days except she’s telling to each team, “You get an injury! And you get an injury! EVERYBODY GETS AN INJURY! ” With no further ado, here’s week 1 by the numbers:


45 = Number of players who missed game time due to injury.

4 = Number of players placed on season-ending IR.

10 = Number of concussions.

1 = Number of referees carted off with a broken clavicle.

Almost 25% of the reported week 1 injuries were concussions. It’s an incredible stat that gets more concerning every year. Heck, even Hollywood has taken notice and casted Will Smith to play the role of Dr. Bennet Omalu who discovers Chronic Traumatic Encephalopathy. Haven’t seen the trailer yet? Go here. But promise to come back and finish reading, okay?

This week, we’re taking a plane down to Washington, D.C. for a visit with the Redskins. Just over 5 minutes into the first game of the 2015-16 season, the Redskins lost their best wide receiver to an injury. Five freakin’ minutes! Poor DeSean Jackson was the victim of the notoriously popular hamstring strain. In fact, from 1998 to 2007, hamstring strains were the second most common injury in the NFL.1 In first place? Knee sprains.

Screen Shot 2015-09-15 at 10.58.34 PMI know you’re thinking, “Girl, you’re losing your mind. You covered hamstring strains last year!” I did, you’re right. And if I were my old lazy self, I would have copied and pasted that entire post to finish this entry in a record 17 minutes. But I care about you guys too much. Apart from my stuffed animals, you’re the only ones that truly listen to me…

So let’s talk about hamstring strains again! But this time around, we’re getting a little more technical. I forgot to mention earlier that I’ve spent the last 9 months being super scholarly and reading research articles. I needed something to keep me nerdy while I took a break from blogging! And I found my new hobby in p-values, likelihood ratios, and confidence intervals. (Although, I confess that I have no idea what any of that means. Raise your hand if you’re like me and you highlight around those fancy numbers in articles! If someone is willing to explain them to me, I’ll pay you in Starbucks.)

Back to Jackson because I know the guy likes being in the spotlight. Only five minutes into the game (have I mentioned that yet?), Jackson is thrown a pass a few inches too far from him but he sprints and stretches out for it anyway. He doesn’t make the grab and, to add insult to injury, he immediately slows down clutching his left hamstring. Upon evaluation on the sideline, he’s quickly ruled out of the game.


For all of you fantasy footballers out there, I’m sure you want to know when he’ll be back. To accurately predict the future we need one of two things: a magic 8-ball or Professor Charles Xavier. Unfortunately, my magic 8-ball is packed up somewhere and Prof X isn’t returning my texts (he’s, like, so bad for that, ugh). This means we have to rely on a few subjective and objective measures to predict Jackson’s return to sport!

4372263-5321356645-ProfeWhile grilling him on his hamstring boo-boo, we want to focus on three specific questions:

  1. Is it painful to walk?
  2. Did you have to stop playing within 5 minutes?
  3. Have you ever injured your hamstring before?

If he says yes to all of these questions, then he’s more likely to take a longer time to return to football.23 Pain with walking for more than one day and immediately stopping activity upon injury indicate a higher degree of damage to the muscle and therefore longer time to heal. In fact, if he grades his pain higher than 6 on a visual analog scale from 0 to 10, he should expect longer recovery.3 Previous injury is also known to delay return to sport.Screen Shot 2015-09-16 at 10.40.30 AM

We also want to know how the injury happened. The two most common ways to pull a hamstring are sprinting or kicking. Different mechanisms of injury result in damage to different regions of the hamstring. The exact location of the injury is really important! Is the hamstring’s intramuscular tendon or free tendon compromised?

  • FullSizeRenderIntramuscular tendon = some fibers of muscle blend into tendon fibers. Usually related to running injuries when the hamstrings work to slow the leg down to prepare for foot contact. Associated with shorter recovery time.1
  • Free tendon = all tendon and no muscle. Usually related to dancing or kicking motions where there’s lots of hip flexion paired with knee extension and the hamstring is put on excessive stretch. Associated with longer recovery time.1

Can you guess where Jackson’s injury is? If you said intramuscular tendon, you’re right! It was definitely a sprinting mechanism of injury. If you correctly pronounced intramuscular tendon, you get a gold star! You can redeem your gold stars for smiles or hugs at a later date.

After we’ve collected all the facts, we want to check out a couple tests too:

  1. Screen Shot 2015-09-16 at 10.53.58 AMActive knee extension: lying down on your back with your hips and knees bent at 90o degrees, can you straighten your knee without pain?
  2. Tenderness to palpation: how large is the sore area on the hamstring?

Painful active knee extension has been associated with having to wait an extra 4 to 5 days before returning to sport. The larger the tender area, the longer the recovery as well!3

For the best prognosis, let’s hope Jackson can walk without pain, grades his pain low on the scale, and doesn’t have a previous injury. Fingers crossed for pain-free active knee extension and maybe just a little ticklish upon palpation but minimal tenderness as well. If all the stars align, he could be back to catching touchdowns in 3 weeks! But on the other hand, if he’s limping from pain (and not swagger) and that knee extension bugs him, he could be out for closer to 6 weeks.

2013-04-25-07-46-21_askling-mri-hamstring-jpgHere’s another question for you: does he need an MRI? A recent article has shown that a clinical assessment of an acute hamstring strain is more diagnostically accurate than an MRI!4 A thorough history and physical examination gives you enough information to determine the severity of the injury and subsequently predict how long it will take to return to sport.

The only kicker is that the hamstring has to be assessed within 3 to 5 days of injury for the clinical assessment to be credible. This isn’t an issue in the NFL as they have medical staff on the sidelines but might be for us average Joes and Janes. The lesson? Get in to see a physio ASAP if you think you’ve pulled your hammy!

So for now, Jackson will spend some quality time with his team of physios. For all of you fantasy owners with Jackson on your team, please feel free to spam his Twitter account (@DeSeanJackson11) with friendly reminders to do his exercises. Make sure he starts easy with pain-free range of motion then progresses to strengthening.Screen Shot 2015-09-16 at 12.10.02 AM

Good luck to you and your intramuscular hamstring tendon, Mr. Jackson!

– Chris (0-1)


  1. Heiderscheit, B.C., Sherry, M.A., Silder, A., Chumanov, E.S., & Thelen, D.G. (2010). Hamstring strain injuries: Recommendations for diagnosis, rehabilitation, and injury prevention. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 67-81.
  2. Warren, P., Gabbe, B.J., Schneider-Kolsky, M., & Bennell, K.L. (2010). Clinical predictors of time to return to competition and of recurrence following hamstring strain in elite Australian footballers. British Journal of Sports Medicine, 44, 415-419.
  3. Wangensteen, A., Almusa, E., Boukarroum, S., Farooq, A., Hamilton, B., Whiteley, R., … Tol., J. (2015). MRI does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: A prospective cohort of 180 male athletes. British Journal of Sports Medicine, 0, 1-10.
  4. Warren, P. (2008). Hamstring strains; Is an MRI necessary?: Comparing MRI with clinical assessment in AFL footballers with a hamstring strain. Sport Health, 26(3), 15.


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