BY PHIL NEWTON, FITNESS EXPERT

Ramy Ashour posted this picture of his troublesome hamstring on his Facebook page, straight after pulling out of the recent El Gouna PSA tournament.



He explained that his recurrent hamstring problem is a consequence of knee surgery he had as a teenager. This surgery is very common and involves taking a portion of hamstring tendon to reconstruct a torn anterior cruciate ligament. The offending area of the hamstring usually breaks down because it cannot transmit the high loads that sprinting and lunging produce.

For most people, the hamstring heals and strengthens to the point that full sporting function returns. However, it seems that Ramy has been unfortunate to fall into the small percentage of people who go on to suffer from recurrent hamstring pain.

- MORE ON RAMY ASHOUR: NEWS AND FEATURES



Ramy’s hamstring picture graphically illustrates a portion of the muscle which has ruptured. This can occur suddenly or may happen cumulatively after several strain injuries. The injuring movement may be a forceful stretch, such as an explosive lunge or a fast contraction

of the muscle during a sprint. The injured area heals through a process of scar tissue formation, but problems can occur if this new tissue isn’t strong enough to transmit the high forces that professional squash players generate when moving explosively on court. The scar tissue effectively becomes the weak link in the chain, can’t sustain high loads and repeatedly breaks down.

Problems like this are notoriously difficult to solve. Trying to repair a torn hamstring would probably end up producing even more potentially weak scar tissue. Injecting the area with substances that promote healing may be offered. Platelet rich plasma (PRP) injections have been used to treat hamstring injuries, but the results are far from impressive. So the most obvious solution is one which an athlete with a recurrent hamstring problem probably doesn’t want to hear – it’s back to the gym.

Research shows that improving hamstring strength reduces injury risk. Injuries of this nature don’t usually benefit from extensive stretching work. In fact, this kind of conditioning work could make matters worse. The offending area of the hamstring usually breaks down because it cannot transmit tensile loads [the resistance to stretching or tearing along its longest axis], not because it is too short or tight.

So work needs to concentrate on improving the tensile strength of the weak link by exposing it to near-maximum loads, until it can withstand the amount of force that dashing around on a squash court generates. This is a gradual process and takes at least three months to achieve.

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