Hamstring Injuries: Why The Waiting Game Is Best For Odell Beckham

This is the kind of post that I've wanted to do for some time now. It gives me a chance to blend what I am going to do in real life with some relevance towards our beloved New York Giants. I've seen many a post bemoaning Odell Beckham Jr's now infamous hamstring (and to a degree, Devon Kennard's as well). There's been a lot of confusion about what a hamstring injury entails and (more importantly, in our case) the timetable for return and risk of re-injury. So let's explore all those topics.

Before we begin, just a disclaimer, I'm not going to be specializing in sports or musculoskeletal medicine and I am, by no means, an expert on the subject. So while I'm confident that the peer-reviewed journals I'm using to write this are accurate, take it for what it is. Thanks!

The Anatomy

There's no way we can begin a discussion on assessing risk of re-injury or timetables for return without actually going through what exactly a hamstring is. So let's do just that (don't worry, it'll be quick).

So as you can see, the hamstring muscles consist of three large muscles, the biceps femoris, semitendinosus, and semimembranosus. They make up the back of your thigh and the function of these muscles involves bending your knee in flexion. They also help counter the effects of your quads so you keep your balance. So yeah, kind of important that they are working if you're an athlete or really any human who likes to walk.

The Injury

A hamstring "strain" is assessed based off the actual damage done to the muscle or it's tendons. It happens because of sudden kinetic energy (i.e. sprinting), so it's unsurprising that Odell Beckham injured his during practice. Let's look at why it happens:

As you can see, our friend Michael Vick here has a hamstring pull. He seems to get it as his foot hits the ground. That's the mechanism behind the injury. As I mentioned before, the hamstrings perform the crucial task of balancing out the quads. What do the quads do? They extend the leg. When you're running, you extend your leg when your foot hits the ground. In order to counteract that, your hamstrings work incredibly hard, and so if your foot hits the ground hard, there's a chance for damage because of all that stress to the hammies.

This is why hamstring injuries are bigger issues for elite athletes like Michael Vick or Odell Beckham. They run so fast that the force of their foot hitting the ground relative to their hamstrings is much greater, so the chance of injury is higher.

There's three clinical definitions of hamstring injury assessment. They are:

Grade I: The patient experiences some tightness in the back of thigh and some swelling. Minimal pain and only a few muscle fibers if any may be torn.

Grade II: The patient's actual ability to walk might be affected. Sudden bouts of pain might occur during activity and pain can be reproduced when flexing the knee against resistance or by directly squeezing the hamstring muscle. Can be a partial tear of one of the hamstring muscles.

Grade III: Could be a complete tear of one or more muscles as the patient will likely need crutches to walk and experiences severe pain and weakness. Might need surgery.

As far as I can tell, Odell Beckham probably suffered from a Grade II strain, though without the specific story from him and his doctors, you can't say with absolute certainty. Here's an example of an MRI consistent of hamstring injury:

All it shows is how much of a tear the injury is and what muscle is involved. This particular MRI shows that a significant amount of muscle fibers are involved in this Grade 1 hamstring injury. You can sometimes see "blood" in the MRI, and that is indeed what Odell Beckham stated the doctors found in his MRI. Here's an example of that:

That shows blood trapped in the muscle fibers in a Grade II injury. This will "dry up" and get smaller as time wears on and can give you an idea of how old the original injury has been. After a while, fibrous tissue invades the area to help heal it, and that is also sometimes visible.

Recovery and Risk

Risk for re-injury is quite high, especially in professional athletes. Why is that? It's really simple. Players come back way too fast. Recovery from a hamstring injury happens in three phases:

The first phase involves the time right around when the injury happens. Because part of the muscle gets torn and damaged, some bleeding occurs which leads to inflammation and fluid surrounding the area. Kind of like bruising to the max. This is when you can't do anything, so your body can lay down building blocks for tissue to come in and start re-building that muscle.

The second phase is when the body starts laying down scar tissue around the area of injury, and the muscle fibers slowly start regenerating. The timeframe of this is the first week to the first few weeks. You can start to move, but you still can't do much.

This is the phase where re-injury occurs in athletes quite often. They come back during this phase because they are feeling better, but the scar tissue scaffolding is still weak. Too much, too fast results in that tissue breaking down and re-injury. If I were a betting man, I'd bet THIS is why Odell Beckham suffered that "setback."

The third phase is the remodeling phase of the hamstrings where the scar tissue matures and the muscle regeneration continues. This is a delicate balancing act and very, very tricky and risky for the athlete. In one end, you want to start moving and start working those muscles. You don't want them to get weak from inactivity. Also, when scar tissue matures, it becomes stiff and limits your ability to move. You want to slowly start breaking that scar tissue down as your muscle starts to regenerate, however you don't want to go too fast to the point that you start doing that before your muscle is fully healthy. That will just lead to re-injury and starting all over again.

THAT is where Odell Beckham has been. THAT is why despite him "looking" fine the Giants have been limiting him in practice. He's got to start slowly, start shaking off that scar tissue, but at the same time they've got to make sure that the muscle is fully healed. MRI's won't necessarily show that. MRI's are very useful for diagnosing acute injury because there's a lot there to see. During the healing phase, you can't see much so its a bit of a guessing game. This is why the Giants are going through the "better safe than sorry" approach. In another study of a group of rugby players, approximately 40 percent of players coming back from hamstring injury were found to have impaired performance as compared to their pre-injury levels (some problems with this study, including small sample size and other flaws, but you get the main idea here). Good, thorough, rehabilitation for the player can prevent that.

Final Word

If Odell Beckham can practice this upcoming week and if he can gradually start doing more, I'd be cautiously optimistic that these troubles are behind him. At the very least, we know why the Giants are taking it so slow with their prized first-round pick. Re-injury among those suffering prior hamstring injuries is high, and often due to coming back too fast and doing too much while the muscle regeneration hasn't been completed. This is the right decision by the Giants, and the hope is that Beckham will come back and start making plays like this for Big Blue:

References

1) http://www.fisiocenterpuebla.com/Portals/0/Documentos/H/HamstringsTear%20XIII.pdf

2) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724419/pdf/v035p00435.pdf

3) http://www.aspetar.com/journal/viewarticle.aspx?id=28#.VCn-VPldWSo