Tottenham and England star striker Harry Kane injured his left hamstring during the team’s New Year’s day match vs Southampton, limping off the field while clutching at the back of his leg. To add insult to injury, his set-piece goal was ruled offside by VAR.
In this piece, I’ll explain why VAR is to blame for the injury, Brexit, and world famine…but seriously, I’ll explain Kane’s hamstring tear, return timeline, physio process, and re-injury risk. If you prefer a video format, I have you covered:
The hamstrings are a group of three muscles on the backside of the upper leg that begin at the ischial tuberosity and travel down to the knee. The three muscles are the semimembranosus, semitendinosus, and biceps femoris which has a long and short head.
The most common site for hamstring tear is the musculotendinous junction of the long head of the biceps femoris muscle. This junction is the transition point between the muscle belly and thinner, coiled tendon.
Mechanism of injury
Kane’s kick placed his left leg into hip flexion and knee extension. This places a double stretch on the hamstring muscles and, additionally, the kicking motion places what’s called an “eccentric stress” on the muscles where they’re contracting while lengthening to decelerate and control the high speed kick.
This triple stress movement is a common cause for hamstring tears in football and Kane immediately pulled up in discomfort and grabbed at his left hamstring.
Additionally, the hectic and busy Premier league holiday schedule did Kane – or any EPL players – no favors as the research clearly shows heavy jumps in activity can increase soft tissue (muscles, ligaments, tendons, bones, etc) injury risk by as much as 5x. At this point, I’m more surprised when I don’t see a slew of injuries during the holiday slate of games.
Severity and return timeline
Kane’s return to play (RTP) timeline depends on the severity of the tear which is categorized into three grades. Based on the fact that Tottenham decided on surgery after nearly a week of re-assessment, my educated guess is that Kane had a tear between a grade 2 and 3 with the medical staff eventually deciding that it was severe enough to operate on.
In the case of surgery, the tear is typically at either end of the muscle where it’s in tendon form – as touched upon earlier – and the tendon is pulled off the bone, termed “avulsion”. The surgery will re-attach the the muscle back to the bone and speaking to a surgeon on the topic, I was told the main obstacle with this surgery is avoiding the sciatic nerve which runs down the hamstrings.
The team has announced Kane will be back in training in early April which aligns with the 3+ month return timeline that’s typical after this surgery.
Kane’s hamstring protocol will work on eliminating pain, restoring normal pain-free knee range of motion, normalizing gait (walking), gradual progressive strengthening with an eventual emphasis on eccentric strengthening, neuromuscular and postural control, maintaining some level of overall fitness, and normalizing key ratios such as quadriceps to hamstring strength and side to side lower body symmetry.
The hamstring is heavily involved in football activities – which may be why it’s the most commonly injured muscle in football, with some studies showing up to a 50% prevalence rate in elite footballers – and therefore you have to be very methodical with rehab.
Once Kane has met key metrics and the physio team feel he’s ready, he’ll be cleared for higher intensity return to sport with increased sport-specific activity, team training, and then reintroduced into games.
The trickiest part with hamstring injuries – far more than the rehab – is avoiding re-injury. A previous hamstring injury is the most predictive factor of future hamstring injury with research showing nearly a 30% rate of reinjury, most occurring within the first two weeks, and nearly 3x higher risk of hamstring injury for up to a year following the initial tear.
For a stark reminder of that, Kane need not look any further than teammate Delle Alli who suffered four recurrent left hamstring tears in a two year period.
Further, for Kane who is now 26 years old and has been playing consistent top flight football for nearly six years, there’s additional risk as the research shows athletes older than 25 are up to 4.4 times more likely to injure a hamstring compared to younger players and data suggests that the overall risk of hamstring injury increases by 30% year over year after a pro footballer starts his or her career.
There’s some thought that surgery may decrease these re-injury risks due to less build up of scar tissue in the injured hamstring muscle but we’re unsure of whether that significantly decreases re-injury risk.
Regardless, it behooves Tottenham to be careful with Kane’s recovery and unfortunately even when he does get back to the pitch, there’s a significant chance for re-injury. That injury risk is compounded by the fact he won’t have much time away from the pitch this summer due to the Euro 2020 tournament.
In sum, hamstring tears suck.
That’s a wrap for this article. Thanks for reading. My goal is to provide you with in-depth, evidence based, narrative free analysis and you can always find me on IG and Twitter @3CBPerformance. Make sure to sub to the blog, YouTube channel, and follow along on all social media for the latest updates. 3CB out.