Just minutes after the ecstasy of Clint Dempsey’s goal in the first minute of the World Cup, the hearts of American fans sank.

While chasing down a ball at full speed along the left sideline, US striker Jozy Altidore lowered his head to control the ball. He Ball soccer goalquickly grabbed the back of his thigh and fell to the ground. He was quickly carried off the field by stretcher.

“I was sprinting and I felt something, and we’ll see what happens,” Altidore told reporters after the match. “Of course it was tough for me, I was crushed. I knew right away I couldn’t continue, so that was probably the worst feeling.”

A strained hamstring

A spokesman for US Soccer soon revealed the injury to be a strained left hamstring. Altidore missed the remainder of that win against Ghana and the subsequent draw against Portugal. Today, as the American team plays one of its most important matches ever against Germany, the 24-year-old Altidore will again watch from the sidelines.

On Tuesday, US Men’s National Team head coach Jurgen Klinsmann announced that his striker has not recovered enough to battle his former German side. “Jozy is recovering really well,” Klinsmann said. “He’s doing a tremendous job. Our medical staff is on top of it. This game comes still too early for him, but we’re working on him. We’re getting him back in this tournament, as we said. So once this game is done — hopefully successfully — we’ll have a good chance to have him back then in the team.”

Altidore’s hamstring injury history

Sadly, such a disappointing injury is not a new experience. Altidore suffered a hamstring injury in the quarterfinals of the 2011 CONCACAF Gold Cup and missed the semifinal and final match.

Altidore referenced his 2011 hamstring injury and hopes that history wouldn’t repeat itself this time. “That sucked, missing that final,” Altidore admitted. “Hopefully I can recover quicker. We’ll have to see, but it felt similar and hopefully I can recover and get back on the field.”Grabbing hamstring

Biggest risk factor for hamstring injury

Hamstring injuries are among the most common injuries in football, baseball and, yes, soccer. Altidore now demonstrates one of the most challenging aspects of these injuries. A player with a history of hamstring injury has a dramatically higher risk for suffering another one.

Studies on hamstring injuries paint a gloomy picture. Athletes with a prior hamstring strain are between two and six times as likely to suffer subsequent strains, often within the first few weeks after returning to play. Even years after the injury, they are twice as likely to suffer a hamstring injury than a player who hasn’t suffered one.

Why exactly these injuries are so likely to recur is unclear. Many experts argue that these injuries can heal with scar tissue formation and reorganization of the muscle that could make the athlete more susceptible, even years later.

Risk of an injured player returning to play too quickly

Regardless, most agree that rushing a player back to play without adequate rehabilitation significantly increases his risk of reinjury. A soccer player must be able to run without pain, but he must also regain full strength and functional ability.

If the US team doctors and Klinsmann hurry Altidore back before he is 100%, they risk the forward pulling up lame again and missing the rest of the tournament.Fans watching soccer

The US team has played well in Altidore’s absence. Despite giving up a last-minute goal, their inspired play against Portugal has fans dreaming of a win against Germany and advancing in the World Cup.

Thousands of the American Outlaws will chant “I believe that we will win” in unison today. While Jozy Altidore won’t take the field in Recife, Brazil, we can hope that he recovers quickly and returns to help us win in the knockout round next week.

Note: A modified version of the following post appears as my sports medicine column in the June 26, 2014 issue of The Post and Courier.

Also listen to the following podcast discussions:
Episode 148: Jozy Altidore (starts at 20:55)
Episode 128: What are the most effective ways to manage hamstring injuries in athletes? (starts at 5:34)

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Elliott MCCW, Zarins B, Powell JW, Kenyon CD. Hamstring Muscle Strains in Professional Football Players: A 10-Year Review. Am J Sports Med. April 2011. 39:843-850.

Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic Risk Factors for Hamstring Injuries Among Male Soccer Players: A Prospective Cohort Study. Am J Sports Med. June 2010 38:1147-1153.

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