Hamstring Strain

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What is a Hamstring Strain?

A hamstring strain is a common leg injury involving a tear in one or more of the hamstring muscles. A hamstring strain can range from mild to very severe involving a complete tear of the hamstring muscle.
You have four hamstring muscles: semimembranosus and semitendinosus (medially) and biceps femoris – short and long heads (laterally).

What Causes a Hamstring Strain?

Common reasons for hamstring strain or injury can be categorised as primary or secondary.

Primary

Poor timing-intermuscular coordination and eccentric strength in the hamstring muscles during the switch between late leg recovery and initial leg approach in the swing phase of sprinting (Woods et al. 2004).
Lack of “stiffness” and eccentric strength in the hamstring muscles during the ground contact phase of running (Bosch and Klomp 2005). “Stiffness” refers to the ability of the hamstring muscle to absorb shock and rebound. Dropping a golf ball onto concrete is an example of stiffness, it immediately rebounds off the surface.
Previous hamstring strain is a very good indicator of potential for future injury (Crosier 2004).

Secondary

Poor running mechanics. This consists primarily of overstriding or poor pelvic control, which puts the hamstrings in a vulnerable position at ground contact.
Improper warm-up. Your warm-up must be active and dynamic to prepare the hamstring muscles for the forces involved. Passive stretching is only one segment of warm-up.
Inappropriate training loads. Your hamstrings are primarily fast twitch Type II fibres that fatigue quickly. High speed work should be done early in workout, as close to warm-up as possible to avoid fatigue.
Fatigue (neural and local muscle).
Lower back pathology. Abnormalities of the lumbar spine or poor pelvic control that can cause nerve dysfunction and subsequent muscle weakness can predispose you to injury.
Playing surfaces. A wet slippery surface will put more strain on the hamstring due to slipping.

What are the Symptoms of a Hamstring Strain?

Mild hamstring strains may feel more like a tightness or low grade ache in your hamstring. Severe hamstring strains can be extremely painful, making it impossible to walk or even stand.
Other possible symptoms of a hamstring strain are:
Sudden and severe pain during exercise, along with a snapping or popping feeling.
Pain in the back of the thigh and lower buttock when walking, straightening the leg, or bending over.
Hamstring tenderness.
Bruising.

How is a Hamstring Strain Diagnosed?

On examination, your physiotherapist or sports doctor will look for signs of pain on hamstring contraction, reduced hamstring flexibility, tenderness or a palpable lump or gap within the hamstring muscle bulk. Pulled hamstrings are graded 1, 2 or 3 depending on severity.

Grade 1 Hamstring Strain
With a grade 1 hamstring strain you may have tightness in back of the thigh but will be able to walk normally. You will be aware of some hamstring discomfort and unable to run at full speed. There will be mild swelling and spasm. Bend your knee against resistance is unlikely to reproduce much pain.

Grade 2 Hamstring Strain
With a grade 2 hamstring strain your walking pattern will be affected and you will most likely be limping. Sudden twinges of hamstring pain during activity will be present. You may notice some hamstring muscle swelling and your hamstring will be tender to palpate. It will also be painful for you to bend your knee against resistance.

Grade 3 Hamstring Strain
A grade 3 hamstring strain is a severe injury involving a tear to half or all of the hamstring muscle. You may need crutches to walk and will feel severe pain and weakness in the muscle. Swelling will be noticeable immediately and bruising will usually appear within 24 hours.
Diagnostic MRI may also be used to specifically identify the grade of hamstring tear and its exact location.

Hamstring Strain Treatment

Many patients with a hamstring start to feel better within a few days of the injury. However, there is an extremely high hamstring re-injury rate due to a poor rehabilitation process.
Hamstring strains are one injury that professional guidance is highly recommended for both an accurate diagnosis but also provide you with the best chance of avoiding repeat hamstring injuries.
Repeat hamstring injuries have unfortunately curtailed many a bidding athlete’s career.

Hamstring Physiotherapy Treatment

Your physiotherapy treatment will aim to:
Reduce hamstring pain and inflammation.
Normalise your muscle range of motion and extensibility.
Strengthen your knee muscles and hamstrings.
Strengthen your lower limb muscles: calves, hip and pelvis muscles.
Normalise lumbo-pelvic control and stability – a co-factor in many hamstring strains.
Normalise your neurodynamics to enable your sciatic nerve to pass freely without scar adhesions.
Improve your game speed, proprioception, agility and balance.
Improve your technique and function eg running, sprinting, jumping, hopping and landing.
Minimise your chance of hamstring re-injury.

Hamstring Strain Treatment Options

• Early Injury Treatment
• Avoid the HARM Factors
• Soft Tissue Injury? What are the Healing Phases?
• What to do after a Muscle Strain or Ligament Sprain?
• Acupuncture and Dry Needling
• Sub-Acute Soft Tissue Injury Treatment
• Core Exercises
• Gait Analysis
• Biomechanical Analysis
• Balance Enhancement Exercises
• Proprioception & Balance Exercises
• Agility & Sport-Specific Exercises
• Medications?
• Orthotics
• Soft Tissue Massage
• Brace or Support
• Electrotherapy & Local Modalities
• Heat Packs
• ITB Roller
• Kinesiology Tape
• Neurodynamics
• Prehabilitation
• Running Analysis
• Strength Exercises
• Stretching Exercises
• Supportive Taping & Strapping
• TENS Machine
• Video Analysis
• Yoga

Kinesio Taping for a Hamstring Strain

Many patients will try a thigh support or kinesio taping for hamstring strains. They provide confidence, warmth and proprioceptive feedback, which should reduce your likelihood of hamstring re-injury.

Hamstring Surgery

Hamstring surgery is rarely required. It appears limited to complete ruptures or to remove scar tissue from chronic hamstring tears.

Hamstring Strain Recovery Times

While every hamstring injury and the demands of your sport differ, here are some general hamstring strain recovery times when you follow an optimal physiotherapist-guided rehabilitation program.

Grade 1 – 1 to 3 weeks
Grade 2 – 4 to 8 weeks
Grade 3 – 3 to 6 months. These may also require surgery.

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