Hamstring Injury and Management

Hamstring muscle injuries are most common in sports that require rapid acceleration/deceleration, change of direction, jumping and kicking. The hamstrings, located at the back of your thigh, consist of three muscle – semitendinosis, semimembranosis and biceps femoris. They act to actively bend the knee and extend the hip.

Hamstring tears are normally graded from 1-3, grade 1 being a mild strain and grade 3 being a large tear or complete rupture. For example, you feel a hamstring tear as a sudden sharp pain. If quite severe, athletes may be unable to weight bear following injury. Less severe hamstring tears may allow the athlete to continue playing, or just experience pain after playing soccer etc.

Hamstring tears can occur due to overload of one or more of the three hamstring muscles. In addition, this can occur during sprinting where the hamstrings work extremely hard to decelerate the shin bone just before the foot strikes the ground. Most importantly, stretch related hamstring injuries usually occur higher at the back of the thigh and tend to occur with kicking, or taking longer strides.

There are many factors which can increase the risk of tearing the hamstring.

Risk Factors a Hamstring Injury:

• Not warming up before exercise

• Over-development of the quadriceps muscles

• Your hamstrings become overloaded when you have a weak core

• Previous hamstring injury

• Poor hamstring flexibility

• Poor eccentric strength meaning the hamstring lacks the ability to absorb shock from impact and rebound quickly (Bosch and Klomp 2005).

The main symptoms of a hamstring tear include:

• Sudden, sharp pain, sometimes with and audible pop

• Muscle spasm and tightness following injury

• Tenderness over the injury site

• Swelling and sometimes extensive bruising extending down the thigh

• In some cases a palpable defect in the muscle

• Inability to weight bear

• Inability to flex the knee

Initially, you treat a hamstring injury by pain and inflammation reduction. To reduce pain and inflammation, you should follow the principals of RICE are followed (rest, ice, compression, inflammation). Ideally, it is best to leave hands on treatment such as massage for 48-72 hours, until swelling and bleeding in the muscle has settled.

However, timeframes for recovery tend to vary, depending on the nature and severity of injury. As a general rule, Grade 1 hamstring strains should be rested from sporting activity for about three weeks and Grade 2 injuries for a minimum of four to eight weeks. If a complete rupture has occurred, however, it may take 12 weeks or longer to return to sport, and possibly require surgical repair.

Above all, physiotherapy treatment initially focuses on reducing scar tissue and ensuring full flexibility of the hamstring muscles as it heals. This is achieved through the use of massage, dry needling and passive stretching. During recovery, you can use kinesio-taping or other taping techniques to promote healing. You have to achieve adequate flexibility to start strengthening you hamstring.

Your physiotherapist will aim to:

• 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 e.g. running, sprinting, jumping, hopping and landing.

• Minimise your chance of hamstring re-injury.

Occasionally hamstring injuries may be confused with sciatic nerve pain or referred pain. A pinched nerve can sometimes replicate the symptoms of a hamstring injury. It is therefore vital that you seek a professional diagnosis from an expert in hamstring and back injuries.

If you have injured your hamstring or have been struggling with a recurring hamstring injury, contact us here today. All of our physiotherapists are experiencing in treatment and managing acute and chronic hamstring injuries and can guide you through your rehabilitation to get you back to your best.