(Also known as Hamstring Tear, Strained Hamstring, Torn Hamstring Muscle, Pulled Hamstring)
What is a hamstring strain?
A hamstring strain is a condition that is frequently seen in running and kicking sports and is characterised by partial or complete tearing of one or more of the hamstring muscles located at the back of the thigh (figure 1).
The muscle group at the back of your thigh is commonly called the hamstrings. The hamstrings comprises of 3 muscles:
- biceps femoris
These muscles originate from the pelvis and insert into the top of the lower leg bones (figure 1).The hamstring muscles are responsible for bending the knee and straightening the hip during activity and are particularly active during running, jumping and kicking.
During contraction of the hamstrings, tension is placed through the hamstring muscles. When this tension is excessive due to too much repetition or high force, one or more of the hamstring muscles can tear. This is known as a hamstring strain.
Tears to the hamstring muscle can range from a small partial tear whereby there is minimal pain and minimal loss of function, to a complete rupture which may require surgical reconstruction. Hamstring strains range from a grade 1 to a grade 3 tear and are classified as follows:
- Grade 1: a small number of fibres are torn resulting in some pain, but allowing full function.
- Grade 2: a significant number of fibres are torn with moderate loss of function.
- Grade 3: all muscle fibres are ruptured resulting in major loss of function.
The majority of hamstrings strains are grade 2 tears.
Causes of a hamstring strain
Hamstring strains commonly occur due to a sudden contraction of the hamstring muscles often when they are in a position of stretch. This sometimes occurs with rapid acceleration whilst running or when a footballer performs a long kick. They are commonly seen in running sports such as football, hockey and athletics (particularly sprinters, hurdlers, and long jumpers). Hamstring strains tend to occur more commonly in the older athlete and particularly following an inadequate warm-up.
Signs and symptoms of a hamstring strain
Patients with a hamstring strain usually feel a sudden sharp pain or pulling sensation in the back of the thigh during the provocative activity. In minor cases, the patient may be able to continue the activity only to have an increase in symptoms upon resting later (often that night or the next morning). In more severe cases, the patient may be unable to continue the activity and will often limp or be unable to walk off the playing field.
Patients with a strained hamstring usually experience an increase in pain during activities which place tension on the hamstring muscles. These activities may include: walking (especially uphill), going up and down stairs, running, jumping, kicking and performing a hamstring stretch. It is also common for patients to experience pain or stiffness after these activities with rest, especially upon waking in the morning.
Patients with this condition may also experience swelling, muscle spasm, weakness, pain on firmly touching the affected region of the hamstring muscle and bruising in the back of the thigh.
Diagnosis of a hamstring strain
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a hamstring strain. Further investigations such as an MRI scan or Ultrasound may be required, in rare cases, to confirm diagnosis.
Treatment for a hamstring strain
Prognosis of a hamstring strain
With appropriate management, patients with minor hamstring strains can usually recover in one to three weeks. With larger tears, recovery may take four to six weeks or longer depending on the severity. In cases of a complete rupture of the hamstring muscle, surgery may be considered with intensive rehabilitation to follow. Return to sport or activity may then take 6 months or longer.
Contributing factors to the development of a hamstring strain
There are several factors which can predispose patients to developing a strained hamstring. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:
- muscle weakness (particularly the hamstrings or gluteals)
- muscle tightness (particularly the hamstrings, quadriceps and hip flexor muscles)
- inadequate conditioning of the hamstring muscles
- inappropriate training or technique
- excessive training or activity
- inadequate recovery periods from sport or activity
- poor biomechanics
- poor posture
- decreased fitness
- inadequate warm up
- joint stiffness (particularly the lower back, hip and knee)
- poor core stability
- inadequate rehabilitation following a previous hamstring strain
- neural tightness
- muscle imbalances
Physiotherapy for a hamstring strain
Physiotherapy for patients with a strained hamstring is vital to hasten the healing process and ensure an optimal outcome. Treatment may comprise:
- soft tissue massage
- electrotherapy (e.g. ultrasound)
- dry needling
- muscle energy techniques
- joint mobilization
- ice or heat treatment
- biomechanical correction
- the use of crutches
- progressive exercises to improve strength, flexibility, core stability and balance
- activity modification advice
- technique correction
- anti-inflammatory advice
- devising and monitoring a return to sport or activity plan
Other intervention for a hamstring strain
Despite appropriate physiotherapy management, some patients with a strained hamstring do not improve adequately. When this occurs, the treating physiotherapist or doctor can advise on the best course of management. This may include investigations such as an ultrasound, CT scan or MRI, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition. In very rare cases, of complete hamstring rupture, surgical intervention may be considered.
Exercises for a hamstring strain
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.
Static Hamstring Contraction
Begin this exercise in sitting with your knee bent to about 45 degrees (figure 2). Press your heel into the floor tightening the back of your thigh (hamstrings). Hold for 5 seconds and repeat 10 times as hard as possible provided the exercise is pain free.
Basic Hamstring Stretch
Begin this exercise sitting with your back straight and your legs hanging over the edge of a chair or bench (figure 3). Slowly straighten your knee as far as you can go without pain, and, provided you feel either nothing, or, no more than a mild to moderate stretch (figure 3). Hold for 5 seconds and repeat 10 times provided the exercise is pain free.
Begin this exercise lying on your back in the position demonstrated (figure 4). Slowly lift your bottom pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds then slowly lower your bottom back down. Repeat 10 times provided the exercise is pain free.
Physiotherapy products for a hamstring strain
Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:
Physiotherapy products that may be beneficial after the initial 72 hour period following injury and under guidance by the treating physiotherapist include:
To purchase physiotherapy products for a strained hamstring click on one of the above links or visit the PhysioAdvisor Shop.
- Hamstring Stretches.
- Hamstring Strengthening Exercises.
- Balance Exercises.
- How to use Crutches.
- R.I.C.E. Regime.
- Ice or Heat.
- Return to Running Program.
- Thigh Diagnosis Guide.
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