Hamstring Injuries

Hamstring 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: semi-tendinosis, semi-membranosis and biceps femoris. They act to actively bend the knee and extend the hip.

Hamstring Tears

Hamstring tears are normally graded from 1-3, grade 1 being a mild strain and grade 3 being a large tear or complete rupture. Tears are normally felt as a sudden, sharp onset of 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. This can occur during sprinting where the hamstring works extremely hard to decelerate the shin bone just before the foot strikes the ground. 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.

Risks Include:

• Not warming up before exercise

• Overdevelopment of the quadriceps muscles

• Weak gluts and core muscles causing the hamstring to be overloaded

• 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).

Main symptoms of a hamstring tear:

• 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 to treat a hamstring injury, you should aim to reduce pain and inflammation. RICE treatment stands for rest, ice, compression and 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.

Timeframes for recovery tend to vary, depending on the nature and severity of injury. When you have a Grade 1 hamstring strain, you should rest from sport activities for three weeks. If you have a Grade 2 strain, you should rest for four to eight weeks. If a complete rupture has occurred, it may take 12 weeks or longer to return to sport, and possibly require surgical repair.

Physiotherapy treatment initially focuses on reducing scar tissue and ensuring full flexibility of the hamstring muscles as it heals. You reduce scar tissue by massage, dry needling and passive stretching. You can use various taping techniques to offload irritated tissues and promote healing. Once adequate flexibility has been achieved, focus moves towards strengthening.

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 eg 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.