Hamstrings are 3 muscles that are found at the back of the thigh. They attach between our pelvis in the area commonly referred as “sit bones” and the area right below our knees. They mainly function to bend our knee but one of the muscles also functions to extend our hip. The function of the hamstrings is counteracted by the quadriceps muscle, making the two muscle groups work in opposing pulley forces around the joints.
Hamstrings strains are commonly referred as a “pulled hamstring” and can vary according to the grading of the injury as well as where they are located. The strains can happen either at the origin (higher on the thigh), in the middle of the muscle belly, and around the insertion (closer to the knee).
Grade I: a mild muscle pull of the muscle fibers where they have been “over stretched” but not torn.
Grade II: a partial tear of the muscle or tendon fibers
Grade III: a complete tear of the muscle or tendon.
An ultrasound may be necessary for an accurate diagnosis and grading of the injury.
There are a variety of factors that contribute to this kind of injury, such as:
· Poor body conditioning or preparation for training such as warming up
· Poor or inadequate stretching
· Muscle imbalances, especially common in patients with weak glutes.
· Inappropriate footwear in athletic participation.
· In the case of overuse injury: doing too much, too fast, too soon, found when patients increase speed and/or frequency suddenly and therefore load incorrectly.
Hamstring injuries are common in runners and other athletes such as football players, rugby players, gymnasts and dancers
Signs and Symptoms:
These generally vary according to the grading of the injury.
Grade I: A sudden, sharp pain or tenderness that may go away after warming up. Some leg movements are painful but worse pain is experienced after cooling down from exercising the muscle. This kind of injury does not affect the strength of the muscle.
Grade II: A sharp and/or throbbing, burning kind of pain that is accompanied by loss of strength of the muscle. These kind of injuries may present with bruising and inflammation (redness, heat, swelling).
Grade III: A strong sharp pain and tenderness, these injuries commonly present with bruising and inflammation, as well as a sensation or even sound of a “pop” at the time of the injury, with possible palpable defect. There is a significant loss of strength to full loss of strength of the muscle, depending on whether it’s on one of the muscle bellies or collective tendon.
Because there are 3 muscles in the group, it is possible for the other two muscles to help compensate for a torn muscle, allowing for the muscle complex to still maintain partial or full capacity (depending on the extend of the injury).
If you suspect a Grade II or III injury it is advisable to go seek help immediately.
In the initial stages:
· RICE –
o Rest from aggravating physical activities
o Ice – apply ice to ease the inflammation and pain it causes. Apply ice to the area for 10-20 minutes in 3 hour intervals.
o Compression – Apply compression to control the swelling and give feedback about movement in the area. Wrap the leg with elastic bandage in a comfortable manner that does not hinder circulation to your lower leg and foot.
o Elevation: Elevate your leg so that the affected area is above the level of your heart.
· Pain Killers: you may choose to take pain-killers or some short-term oral NSAIDS to assist you during your recovery period. Remember to always consult your medical team before taking any medication.
The recovery process depends on the grade and seriousness of the injury.
Grade I = RICE, physiotherapy intervention and sport specific training
Grade II = Often treated similarly to Grade I according to the assessment. Seldom requires surgery, except in some severe cases or by choice of the injured.
Grade III = often requires surgical intervention followed by physiotherapy rehabilitation.
Physical rehabilitation will consist of a combination of a stretching and strengthening program, prescribed by your physiotherapist, according to the assessment performed until the patient has fully recovered. This process includes a gradual return to activities to full return to sports at pre-injury level. It is also important to identify and treat any underlying mechanical issues that may have contributed to the injury in the first place.
· Correct pacing and dosing of exercise
· Warming up effectively before exercising
· Using correct equipment and technique
· Good physical conditioning for the sport requirement with good biomechanics.
Please contact us if you have any questions!