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Hamstring Strains

All the information you need to know about the identification and treatment of hamstring strains.

What is a hamstring strain?
A hamstring strain is a common leg injury involving a tear of any of the four muscles that make up the hamstring.
You have four hamstring muscles: semimembranosus and semitendinosus (medially) and biceps femoris - short and long heads (laterally).
Strains can range in severity from a mild strain to a complete tear. It is important to understand the causes, symptoms, and treatments available to ensure a full recovery and future prevention. 
What are the causes of a hamstring strain?
Primary
Previous hamstring strain is a very good indicator of potential for future injury (Crosier 2004).
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 eccentric strength in the hamstring muscles during the ground contact phase of running (Bosch and Klomp 2005).
Secondary
  • Poor running mechanics: Proper mechanics are key to preventing injury while exercising. It is important to keep hips and back aligned and upright. Keep the length of your stride in mind, your feet should land just below your body. Your feet should land lightly on the pavement and your calves should propel your body forward.
  • Improper or lack of warm-up: It is always important to stretch before exercising. Static stretching is helpful, but dynamic stretches done while moving can be even better in preventing strains or tears.
  • Fatigue or excessive training: Tiring your body can lead to injury. Cycling through an array of exercises is a great way to prevent fatigue. Give yourself some rest days to allow your body to heal. A few breaks now could ensure your body remains fit long into the future.
  • 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.

Symptoms
Hamstring injuries range in severity. The most mild strain could just present as a feeling of tightness, tenderness, or a dull ache. Severe hamstring injuries could result in an inability to walk or extreme pain. If you feel a sudden snapping or popping while exercising it is best to get immediate medical attention. Always seek a professional diagnosis because the symptoms of a hamstring strain can be very similar to a lower back injury or a pinched sciatic nerve. 
How is a Hamstring Strain Diagnosed?

Pulled hamstrings are graded 1, 2 or 3 depending on severity.

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.
  • Bending your knee against resistance is unlikely to reproduce much pain.
  • Recovery time: 1-3 weeks
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.
  • Recovery time: 4-8 weeks
Grade 3 Hamstring Strain
  • This 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.
  • Recovery time: 3 to 6 months. These may also require surgery.
Diagnostic MRI may also be used to specifically identify the grade of hamstring tear and its exact location.
Treatment
In cases of a mild strain, resting for several days will make you feel better but there is a high rate of re-injury.
Severe cases may need surgery to repair a torn or snapped tendon.
Regardless of the severity, professional treatment is recommended to prevent re-injury. A physiotherapist can treat and help prevent future injury by:
  • Reducing hamstring pain and inflammation.
  • Normalising your muscle range of motion and extensibility.
  • Strengthening your knee muscles and hamstrings.
  • Strengthening your lower limb muscles: calves, hip and pelvis muscles.
  • Normalising lumbo-pelvic control and stability - a co-factor in many hamstring strains.
  • Normalising your neurodynamics to enable your sciatic nerve to pass freely without scar adhesions.
  • Improving your game speed, proprioception, agility and balance.
  • Improving your technique and function eg running, sprinting, jumping, hopping and landing.
  • Minimising your chance of hamstring re-injury.
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