Hamstring Injuries

Hamstring injuries are common among athletes and active individuals, and they refer to any type of damage to the muscles or tendons in the back of your thigh. The hamstrings are a group of three muscles that run from the pelvis to the knee and are responsible for hip extension and knee flexion, often referred to as a hamstring strain or pulled hamstring they are one of the most common injuries seen in football, rugby and athletics, indeed any sport or activity which will require sprinting.

Hamstring Injury

The three hamstring muscles which make up the hamstring muscle group are:

• Biceps Femoris

• Semitendinosus

• Semimembranosus

Biceps femoris sits on the outside of the thigh and is the hamstring injured most often during sprinting mechanisms of injury. Semitendinosus and Semimembranosus sit on the inside (medial) aspect of the thigh and are more commonly injured during stretch mechanisms of injury.

A hamstring injury would be strongly suspected when an individual feels a sharp pain or popping sensation at the back of the thigh during activity however they don’t always result in a sudden pain and can also come on as a more gradual tightness or cramp sensation (especially in the presence of muscle fatigue). This is why accurate assessment and diagnosis of the injury by a physiotherapist (physical therapist) or sports medicine doctor is so important.

How do hamstring injuries happen?

The vast majority of injuries happen during sporting activity when the muscles at the back of the thigh are being asked to worked hard. The hamstring muscles are speed muscles, they are most active during high speed activity such as sprinting or kicking but are also working during less explosive activities such as jogging.

Hamstring Muscles and Physiotherapy - Injury Recovery

In general hamstring injuries happen when an already fatigued muscle is pushed beyond its physiological capability or when they are suddenly asked to be explosive (such as sprinting maximally) or are stretched.

In simple terms they can be grouped as sprint or stretch injuries and this will impact slightly how they are managed later in the rehabilitation process. In the early stages however the medical advice and management is fairly simple and explained below.

I’ve injured my hamstring, what should I do now?

Until you can get formally assessed by a physical therapy specialist or sports doctor you can do some simple things in the first few hours to manage the hamstring injury.

Rest – This seems like simple advice but if you have just got a sharp pain at the back of the thigh then it’s a good idea to stop the activity that you are doing. Even if the pain eases and you feel you can continue it’s probably best to recognise that potential muscle strains have occurred and begin the management of it.

Apply Ice pack – Ice is a great way to reduce swelling and pain.

Use compression – Apply a compression bandage to the injured leg. The compression will also help to limit swelling and bleeding and in more severe injury this can make a big difference to your comfort. Any muscle tissue or muscle fibers which can be protected will help you further down the line.

Avoid putting weight on the injured leg – If the pain is severe and you are struggling to walk without pain, use crutches to protect the injured tissues. These simple things can really help things to begin to heal from day 1.

How severe is my hamstring injury?

Most hamstring tears which only involve a partial muscle tear or mild hamstring strain recover well with appropriate treatment, rehabilitation and advice about returning to sport. On rare occasions with a more severe tear, complete muscle tear, hamstring tendon injury or rupture it can be advisable to have the muscle injury surgically repaired, but these injuries are very much in the minority. So how do we decide how severe the injury is and how to appropriately manage them?

When you visit a Physiotherapist at MVMNT, they will carry out a complete assessment of the injured muscle and grade it based on the severity.

This grading system combines clinical information (how you did it) with clinical assessment (palpation, muscle testing, length testing).

Grade 1 – Low grade hamstring muscle strain. Usually able to complete the activity or complain of a tightness only. Will present with full power though it may be painful when the muscle is asked to contract. The area of muscle tenderness is likely to be small and length testing will be normal or show only a mild loss of range of motion.

Grade 2 – A moderate grade hamstring injury. In these cases you are more likely to have had a sudden onset or more severe pain at the back of the thigh. It is likely that you had to stop the activity you were doing almost immediately. On assessment there will be pain and loss of power with muscle testing and more significant loss of range of motion with muscle length testing. The area of muscle length tenderness will be longer and more severe.

Grade 3 – A significant grade hamstring injury. Sudden onset of severe pain in the back of your thigh possibly with a popping sensation. Significant pain and loss of power with a large loss of range of motion. It is likely walking will be painful and difficult and you may not have been able to walk at all in the mediate aftermath of the injury needing a stretcher to leave the field or court of play.

I Know My Grade of Hamstring Injury – Now What?

The usual question when somebody injures their hamstring is when can I play sports again and with accurate diagnosis and prognosis it will be possible to determine this.

With a grade 1 hamstring injury you should be looking to get back to sport and previous activity in around 2 weeks, for a grade 2 hamstring injury it would be 3-4 weeks and for a grade 3 hamstring injury a minimum of 6 weeks.

It is important to note these are guidelines and every muscle injury and individual should be treated as an individual case based on physical exam as the injury recovers. The muscle needs to be given chance to rest and heal before gradually being reloaded with exercises. As the muscle gets stronger running can be started and progressed alongside this, extreme stretching should be avoided.

Each stage should be monitored by a physiotherapist and progressed based on how the muscle responds. In basic terms, let it settle, let it heal, get it strong and expose it to the demands of what you want to get back to gradually and you won’t go too far wrong.

If you have any questions on whether physio is the best option for you, or you have any questions about MVMNT in general, feel free to contact via email.

- Jay Towolawi, Specialist Sports Physiotherapist and MVMNT Founder.