When one or more of the three muscles or tendons located at the back of the thigh are partially or fully torn, an individual experiences a hamstring strain injury. This type of injury is prevalent among athletes who are involved in high-speed running sports such as soccer, football, and track. Furthermore, a person who suffers a hamstring muscle tear is more likely to experience a subsequent injury, which is 2 to 6 times higher. Physical therapy is usually an effective method for managing hamstring strain injuries in a majority of cases.
Movement experts are physical therapists who enhance the standard of living by providing hands-on care, teaching patients, and directing movement. For an assessment, you may reach out to a physical therapist directly.
What Are Hamstring Injuries?
There are three muscles located at the back of the thigh that attach the pelvis to the leg, known as the hamstring muscle group. These muscles are responsible for the extension of the hip and flexion of the knee, and are considered the primary muscle group for these movements. The three muscles within this group are:
- Semitendinosus.
- Semimembranosus.
- Biceps femoris.
Muscles have two parts: the muscle “belly,” which moves a limb by contracting or relaxing, and the tendon, which connects the muscle belly to a bone. Strains in the hamstring occur when the muscle belly is damaged due to excessive force while being stretched. Such injuries usually occur during high-speed running, sudden movements, or when the muscle is overstretched during activities like sprinting, hurdling, kicking, or heavy lifting.
Factors that increase the likelihood of sustaining hamstring strains include:
- A history of prior hamstring strain injury.
- Hamstring weakness.
- Increasing age.
- Poor flexibility of the quadriceps and hip flexors (muscle tightness).
- Inadequate warm up before activity.
- Muscle fatigue.
How Does It Feel?
The onset of sudden pain in the back of the thigh characterizes a hamstring strain injury, prompting the individual to cease the activity abruptly. Although mild injuries may cause symptoms for only a few days, severe ones may persist for weeks. Typical symptoms include:
- A sudden, sharp pain in the back of the thigh or in the buttocks.
- A feeling of a “pop” or tearing in the muscle.
- Bruising within hours or days after the injury.
- Tenderness to touch in the affected area.
- Difficulty sitting comfortably, lifting the leg when lying down, or straightening the knee.
- Difficulty walking or running, resulting in a limp.
Hamstring Strain Symptoms
Listed below are some symptoms that can help you determine if you have a hamstring tear. It’s important to keep in mind that the severity of symptoms of a hamstring strain may differ depending on where and how severe the tear is.
Included in the symptoms are:
- Pain
- Soreness
- Swelling
- Muscle spasms
- Stiffness, limited range of motion
- Bruising
- Weakness
- Discomfort during movements that involve the muscle
Potential causes of hamstring strains
Hamstring strains are typically associated with athletic or physical exertion and are usually evident to the person who experiences them. The following are some possible factors that increase the likelihood of hamstring strains:
- Poor flexibility in the hamstrings, glutes, or calves
- Sprinting without a proper warmup
- Sudden stops from sprints
- Overuse or fatigue – engaging in physical activity that the trainee did not properly build up to over time.
- Poor warm up routine before physical activity
- Muscle imbalances: The quadriceps and hamstrings are a force couple which means they work together to perform movements in the knee. As a result of, if one muscle group is weak the other will compensate. This may result in injury. It is also important to evaluate the posterior kinetic chain: glutes, hamstrings, lumbar spine muscles, and calves.
Who is most at risk for hamstring strains?
As previously mentioned, hamstring strains and tears are typically linked to sports and exertion. Therefore, the following information should not be unexpected. Nevertheless, there appear to be certain athletic activities in which hamstring injuries occur more frequently:
- High school, collegiate, and professional athletes. There is an increased incidence rate with athletes that play football, soccer, and track & field.
- People that have had prior hamstring injuries.
How is it diagnosed?
In order to diagnose a hamstring strain injury, your physical therapist will first obtain a comprehensive understanding of your medical background and the circumstances surrounding the injury. Possible inquiries that your physical therapist might make include:
- What were you doing when you first felt the pain, and did you feel a “pop”?
- Where do you feel the pain now?
- Did you notice any bruising after the injury?
- What were you not able to do immediately following the injury, and how have you been functioning since the injury (eg, walking, sleeping, lifting your leg)?
- Have you had a similar injury before?
A clinical assessment will be carried out by your physical therapist, which may involve the administration of some of the following assessments and criteria to establish the type of injury you have sustained:
- Observation, to note any discoloration or bruising.
- Pain assessment, to identify your current pain level, and the activities that make your pain better or worse.
- Palpation (gently pressing with the fingers), to pinpoint the location and size of the tender area through touch, which will help determine the severity of the injury.
- Range-of-motion test, to compare the motion of your injured leg with your healthy leg.
- Muscle-strength test, to determine the strength of the hamstring muscles when bending or straightening your knee and hip.
- Gait analysis, to note any limping or changes in how you are walking.
The severity of hamstring strain injuries is generally classified into three grades, namely Grade I, II, or III.
- Grade I: Mild strain with minimal tearing; usually feels like a pulled or cramping muscle.
- Grade II: Moderate strain with partial tearing; may cause a stinging or burning sensation at the back of the thigh.
- Grade III: A severe, complete muscle tear; may result in a “lump” on the back of the thigh where the muscle has torn.
In cases where your physical therapist suspects a Grade III injury, you may be directed to an orthopedic physician to undergo medical diagnostic imaging, such as X-rays or MRIs, to determine the severity of the injury. If the injury involves a fracture in the ischial tuberosity, which is a part of the pelvis commonly referred to as the “sit-bone,” or a complete tear in the muscle, surgery may be necessary.
Hamstring strain treatment options: What can you do?
RICE
The RICE protocol, encompassing rest, ice, compression, and elevation, is widely known amongst us. Alongside following the RICE protocol, refrain from engaging in activities that lead to heightened discomfort, pain, or swelling.
Medication
At first, Tylenol or Ibuprofen that are available without a prescription might be beneficial. Nonetheless, it is crucial to avoid depending on these medications in the prolonged period.
How Can a Physical Therapist Help?
As soon as you sustain a hamstring strain injury, it is recommended to seek assistance from a physical therapist. Before your scheduled physical therapy appointment, you may:
- Rest the injured area by avoiding aggravating activities, such as walking or working out. If you are having notable difficulty walking, you may need crutches. Do not overstress the injured area.
- Apply ice to the injured area 3 to 4 times a day for 15 to 20 minutes (with a towel placed between your skin and the ice).
A personalized treatment plan tailored to your injury and desired outcomes will be created by your physical therapist. Your treatment options could consist of:
Physical therapists are skilled in manual therapy which involves the use of hands to carefully shift and adjust muscles and joints for enhanced mobility, flexibility and strength. Your physical therapist might perform gentle movements and massage on the affected region to facilitate recovery. These techniques are useful for effectively addressing areas that may be challenging to manage independently.
Performing range-of-motion exercises is crucial during the recovery period. Despite the likelihood of experiencing stiffness in the hamstring muscles post-injury, it is imperative to refrain from stretching them too soon. To determine your readiness for gentle flexibility exercises and to provide guidance on proper execution both in the clinic and at home, your physical therapist will advise you accordingly.
As part of your rehabilitation program, muscle strengthening exercises will be crucial, with a focus on strengthening the hamstring. Your physical therapist will assess the strength of your leg muscles and provide targeted exercises designed to address any areas of weakness.
After recovering your hamstring strength, your physical therapist will evaluate your movement to prevent straining the previously damaged area. They will create a functional exercise program for your hamstring muscles, gradually increasing the intensity until you can perform more challenging activities.
If your hamstring strain injury is severe enough to require surgery, a physical therapist will oversee your rehabilitation after the operation. To ensure thorough and consistent postoperative care, your physical therapist will be in contact with your surgeon.
Hamstring Strain Exercises
The following is the section of the post that you have likely been waiting to read. It is commonly observed in physical therapy that individuals who commit to performing consistent therapeutic exercises specifically for hamstring strains experience the most favorable results and have a reduced risk of re-injury.
Here is a brief workout routine that can be done in under 20 minutes and can assist in the rehabilitation of your hamstring. The exercises provided are specifically designed for the initial phase of recovery, which involves prompt action. As your symptoms are handled and you become prepared to advance, there is a sequence of steps to follow.
Hamstring Stretch
This hamstring stretch offers a delicate stretch to the hamstrings and may seem familiar from our past posts. Although there are various ways to stretch the hamstrings, this is our preferred method for rehabilitation goals. Lying on your back enables a soft stretch without any resistance, unlike a sitting hamstring stretch which might be too forceful at first. Make a call based on your own discretion for this one.
To perform the exercise, lie on your back and flex the knee that is not affected to alleviate pressure from your back. Keep the affected leg straight and fasten the strap to the underside of your foot. With the assistance of the strap, elevate your leg while maintaining a straight knee until you sense a stretch. Maintain this position for 30 seconds and replicate the procedure three times.
It’s important to avoid pain while stretching. If you feel any discomfort, it means you are pushing too much. Remember that recovery takes time, so it’s best to focus on your current abilities and gradually improve them.
Prone Hamstring Curls
A gentle exercise for activating the hamstrings is presented here. This exercise closely resembles the use of a hamstring curl machine in a gym. However, there is no application of external weight or resistance in this exercise.
To perform this exercise, start by lying on your stomach with your feet hanging off the bed for additional comfort. Slowly bend your knees to a 90-degree angle and then return them to your bed. Make sure to do this exercise in a steady manner. Take a break of 30 to 60 seconds between three sets of 15 to 30 repetitions.
Straight Leg Raises
The hip flexors and quadriceps can regain strength with this excellent exercise. Similarly to the other exercises, it requires lying down without using external resistance. Keep in mind that we are referring to the early stage of recuperation following a hamstring injury, and there will be ample opportunity to reintegrate conventional strengthening practices subsequently.
To perform this exercise, lie on your back and stretch your affected leg. Then, fold your other leg and lift your affected leg to the level of your other knee. Maintain a steady pace and keep your affected knee straight. Rest for 30 to 60 seconds between 3 sets of 15 to 30 repetitions.
Hip Adduction- Ball Squeezes
To avoid overloading the hamstrings in the future, it is beneficial to improve the strength of the muscles surrounding them. Exercises like ball squeezes are an effective way to strengthen the hip adductors, which are the muscles located on the inner thigh.
To do it, lie on your back with your knees bent and put a ball or folded pillow between your knees. Press into the ball or pillow and hold for 5 seconds, then release and repeat for 3 minutes.
Hip Abduction
By performing this activity, your glutes will become stronger and better able to support the hamstrings, thereby reducing the risk of muscle strains in the future.
To perform this exercise, lie on your back with your knees bent. Secure the TheraBand tightly around your knees. Now, spread your knees apart while keeping your feet close together. Gradually come back to the initial position. Do this for 3 minutes continuously.
Prevention
In case you have a record of straining your muscles, it is advisable to take sufficient time for recuperation before resuming sports or increasing your physical activity. Nonetheless, after you have fully restored, it is essential to comprehend methods of evading muscle pulls in subsequent instances.
Make sure to perform a suitable warm-up before working out and a cool-down afterward. Practice the stretches recommended in this article on a daily basis. Once you have fully recovered, feel free to progress to more challenging strength exercises with heavier weights or higher intensity.
The importance of keeping oneself hydrated cannot be stressed enough. Inadequate water intake can lead to muscle cramps and injuries since the muscles require water to function properly.
