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Hamstring Strain (Pulled Hamstring)
A hamstring strain or pulled hamstring is felt as a sudden sharp pain at the back of the thigh. Treatment involves immediate first aid of rest, ice and compression followed by a full rehabilitation and exercise program.
Symptoms of a hamstring strain include a sudden sharp pain at the back of the thigh usually whilst sprinting or a fast stretching movement or high kick. Hamstring strains are graded 1, 2 or 3 depending on how bad they are. A grade 1 injury may only be a slight twinge whilst a grade 3 can result in the athlete being unable walk with swelling and bruising developing soon after. A doctor may order an MRI scan which can help determine the exact location and extent of the injury which can give a more accurate prognosis and estimate of recovery time. How bad is my pulled hamstring?
Read more on symptoms and diagnosis.
What is a hamstring strain?
The hamstring muscle group consists of three separate muscles; the semitendinosus, semimembranosus and biceps femoris. They originate from the lower part of the pelvis and insert into the back of the shin bone. When contracting they mainly bend the knee and extend (straighten) the hip joint. Acute or sudden hamstring strains usually happen in two ways, either sprinting related or stretch related for example in martial arts, gymnastics or dancing.
During sprinting the hamstring muscles work extremely hard to decelerate the shin bone just before the foot strikes the ground and it is at this point that the hamstring is most likely to tear. Stretch related injuries usually occur higher at the back of the thigh in the tendon of the semimembranosus muscle. Sprinting related hamstring injuries often feel worse but recover more quickly, whereas stretch related hamstring strains can take longer to heel as the injury is more likely to the tendon where blood flow is lower.
Read more on causes and prevention.
Treatment for a hamstring strain can be categorized into immediate first aid and longer term treatment which begins after the initial acute period has passed.
Immediate first aid consists of the PRICE principles of protection, rest, ice, compression and elevation and will usually last 3 to 4 days depending on severity. A cold therapy and compression wrap should be applied immediately for 10-15 minutes and repeat this every hour for the first day. After this, every 2-3 hours is usually sufficient. A compression bandage or thigh support can be worn to minimize bleeding in the muscle and help control swelling. Rest as much as possible with the leg elevated to hel to help drain away swelling and tissue fluids.
After the initial acute stage has passed hot and cold can be alternated and during the later stages of treatment heat alone is applied for up to 20 minutes to stimulate blood flow and relax the muscles.
A professional therapist may apply sports massage techniques and use electrotherapy such as ultrasound as well as advise on a full rehabilitation program to include stretching, strengthening and functional exercises.
Performing foam roller exercises for the hamstrings can massage and apply myofascial release to the muscles. Pressure is applied from just above the knee upwards following the direction of blood flow.
Read more about treatment for hamstring strains.
Both stretching and strengthening exercises are important. Our four strand hamstring strain rehabilitation program includes gradually progressive exercises which the patient can work through until fully fit. Exercises should begin as soon as possible after the acute stage but always be done pain free.
Stretching - after the initial acute stage very gentle stretching exercises can begin as long as they are pain free. Initially simple static stretching exercises should be done with leg both straight and slightly bent in order to target different parts of the muscle. In the later stages of rehabilitation more dynamic and functional (sports specific) stretching exercises should be done.
Read more on stretching for hamstring rehabilitation.
Strengthening exercises should always be done pain free begin with gentle static or isometric contractions as soon as possible after the initial acute period. The patient will gradually progress through a serious of more dynamic and functional exercises involving movement. Eventually sports specific exercises and drills should be performed before returning to full competition or training.
Read more on our 10 essential hamstring strengthening exercises.
Maintaining fitness is important not only to speed up the athletes return to full fitness but to keep them sane! After the acute stage stationary exercise machines such as rowing machines and cross trainers are used. Gradually the athlete progresses to gentle jogging and shuttle runs. Finally acceleration runs and sprinting speed is gradually developed.
Read more about out progressive aerobic fitness program for hamstring strains.