Hamstring Strain (Pulled Hamstring)

A hamstring strain or pulled hamstring is one of the most common sports injuries. We explain hamstring strains and outline a detailed rehabilitation plan used by professional athletes.

Pulled hamstring symptoms

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. See hamstring strain assessment for more details.

Hamstring strain explained

Biceps femoris long headAcute or sudden hamstring strains usually happen in two ways, either sprinting related or stretch related for example in martial arts, gymnastics or dancing.

The hamstring muscle group consists of three separate muscles; the semitendinosus, semimembranosus and biceps femoris. Sprinting related hamstring strains most commonly occur lower down the thigh in the long head of the biceps femoris muscle (at the point where the muscle joins the tendon). 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.

Semimembranosus proximal tendonStretch related hamstring strains 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.

It is important to rule out other causes of hamstring pain such as a contusion resulting from a direct blow or impact and referred pain which may be the result of problems in the hip or lower back. Problems with the lower back and pelvis may increase the likelihood of suffering a hamstrings strain and should always be considered, particularly for recurrent hamstring injuries.

Pulled hamstring treatment

Hamstring massageIt is vitally important that treatment for a hamstring strain starts immediately following injury with the principles of PRICE (protection, rest, ice, compression and elevation). Cold therapy and compression 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 can be worn to minimize bleeding in the muscle and help control swelling. Rest as much as possible with the leg elevated to help.

The initial acute stage of all hamstring injuries will last 24 to 48 hours. After this time a full hamstring strain rehab program such as that developed for Sportsinjuryclinic.net by premiership football physiotherapist Neal Reynolds should be followed. The hamstring strain rehab program is based around four areas:

Hamstring stretching exercisesHealing and treatment which includes applying hot or cold therapy, sports massage and electrotherapy such as ultrasound.

Stretching exercises which can begin only when pain allows. It is likely that strengthening exercises will be possible before the leg is ready for stretching.

Strengthening exercises which begin with gentle static or isometric contractions and progress gradually through dynamic exercises involving movement to eventually performing more advanced strengthening exercises and sprint training.

Maintaining fitness. ThisIsometric hamstring exercises 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.

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.

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