Hamstring Strain
The hamstring muscle group contains 3 muscles: the semimembranosus, semitendinosus, and biceps femoris. The muscle group is partly in charge of hip extension and mostly in charge of knee flexion (bending the knee). These muscles may be strained from excessive stress during contraction or from extreme stretch. Strains most commonly involve the biceps femoris near the back of the knee (1,2).
How do you grade a hamstring strain?
Hamstring strains are classified from Grade 1 to Grade 3 based upon the amount of tissue damage, with Grade 1 representing strain without significant fiber tearing, Grade 2 indicating partial muscle tearing, and Grade 3 signifying complete muscle or tendon rupture.
The hamstring muscle is the most commonly strained muscle in the lower extremity of elite athletes (3).Sports that involve sprinting and jumping, like track, football and soccer predispose athletes to strain injuries while participants in water skiing, martial arts and dancing are more prone to stretch-type injuries (1,4,5). Strains related to sprinting or running often occur just before foot contact as the hamstring muscles are stretched and working hardest (6,7).
What are the risk factors for hamstring strains?
The majority of sports related hamstring injuries tend to occur during competition, particularly as the athlete gets fatigued and tired (38).
Hamstring and Quadricep Balance: An imbalance of muscular strength (overactive quadriceps, underactive hamstrings) leads to injury when excessive quadriceps strength overpowers the capacity of the hamstring (8,38).
In addition to muscular fatigue, a combination of several other factors increases the risk of hamstring strain: insufficient warm up, a history of prior injury, and hamstring inflexibility or weakness (1,8,10,11,16,37,38).
Additional known biomechanical risk factors include tight muscles: quadriceps or iliopsoas (hip flexors), poor lumbar stability, and poor running mechanics (13,14,39). Injuries are thought to occur when the number of risk factors reaches a critical threshold.
Who is is more likely to get hamstring strains?
Hamstring injuries are more common with age and affect African Americans more frequently (15,16). A study of college soccer players suggests that hamstring injures are more common in males (17).
What are the symptoms of a hamstring strain?
Most hamstring injuries occur abruptly during activity with a tearing sensation accompanied by significant pain in the back of the thigh. In about 10 percent of cases, symptoms start more gradually (2). Symptoms of hamstring strain vary from a mild ache to debilitating pain, based upon the site and amount of tissue damage. The most common presenting symptoms include pain in the lower buttock and posterior thigh when straightening the leg, particularly while walking or flexing forward.
Do I need X-rays or imaging for a hamstring strain?
The diagnosis of hamstring strain should be based upon an accurate history and physical evaluation. X-rays are generally unnecessary unless there is suspicion of avulsion fracture of the ischial tuberosity or other pathology (16,19). Advanced imaging of the hamstring, including MRI or ultrasound, (with MRI being more sensitive (21)) is reserved for more severe injuries in order to help determine whether surgical intervention will be necessary (22).
Management of Hamstring strains
The management of hamstring injuries is often challenging for both clinicians and patients, as healing is often delayed with persistent symptoms and re- injury rates between 12 and 31% (23,24).
The proximity of the injury to the buttock crease generally correlates with the recovery period, with more proximal injuries requiring longer resting periods (25,26,39). Recurrent injuries often take twice as long to heal as the initial injury. (28) Athletes who do not adequately rehabilitate their injury and return to sport prematurely are at greater risk of re-injury and diminished performance (4,8).
Treatment of Hamstring Strains
The rehabilitation of hamstring injuries can be divided into three phases.
Phase I: Reduce pain and swelling following an injury. Use the RICE protocol (Rest, Ice, Compression, Elevation). Ice may be applied 15 minutes on, 15 minutes off. The compression bandage can help limit swelling. Pain tolerance dictates return to normal walking, with light range-of-motion exercises. Avoid excess stretching of the hamstrings initially after injury.
Phase II: Phase II begins with a patient can walk without pain and can perform resisted knee bends. Goals of phase II include flexiblity, strength, and function of hamstrings. Athletes should avoid sprinting and slowly increase their running speed up to 50% of their maximum. Stationary cycling or swimming can be utilized. Stretching of the hamstrings can be utilized in this phase, along with hip flexors, quads, and spine muscles. Nordic hamstring eccentric exercises have significant evidence in rehabbing hamstring injuries and minimizing reoccurrence (33,34). Core stability exercises and agility drills have been shown decrease injury rates compared to isolated stretching and strengthening (23,28). Myofascial release techniques (ART, IASTM) can be used judiciously.
Phase III: Phase III begins when a patient can perform a resisted knee bend without pain and can run at 50% speed without pain. Phase III goals include return to activity through specific drills and trunk stability exercises. Patients will gradually increase from jogging to full sprinting. Early return to sport will likely result in a recurrent or more severe problem (8). Proper dynamic warm up and cool down should be taught.
Should I use NSAIDS fora hamstring strain?
There is some controversy regarding the use of NSAIDS for hamstring strains, as some studies suggest that these drugs may have a negative effect on recovery (30,31 )
At Creekside Chiropractic & Performance Center, we are highly trained to treat hamstring strains. We are the only inter-disciplinary clinic providing services to Sheboygan, Sheboygan Falls, Plymouth, and Oostburg including chiropractic, manual therapy, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.
Evidence Based-Patient Centered-Outcome Focused
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