A hamstring strain is a condition whereby tearing has occurred in some or all of the muscles on the back of the thigh – known as the hamstring muscles. It is a relatively common condition especially in sports injuries where many types of athletes are affected, including: sprinters, hurdlers and football players.
These muscles attach to the pelvic bone and insert just below back of the knee and are responsible for bending the knee and extending the leg backwards and also help lower the trunk forwards and backwards from a standing position. They are particularly active during running (especially making a quick sprint) jumping, walking and also help control the leg when kicking and can be injured following excessive tension through them.
Early intervention is desirable to ensure that rehabilitation is provided at the correct stages of muscle healing. Home exercises are a vital part in ensuring a good repair to the injured area and assist in returning the individual back to full activities as soon as possible.
What is the cause of a Hamstring Strain?
When the tension through the hamstring muscles is excessive such as too much repetition, high force or overstretching, one or more of the hamstring muscles can tear. Sometimes this tear can be at the attachment point of the muscle at the pelvis or more commonly in the muscle itself. It is more likely to occur in sportsman if there is insufficient warm up and stretching of the muscles before activity and / or at the start of the sporting season if they are not sufficiently prepared and conditioned for this level of exertion.
We use a grading system in an attempt to describe the extent of the hamstring strain:
Grade 1: a small number of muscle fibres are torn resulting in some pain but allowing full function.
Grade 2: a significant number of muscle fibres are torn with moderate loss of function.
Grade 3: all muscle fibres are ruptured resulting in major loss of function.
The majority of groin strains seen by osteopaths are grade 2.
What are the symptoms of a Hamstring Strain?
Pain can be felt just below the buttock on a bony prominence called the ischial tuberosity. This is where the muscle attaches to the pelvis. More commonly pain can be felt halfway down the back of the thigh – this is where the main bulk of the hamstring muscles are. Difficulty may be felt going up stairs, sit to stand movement, running and in more severe cases walking. There is also likely to be a sensation of tightness and cramping in the back of the thigh.
The severity of symptoms is likely to relate to the severity of the injury and so the grading system can help describe what the most likely symptoms will be :
Grade I Hamstring Strain: Mild discomfort, often no disability. Usually does not limit activity.
Grade II Hamstring Strain: Moderate discomfort, can limit ability to perform activities such as running and jumping. May have moderate swelling and bruising associated.
Grade III Hamstring Strain: Severe injury that can cause pain with walking. Often patients complain of muscle spasm, swelling, and significant bruising.
What is the treatment for a Hamstring Strain?
Most mild to moderate sprains and strains can be treated at home using a self-care technique called RICE therapy, and by avoiding HARM.
Using RICE therapy: RICE stands for rest, ice, compression and elevation. Advice relating to each of these areas is out- lined below.
Rest: It is important to rest following the injury to keep the amount of inflammation around the in- jury site to a minimum. Allow pain to guide your level of activity; this means that activities which cause symptoms should be avoided. You can do activities that don’t aggravate your injury. Resting inadequately may prolong your recovery. If your injury is severe enough your clinician may recommend that you use crutches.
Ice: Apply ice wrapped in a damp towel to the injured area for 15 to 20 minutes every two to three hours during the day. Do not leave the ice on while you are asleep, and do not allow the ice to touch your skin directly because it could cause a cold burn.
Compression: Compress or bandage the injured area to limit any swelling and movement that could damage it further. You can use a crepe bandage, a simple elastic bandage, or an elasticated tubular bandage. It should be wrapped snugly around the affected area but it should not be too tight. Re- move the bandage before you go to sleep.
Elevation: If there is obvious swelling in the thigh keep the injured area raised and supported on a pillow to help reduce the swelling. If your leg is injured, avoid having long periods of time where your leg is not raised. In practice this is rarely an issue in hamstring strains.
Avoiding HARM
For the first 72 hours after a sprain or muscle strain you should avoid HARM. This means that you should avoid:
Heat: such as hot baths, saunas or heat packs (applying a controlled amount of heat to affected joints)
Alcohol: drinking alcohol will increase bleeding and swelling and decrease healing
Running: or any other form of exercise that could cause more damage
Massage: which may increase bleeding and swelling
The Rehabilitation Stage (after 48-72 hours)
In the first 2-3 weeks after an injury the body lays down scar tissue over the injury site. The secret of a good repair will be to apply some gentle stress in the form of gradual and progressive stretches through the hamstring muscle over this recovery period. This will help shape a well aligned, uniform repair across the injured muscle and avoids the injury returning. By contrast, if this gentle stress is not applied then scar tissue is laid down haphazardly around the injury site and causes ‘knotting’ within the muscle. This poor repair is susceptible to prolonging the pain and / or can predispose the individual to recurrence.
Exercise
As mentioned above this will be the most important aspect of your management. Gradual and progressive stretching in the early stages may lead on to strengthening the hamstring muscles and perhaps the core abdominal muscles and pelvic muscles. In the latter stages of recovery your clinician may advise on a warm up routine and offer more inventive exercises which may be specific to the sport or activity that you are involved in.
Other forms of treatment
We may recommend heat treatment after the inflammatory stage to increase blood supply and improve the rate of healing. This and soft tissue massage may help loosen tight muscles particularly in preparation for activity. Ultrasound is also used by some clinicians as this is thought to speed up the healing process.
How long will my symptoms last?
Minor hamstring strains (Grade 1) usually resolve within 3 weeks whilst moderate (Grade 2) injuries need a little bit longer (about 4 to 6 weeks). In the case of a complete rupture – which is rare, the muscle may have to be repaired surgically and the rehabilitation afterwards will take at least 3 months.
In terms of returning back to sporting activity we will want you to have full, pain free muscle flexibility and strength. You will need to have demonstrated in training a gradual and progressive return to all aspects of the physical demands of your sport and show that you have regained full fitness. Only then will we be confident to return you back to full competitive sporting activity.
The individual exercise program that you have received must be performed correctly, at the appropriate stage of healing and with the prescribed frequency. Stretching exercises in particular are very important in ensuring a strong repair of the hamstring muscle by influencing the matrix of the scar tissue that is laid down. Failure to do this may result in a poor repair that can prolong the injury and predispose you to the injury recurring. We will be relying on your input to achieve a successful outcome.