Hamstring injuries are common in sports and can cause long-term problems, including a high risk of re-injury. Hamstring injuries are usually more common in sports that cause regular stretch-shortening patterns for the hamstrings, such as high-speed acceleration/deceleration, directional changes, and kicking.
There are a number of risk factors that can lead to hamstring injuries, including a previous hamstring injury. Other risk factors include the following:
- Muscular imbalances
- Hamstring muscle weakness
- Posture
- Fatigue
- Poor warm-up techniques
- And more
One of the best ways to avoid hamstring injuries is through improved technique.
What is a Hamstring Injury?
A hamstring injury is a strain or tear of the tendons and muscles found on the back of the thigh. The hamstrings are tendons at the back of the thighs, which attach these muscles to the bone.
These muscles are not used much for standing or walking; however, they are used during any activity that involves bending the knee, including running, jumping, and climbing.
What Causes Hamstring Injuries?
Hamstring injuries are most common in sudden, powerful movements, including sprinting, lunging, or jumping. These activities can overstretch the tendons and muscles. A hamstring injury may also happen gradually during slower movements.
Mild hamstring injuries may cause sudden pain and tenderness on the back of the thigh. It may be painful to move the leg, but the strength of the muscle remains the same.
Partial hamstring tears tend to be more painful and tender. These injuries may also include some bruising and swelling at the back of the thigh, which may cause loss of some strength in the leg.
Severe hamstring tears are usually very painful, tender, swollen, and bruised. These injuries make it very hard to walk or stand. The injury may be accompanied by a popping sensation when the injury occurs. In this case, the leg may not be usable.
Types of Hamstring Injuries
Hamstring injuries can be categorised by the sudden onset of posterior thigh pain, with possible tenderness upon palpation and decreased function. Grade 1 injuries are some of the most common injuries. Once a hamstring diagnosis has been made, it’s also possible to grade the severity of the injury.
Grade 1 Hamstring Injury: Mild Muscle Pull or Strain
These injuries are most common during high-speed acceleration and deceleration. This usually affects the bicep femoris muscle, especially the proximal aspect of the musculotendinous junction. This type of hamstring injury causes:
- Tightness in the back of the thick that does not affect walking
- Some pain and the inability to run at full speed
- Can also cause mild swelling, but not always
- Bending the knee against resistance usually doesn’t cause much pain
Grade 2 Hamstring Injury: Partial Muscle Tear
Grade 2 hamstring injuries are usually caused by overstretching movements that may involve the proximal muscle belly of the Semimembranosus.
These injuries can result in the following:
- Walking pattern can be affected, causing a limp
- Sudden twinges of hamstring pain can occur during activity
- Swelling may be present, and the area is tender when palpated
- Painful when bending the knee against resistance
Grade 3 Hamstring Injury: Complete Muscle Tear
- This is a severe hamstring strain that can involve a tear to half or all of the muscle belly
- Severe pain and weakness are present, which can make walking challenging
- Swelling may be found immediately, accompanied by bruising that appears within 24 hours of injury
Hamstring Injury Risk Factors
Here are some of the most common hamstring injury risk factors to consider:
- Overtraining: can increase the risk of developing a hamstring injury. Overtraining causes the body to do more than it can over a sustained period, increasing the potential for a hamstring injury.
- Conditioning level: going too far beyond the body’s conditioning level can cause injury or illness. It’s necessary to build up tolerance over time.
- Weak hamstring muscles: are more susceptible to injury
- Imbalance in muscles: an imbalance can cause injury, too, such as when one hamstring is much stronger or weaker than the other.
- Previous injury: past hamstring muscles also increase the risk of the same or a similar injury in the future.
Hamstring Injury Rehabilitation
Acute management of a hamstring injury may involve the following:
- Protection and rest to avoid aggravating the injury, allowing the body to start the healing process
- Applying ice reduces blood flow to the injured area, reducing swelling
- Compression with a tubular bandage may also be necessary to support the injury and reduce swelling
- Elevating the injured area can also reduce swelling
- NSAIDS can also work to reduce pain and swelling
Post Acute Phase
Management of the hamstring injury at the post-acute phase may involve the following:
- Normalisation of the full range of motion and tissue flexibility.
- Massage techniques, with soft tissue release and post-isometric relaxation stretches to improve the full range of motion (not recommended in the first 5-7 days after a hamstring injury)
- Passive and active static stretching
- Strengthening the muscles of the lower back, hip, knee, and ankle
Long-Term Rehabilitation
The rehabilitation of these injuries can be challenging, especially if these are recurring injuries. In that case, hamstring injuries can take longer to rehab rather than an initial injury. The following may be used in rehabbing hamstring injuries:
- Eccentric hamstring loading
- Neuromuscular training
- Improving lumbopelvic control
- Specific warm-ups
- Stretching
- Plyometric/bounding training
The goal of rehabbing is to ensure the patient can safely return to sports while lowering their risk of future hamstring injuries.
Preventing Hamstring Injuries
Strengthening the hamstring muscles generally works to resist muscle fatigue to prevent hamstring injuries. This means improving eccentric strength (the strength used when the muscle is lengthening) is essential.
In addition, minimising hamstring asymmetry can also be beneficial. This removes the chance for the dominant leg to take more of the load when doing double-leg exercises (like deadlifts or leg presses).
Summing It Up
Hamstring injuries are some of the most common, especially in patients who have suffered these injuries in the past. These injuries can be caused when someone goes back into sports too early. However, with the proper exercise and rehab routine, it’s possible to strengthen and heal the hamstring muscles.
The best way to avoid hamstring injuries is with the correct strengthening exercises, focusing on eccentric hamstring strength. And if you suffer a hamstring injury, remember it takes time to heal, rebuild strength and get back to the sports you love.
