Keywords: Hamstring, sprain, pull, leg pain, physiotherapy, bicep femoris, bruising.
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Clinically relevant anatomy
A hamstring strain or a pulled hamstring as it is sometimes called is a tear in one or more of the hamstring muscles. Strictly speaking there are three hamstring muscles (Semitendinosus, Semimembranosus and Biceps Femoris) which are known as the hamstring muscle group.
The role of the hamstring muscles is to bend (flex) the knee and to move the thigh backwards at the hip (extend the hip). Understanding how the hamstrings work give vital clues as to their modes of injury. Mild to severe hamstring strains are extremely common in sprinters and hurdle jumpers and in all sports that involve sprinting activities, such as football and rugby.
During sprinting the hamstring muscles work extremely hard to decelerate the tibia (shin bone) as it swings out. It is in this phase just before the foot strikes the ground that the hamstrings, become injured as the muscles are maximally activated and are approaching their maximum length.
A pulled hamstring rarely manifests as a result of contact -if you have taken an impact to the back of the leg it should be treated as a contusion until found to be otherwise.
Characteristics and Clinical presentation
- A sudden sharp pain at the back of the leg during exercise – most probably during sprinting or high velocity movements.
- Pain on stretching the muscle (straightening the knee whilst bending forwards).
- Pain on contracting the muscle against resistance.
- Swelling and bruising.
- If the rupture is severe a gap in the muscle may be felt.
Strains are graded 1, 2 or 3 depending on severity.
Grade 1 consists of minor tears within the muscle. A grade 2 is a partial tear in the muscle and grade 3 is a severe or complete rupture of the muscle.
- May have tightness in the posterior thigh.
- Probably able to walk normally however will be aware of some discomfort.
- Minimal swelling.
- Lying on front and trying to bend the knee against resistance probably won’t produce much pain.
- Gait will be affected – limp may be present.
- May be associated with occasional sudden twinges of pain during activity.
- May notice swelling.
- Pressure increases pain.
- Flexing the knee against resistance causes pain.
- Might be unable to fully straighten the knee.
- Walking severely affected – may need walking aids such as crutches.
- Severe pain – particularly during activity such as knee flexion.
- Noticeable swelling visible immediately.
Assessment Knee Assessment Back Assessment
Advice to patient
It is vitally important that treatment for a pulled hamstring starts immediately following injury. The most important phase for treatment is the first 48 hours post-injury. In this time the following can be carried out by the athlete themselves:
- Use Cryotherapy (Rest, Ice, Compress, Elevate).
- Use a compression bandage to minimize intra muscular bleeding.
- Early mobilization of the injured lower limb is vital for the correct rehabilitation of the muscle. This includes stretching and strengthening exercises throughout the pain free range. These can aid with decreasing the swelling in the area. In addition, exercise will ensure that any new material will be laid down in correct orientation thus reducing the risk of subsequent injuries.
- See a sports injury specialist.
Healthcare professional or Physiotherapy management
- Use sports massage for hamstrings to speed up recovery. Sports massage is important in the treatment and rehab of hamstring muscle injuries as massage helps correct new muscle fiber realignment and minimizes scar tissue. In addition massage can increase the blood flow to the injured area.
- Use ultrasound and other forms of electrotherapy.
- Prescribe a rehabilitation program.
- Advise on specific stretches.
- Provide mobility aids such as crutches.
- Provide an MRI scan to ascertain the amount of damage sustained.
- In severe ruptures surgery may be needed to repair the damage.
Click here to view a comprehensive hamstring rehab program. Be sure that you are guided by a physiotherapist to ensure correct diagnosis. A little knowledge can be a dangerous thing and these exercises will not be suitable for other conditions that can cause posterior leg pain. In particular it is important to rule out involvement of the back which may be causing neurogenic referral. Hamstring Rehabilitation and Prevention Protocol University of Delaware Sports and Orthopedic Clinic