Hamstring strains

One of the most common injuries in sport is the hamstring strain, as these muscles are very susceptible to injury. The hamstrings are a group of muscles on the back of the thigh.  The upper part of these muscles attach to the lower part of the pelvis and the lower part attaches just below the knee joint. The action of the hamstring muscles is to bend the knee and straighten the hip.

Hamstring strains are most common among sports that require maximal sprints and acceleration (for example soccer, AFL, athletics, cricket, rugby union and league. Risk factors include:

  • increasing age of the player
  • previous injury
  • reduced hip range or movement/ hamstring length
  • poor hamstring strength or low hamstring to quad strength ratio

Prevention of hamstring tears

Eccentric hamstring strengthening exercises have been shown to reduce the risk of hamstring tear and traditional hamstring curls may be ineffective.

Implementing a specific graduated Nordic hamstring exercise program may prevent hamstring strain.

 Signs and symptoms of hamstring strain

There are two distinct types of acute hamstring strains and this will affect the rehabilitation.

Type 1 acute strain

  • injury during sprinting
  • sudden onset of pain, usually have to stop
  • pain in muscle belly
  • shorter rehabilitation

Type 2 acute strain

  • excessive stretch into hip flexion (for example during gymnastics, kicking)
  • less dramatic, less acute pain, may present as less severe
  • injury closer to the tendon, attachment to the pelvis.
  • stretching/ heavy load will aggravate this
  • longer rehabilitation

An MRI should be requested if a total hamstring rupture is suspected.

What is the treatment?

  • Initial treatment aims to minimise bleeding and swelling, promote tissue healing, prevent joint stiffness and protect against further damage using the POLICE principle (see previous blog). This includes using ice for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain is gone.
  • The No HARM protocol should also be applied – no heat, no alcohol, no running or activity, and no massage. This will ensure decreased bleeding and swelling in the injured area.
  • Low grade pain free exercise can start immediately following injury (g. isometric hamstring squeezes or active knee bends), 3-4 times per day.
  • Once able to walk pain free, resisted exercises can start.
  • When pain free, gentle jogging can be introduced and increased gradually (within 4-6 days depending on severity of injury). Caution must be used as the risk of re-injury at this time is high.

Return to full training

  • Pain free, full movement
  • Minimal tenderness full movement
  • Sprint and controlled sport specific tasks

Return to sport

  • Must complete at least one week of normal training without any problems
  • Premature return to sport and inadequate rehabilitation will increase the risk of re-injury

A graduated physiotherapy rehabilitation program will improve the movement, control and strength following a hamstring strain and enable full recovery. If you are experiencing symptoms call us on 9518 0722 to make an appointment or to ask to speak to a physiotherapist if you would like to ask further questions.

Janette O’Toole

Janette O’Toole

Principle Physiotherapist
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