What is Hamstring Injury?
Hamstring are group of three large muscles that are located at the back of the thigh bone. They connect the muscles to the bone and refer to as:
- Biceps femoris
They begin from pelvis or buttocks and ends at lower part of leg i.e. at tibia and fibula. They extend from hip to knee i.e. running through thigh bone. The muscles of hamstrings turn into tendon fibers once they reach knee and anyone can feel the thick tendons at the posterior region of the knee.
Along with quadriceps muscles located on front of thighbone, hamstring muscles helps us in flexing and bending the knee. Both of them assist in controlling the stability, strength, power and movement in the knee. In addition, they also help in straightening and extending the hip. They are not actively involved while walking or standing but directly involved in running, jumping, squatting and climbing.
When one or more of these three muscles gets torn or stretches too far beyond its limits due to excessive and repetitive force, hamstring injury will occur. There are different conditions involved in hamstring like pulls, strains and tears.
Active individuals and athletes requires well-conditioned and healthy hamstrings to get involved in power and high intensity sports like rugby, football, hockey, soccer, tennis, boxing, cricket, etc.
Hamstring injuries are extremely common among athletes because they are involved in powerful accelerations, decelerations, pivoting, turning, running, jumping, kicking or lots of sprinting.
Grades of Hamstring Injury:
The hamstring injury can range from partial tear to complete rupture. Majority of hamstring injuries are grade 2 tears. Thus they are divided into three grades.
- Grade 1 Hamstring Injury – Mild:
- Small number of fibres are torn or stretched too far.
- Mild pain and discomfort
- Microscopic tears
- No disability or loss of fucntion
- Minimal or slight limitation in daily or sporting activities.
- Grade 2 Hamstring Injury – Moderate:
- Large number of fibres are torn or stretched beyond it limits.
- Normal walking will be affected.
- limping is usually noticed when walking.
- Moderate loss of function.
- Moderate and sharp localized pain.
- Tightness can be felt at the back of thigh or near knee.
- Visible Inflammation and bruising.
- Pain can be experienced while touching the affected part or flexing the knee.
- Decrease in range of motion.
- Athletes will be unable to perform sporting activities.
- Most common in athletes and sporting individuals.
- Grade 3 Hamstring Injury – Severe:
- All the fibres of muscles are ruptured or completely torn.
- Major loss of function.
- Severe form of hamstring injury.
- Severe pain even while resting.
- Difficulty in walking.
- Requires assistance of crutches or walker for gait.
- Significant swelling and bruising.
- Muscle spasm.
- Requires surgery.
What are the Symptoms of Hamstring Injury?
Te signs and symptoms of hamstring injury depends on the severity of grades. However, some of the common symptoms are:
- Bruising or discoloration can be clearly visible at the back of thigh. It is caused due to bleeding due to tears in hamstring. If not treated on time, the bruising will passes down to knee and even foot.
- The blood accumulates in the hamstring causing swelling or inflammation. Tenderness will also developed. Moving the muscles can be extremely painful.
- Muscle spasm or sharp localized pain can be experienced due to trauma.
- Popping or tearing sensation can also be felt.
- Weakness and stiffness in muscles.
- Inability to put weight on leg, which is affected with hamstring muscles.
- Athletes can feel pain while walking uphill, climbing up stairs or down stairs, running, sprinting, jumping, kicking, etc.
What are the Causes of Hamstring Injury?
Hamstring injury can be result of multiple causes. Some of the commonly diagnosed causes of hamstring injuries are:
- Muscle Overload: It is one of the main causes of hamstring strain. This happens when muscle is stretched too far beyond its capacity.
- Abnormal Movement: While running, sprinting, jumping, kicking, and lunging, many individuals pulls their hamstring due to abnormal movements or eccentric contraction of hamstring muscles.
- Poor Sporting Mechanics: Over striding or stretching the hamstring muscle makes it vulnerable to strain or injury.
- Improper Warm-up: Performing inadequate or insufficient warm-ups and stretching will also trigger pulls or strain in hamstring.
- Muscle Imbalance: If quadriceps muscles are stronger than hamstring muscles, then it can lead to Even, hamstring muscles become fatigued and tired faster than quadriceps muscles.
- Weak Muscles: If the muscles are weak i.e. hamstring and quadriceps muscles, then it will get damaged due to intensive sporting activities.
- Improper training loads: High intensity activities should be performed at the start of the work-out otherwise hamstring may be pulled since they tend to fatigued quite quicker than other muscles. Sudden increase in sporting activities or workout will also cause hamstring injury.
- Fatigue: Tiredness and exhaustion can make hamstring more vulnerable to get stretched or pulled because fatigue lessen the muscle’s energy-absorbing abilities.
- Abnormal Lumbar Spine: If the lumbar spine or pelvic is poor or abnormal, the muscle around them also tends to become weak resulting in hamstring injury.
- Slippery Playing Surface: Playing in wet and slippery surface will put more stress and strain on hamstring muscles due to fear of falling down or losing your balance. It will lead to hamstring injury.
- High Intensity Sports: Individuals involved in high intensity and power sports or activities are most likely to get affected with hamstring injury such as football, soccer, basketball, rugby, hockey, cricket, running, sprinting, hurdles, marathon runners, dancers.
- Sudden Growth Spurt: During teenage years, bones grow faster than muscles resulting in imbalance and prone to hamstring injury.
- Difference in length of legs: Some individuals have leg length difference i.e. one leg is smaller than other normal leg. In this case, the short leg has tight hamstrings muscles while the normal leg have normal hamstring muscles. This lead to disparity in legs and will most likely result in pull or strain.
- Weak Body Parts: Tight hip flexors and weak muscle of butt also causes hamstring injury.
- History of hamstring injury: If any individual have already pulled his or her hamstring in past, then there is greater possibility of this condition to recur.
Diagnosis of Hamstring Injury: Doctors will check the location of pain and intensity of swelling to determine the accurate the accurate problem. They will conduct physical test and discuss medical history, exercise schedule, sporting activities, workouts, etc in detail.
X-rays are extremely effective in checking any bone detachments i.e. avulsion fracture. Ultrasound and MRI can provide ample pictures of tears in your hamstring muscles and tendons.
Treatment of Hamstring Injury:
Proper treatment and rehabilitation is extremely necessary for healing hamstring injury. The treatment varies greatly according to the grades, types and severity o the tears and strain. However, some of the most common and effective treatment methods for hamstring injury are:
- R.I.C.E.: The PRICE formula is extremely effective in controlling pain, swelling and bleeding. The acronym stands for protect, rest, ice, compress and elevate.
- Protect: Protecting the knee from further injuries is most important part of treatment. Avoid aggravating activities that can increase the pain.
- Rest: Take a short break from daily activities to allow the hamstring injury to heal naturally. Doctors always suggest rest or immobilization for one week or so. Some cases of severe hamstring injuries requires extended period of rest. Keep your leg in still position. Don’t put extra weight on hamstring.
- Ice: Icing on the affected part with icepacks or ice wrapped in towel can constrict the swelling and pain. Applying ice will slow the rate of metabolism and blood flow in the inured area. It will even reduces muscle spasm and sharp localized pain because icing will numb the nerves. Apply for 15-20 minutes several times a day. Other than crushed ice packs, cold gel packs, chipped ice and ice cold sprays can also be used.
- Compression: Compressing the injured area with elastic bandage will reduce bleeding and swelling. Patients will feel decline in pain after wearing compression bandages. Don’t wrap too tightly. Remove and rewrap occasionally one or two times day.
- Elevation: Elevation helps in reducing the swelling. Use pillows to elevate your leg above the heart’s level.
- Medications: NSAIDs or over-the-counter medication such as ibuprofen (Advil or Motrin IB,) or acetaminophen (Tylenol) helps in relieving from the pain and reducing inflammation.
- Walking Aid: Use crutches or cane while walking. Avoid putting excessive or unnecessary burden on you injured leg while the treatment is undergoing.
- Stretching: Mild and gentle stretching should be done gradually after the symptoms subsides. Consult your physical therapist for individualized and specific stretching program according to the severity of your hamstring injury. Don’t perform stretching along with pain.
- Exercises: Static hamstring contraction, basic hamstring stretch and bridging are commonly prescribed exercises that will strengthen the hamstring muscles and prevent the injury to recur. However, it is advisable for consulting your physical therapist before starting the exercises. Some of the other effective exercise are isometric or static contractions, standing knee flexion, hamstring catches, seated hamstring curl, single leg hip extensions, single leg ball pick up, lunge with ball, good mornings, and norwegion leg curl.
- Physical Therapy: Physiotherapy is extremely important and critical for athletes to resume their sporting activities as soon as possible. Some modalities like ultrasound, electrotherapy (electric stimulation) and therapeutic massage are pain-relieving for the patients. Physical therapist will also advise you to start low impact activities like cycling and swimming to strengthen your hamstring muscles.
- Knee Wrap or Thigh Wrap: Wraps can be applied to the injured leg because they will provide support and stability and aid in healing quicker.
- Activity Modification: Some athletes contact hamstring injury while performing certain activities. It is very important to avoid those activities or train properly in the guidance of expert or personal coach. Don’t train watching videos or reading books. Correct your technique personally with experienced sportsmen or athletes.
- Heat: Heating will loosen the tissues of muscles and allow you to actively participate in any activity without any trouble. Always apply heat pack before the stretching or warm-up exercises and ice after successfully completing the workouts.
- Surgery: Surgery for hamstring injury is very rare. Occasionally, surgery is performed, if and only muscle is pulled off from its location.
Recovery Period for Hamstring Injury:
Patients with Grade 1 tears may recover well within a period of one month, if proper medication and treatment is diagnosed. Grade 2 tears may require 1-2 moths for complete recovery while complete rupture in the case of Grade 3 tear, surgery may be performed along with rehabilitation program. In this case, more than 6 months is required for complete and effective recovery from hamstring injury.
Conclusion – Hamstring Injury:
The outlook is good and you can resume your sporting activities after consulting with your physical therapist. Always try to be healthy and in good shape. Perform proper stretching and warm-up exercises before playing or participating in any sports. Always stay in contact with your physical therapist and never take hamstring injury lightly.