Introduction
Imagine the scene; an elite athlete at full stretch suddenly comes to a halt, clasping the back of their thigh – their face etched with shock, agony and disappointment. A team of physios helps the limping casualty away from the pitch or track… unless you’re Derek Redmond of course, and your dad’s a bit of a pushy parent. *see bottom of page
We can all guess the cause, a typical hamstring strain, or maybe a ‘pulled’ or ‘torn muscle’. These terms come from the mechanics of this type of injury – the hamstring being forcibly and abruptly stretched beyond its limits, actually causing the muscle fibres to tear. This characteristically arises during a rapid forward acceleration of the lower leg, and is due to a combination of muscular stretch and contraction. That’s why these injuries are associated not just with sprinting, but with kicking in rugby, football or martial arts. The pain is regularly described as a sensation of being shot, or slapped in the back of the leg, and in severe cases an audible ‘pop’ can even be heard…. Shudderrrr.*
A little anatomy lesson
Here’s a brief insight into Hamstring anatomy: we all know hamstrings as the three taught tendons running behind each knee. But the term can also refer to three important muscles (each sounding a little like dinosaurs), bicep femoris, semitendinosus and semimembranosus which deliver, for example, running, kicking, walking functions to your lower leg.
- They extend the thigh at the hip – draw the leg in a backwards motion.
- They flex the leg at the knee – bend the leg in a heel to glute motion
- They act like ‘brakes’ to decelerate the forward movement of lower leg
As well as these functions, hamstrings can rotate, fine-tuning your leg mechanics and helping to stabilise your pelvis.
What’s the damage doc?
The severity of the injury can be classified between grades 1 – 3, which relates to the depth and degree of the tear in the muscle fibre.
Symptoms (dependent on grade of tear)
- Tenderness along the back of the thigh with possible bruising and swelling
- Sharp pain or tightness along the hamstring muscle when walking, bending over, straightening of the leg
- Weakness or sense of vulnerability when bending the leg at the knee
- Inability to walk without limp
- Pain and stiffness first thing in the morning or when resting following activity
- Pain walking up and down stairs, jumping, kicking, running and loading such as lifting weights – deadlift, hamstring curls, squats etc
- Palpable deviation/gap in hamstring muscle belly
- Inability to weight bear and marked loss of function
- Severe bruising and swelling
- Reported ‘pop’ or ‘snap’ sound at onset
Hamstring strains can also present as an ‘insidious onset’ that is, they gradually develop over time. This is still due tearing of the hamstring muscle fibres, but is typically far less sever (grade 1) and is more likely to originate from a secondary cause, such as an insufficient rehabilitation from a previous hamstring injury, poor biomechanics (pelvic torsions, reduced lumbar spine mobility, muscular imbalances etc), inadequate warm up, or repetitive and excessive loading.
How long can I expect to be out for?
This is sometimes a difficult question to answer, the grade of injury is of course, a very important factor to consider when estimating the probable recovery period, external factors are, however, just as significant. Some to consider are:
- Your age
- Underlying medical conditions
- History of hamstring injury
- Treatment and rehabilitation
- Occupation
- YOU – this is by far the most important factor, listen to advice given by your healthcare professional; the likelihood is, they know what they’re talking about. If you return to sport before they advise and don’t listen to management approaches provided you’ll only risk prolonging your symptoms.
In our experience the following can be expected for each grade
Grade 1 – only a small amount of fibres torn
Grade 1’s can be funny little injuries. Patients tend to complain of tightness or a ‘twinge’ at the back of the leg which causes more of an annoyance than pain. You will be able to run through the injury and you’ll typically find that any discomfort subsides shortly after you’ve stopped the provocative activity.
There’s usually no loss of power or strength, and it would be very unusual for a grade 1 to produce swelling, heat or bruising.
In my experience, the estimated recovery time is anywhere from 2 to 12 weeks (with treatment). The main reason for such a large time scale is that, as mentioned in the last paragraph, sufferers feel able to run or train through the injury – though ultimately, it’s like constantly picking at a scab; you cause a disruption to the healing process and run the risk of making things worse!
Grade 2 – moderate number of fibres torn
This is often referred to as a partial tear of the hamstring muscle belly. The onset is often sudden and may feel like a sharp twinge or pop at the back of your thigh. Patients are able to walk and weight bear, but it’s often very uncomfortable causing a limp.
Bruising, swelling and a loss of power may be observed and in some more severe cases, surgical intervention may need to be considered.
I would expect full recovery time between 2 to 6 months. This injury will certainly require therapy and a carefully followed rehabilitation programme to reduce the potential of ongoing issues.
Grade 3 – partial to full tear/rupture
So, this is the big one – a grade 3 diagnosis suggests that the majority, or all, of the hamstring muscle belly fibres have been torn. When this injury arises, the individual feels like they’ve been ‘shot’ or ‘hit’ in the back of the thigh and drop to the floor in agony.
There will be a substantial loss of function with reduced power, extensive swelling and bruising. Walking and weight bearing will be impossible without the aid of crutches and in the majority of cases will require surgical intervention.
Estimated recover period can be anywhere between 6 months and 1 year+.
What to do with your hamstring stain?
So, the most important step is to have your injury properly assessed and diagnosed. The grade of tear will determine the most appropriate actions to be taken, and hopefully assisting in a fast and effective recovery.
If your therapist suspects anything to be concerned about, they may suggest that you consider imaging such an MRI scan.
For the sake of this blog, let’s go with the notion that your hamstring strain does not require surgery and has been diagnosed as either grade 1 or 2
Immediate action
First things first, stop that swelling!! Good old fashioned RICE will do the trick
- R- Rest – Avoid further damage, be sensible and rest up
- I – Ice – Cold applications regularly for the next 24 – 48 hours. 10 minutes a time 5 minutes in between
- C – Compression – Apply a compression bandage immediately to reduce swelling
- E – Elevation – Use a few pillows under the affected limb to reduce inflammation and promote draining in the area
Short term
- STOP STRETCHING – yes it seems like the right thing to do, but you’ve just over stretched and torn your muscle fibres… Trust me, they don’t need any more. Stretching the hamstring will only disrupt the healing process and prolong your recovery
- Rest – I know ‘rest’ is a horrible word for an athlete to hear but it’s essential. Anyone who’s visited me in practice knows that I try my best to keep patients active. But in this case it’s important. I would advise 3-4 weeks were you avoid excessive hamstring loading activities – running, jumping, kicking, deadlifts, lunges etc.
- Ice – Keep up with the cold compression, remember – if it’s painful, it’s inflamed! Reduce that inflammation with ice packs 10 minutes on x 5 minutes off (and repeat)
- Foam roll/trigger point – target areas of muscular tension with foam rollers and the use of a trigger point ball, this allows you to relax the muscle without actually having to stretch it.
What we can do for you
- Effectively diagnose and determine grade of tear
- Identify mechanical imbalances and predisposing factors such as poor glute activation, weak core stability, and various factors contributing to tight and weakened hamstrings
- Provide exercise aimed at restoring any determined imbalances
- Soft tissue massage to relieve muscle tension, pain and reduce local inflammation
- Joint mobilisation to improve range of movement available and restore potential pelvic misalignment
- Medical acupuncture which is scientifically proven to reduce muscular tension and pain
- Sports and kinesiology taping to provide support, pain relief and improved function
- Advise and educate appropriate footwear, rest periods, ice, orthotics, exercise programmes aimed at strength and mobility, i.e. foam rolling.
And finally…Rehabilitate and return to sport
When your osteopath decides that you’re past the healing stage it’s time to rehabilitate. The majority of this will involve the correction of muscular imbalances and lengthening and reducing tension in the hamstrings through simple stretches.
When you do return to sport, you must remember that you are now in a high category risk for another hamstring tear, as unfortunately, this is a pesky injury with a habit of reoccurring.
Over the first few weeks urge on the side of caution and try applying some of these suggested modifications to your workout routines.
- Reduce your running stride – smaller, shorter steps; the hamstrings are stretched far less and so are placed under much smaller degree of tension, reducing the applied forces significantly
- Switch the treadmill for off-road running – treadmills impound on the same structures over and over again and enforce that repetitive loading. Get some variation
- Split your activities – rather than running 10 miles x 1 weekly, run 5 miles x 2 weekly
Good luck, The Osteo Practice
*Derek Redmond- pushy parent
