A hamstring strain or tear typically occurs with a rapid stretch or sudden overload to one or more of the muscles in the posterior thigh. The hamstring muscle group – Semitendinosus, Semimembranosus and Biceps Femoris, cross both the knee and hip joints, working to flex the knee and extend the hips. As these muscles work over 2 joints, they are exposed to significant force which increases the likelihood of injury. In many sporting actions – including high-speed running, the hips and knees are taken beyond the normal range of motion, exceeding their normal length or capacity (strength), leading to structural damage.
Based on the extent/grade of the injury and other variables such as age and past medical history, the typical recovery time may vary significantly. However, most patients achieve full recovery within 2 – 12 weeks.
At Pure, our Physiotherapists will take a detailed history to obtain more information about your injury to help provide an accurate diagnosis. Within the history, you may be asked exactly how the injury occurred, your pain levels, functional ability post-injury and the level of sporting performance (if applicable) you are involved in. Your Physiotherapist will then carry out a comprehensive physical examination to fully establish a working diagnosis. If a hamstring strain/tear is suspected, you will be given information of the grade of the injury which we have outlined below:
(Javinen et al., 2000)
The key characteristics of muscle strain include:
(Burmitt & Cuddeford, 2015)
Muscle strain treatment & management depends upon an accurate diagnosis from your Physiotherapist. The severity of your muscle strain – and what function or loads your injured muscle will need to cope with, will influence the length of your recovery.
The first-line treatment for a muscular strain in the acute phase include five steps commonly known as P.R.I.C.E.
(Javinen et al., 2007)
Some of the principles/aims of Physiotherapy are listed below. They are employed in a graded, methodical fashion which is specific the phase of healing. Your Physiotherapist at Pure will guide you through this process.
Your Physiotherapist may also include interventions to help optimise your recovery. Manual therapy includes massage, joint mobilisations and trigger point release can reduce discomfort, promote healing and help achieve full function. Acupuncture may also be used which involves the insertion of fine, medical-grade needles, used for pain and healing assistance. These can help to relieve pain and increase movement to help you to perform the exercises prescribed and carry out the rehab. This may be performed in the clinic during your appointment and then you will be prescribed a progressive home exercise program and guided through this.
After approximately 3-7 days we want to begin to activate the injured muscles at a low level, this may be through static hold exercises to begin with to start strengthening the muscles as the pain allows
Loading through movement – for example a hamstring dominant bridge or a hamstring curl, still at a moderately low level. This is putting resistance through a movement such as bending the knee which is one of the functions of the hamstrings. Over 1-4 weeks the intensity can be gradually increased
More functional strengthening can now start to be incorporated such as squats and static lunges – on your feet and replicating every day life!
Explosive muscle strength and activity specific. Our physiotherapist at Pure Physiotherapy will cater this to your lifestyle. We want to replicate you’re the loads your injured area experience in your every day life. If you’re a runner for example this is when we want to introduce jumping and bounding movements before we return to your sport
Graded return to activity, if you are unfortunate enough to be off work for 1-2 weeks (not common with this injury) we perhaps want to think about what tasks you’re doing and introduce them gradually. Once we have gone through the basic principles of your sport like running, changing direction in your rehab, its possible we can think about returning to a training session and eventually game time!
Brumitt, J., & Cuddeford, T. (2015). Current concepts of muscle and tendon adaptation to strength and conditioning. International journal of sports physical therapy, 10(6), 748.
Järvinen, T. A., Järvinen, T. L., Kääriäinen, M., Äärimaa, V., Vaittinen, S., Kalimo, H., & Järvinen, M. (2007). Muscle injuries: optimising recovery. Best Practice & Research Clinical Rheumatology, 21(2), 317-331.
Järvinen, T. A., Kääriäinen, M., Järvinen, M., & Kalimo, H. (2000). Muscle strain injuries. Current opinion in rheumatology, 12(2), 155-161.