Hamstring Strain/Tear

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.

The key characteristics of muscle strain include:

• Swelling, bruising, or redness due to the injury

• Pain at rest

• Inability to use the muscle effectively

• Weakness of the muscle or tendons

(Burmitt & Cuddeford, 2015)

• 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.

• Work/domestic injury – for example stepping down from a higher surface, twisting, lifting something from the floor incorrectly

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:

• Grade 1: Mild damage to individual muscle fibres (less than 5% of fibres) that causes minimal loss of strength and motion

• Grade 2: More extensive damage with more muscle fibres involved (approximately 40% of the muscle fibres). However, the muscle is not completely ruptured. These injuries present with significant loss of strength and motion. These injuries may require two to three months healing time.

• Grade 3: Complete rupture of a muscle or tendon. These can present with a palpable defect in the muscle or tendon. However, swelling in the area may make this difficult to appreciate. These injuries sometimes require surgery to reattach the damaged muscle and tendon.

(Javinen et al., 2000)

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.

• Protection: Apply soft padding to minimise impact with objects.

• Rest: To allow healing & reduce the potential for re-injury.

• Ice: To induce vasoconstriction (narrowing of blood vessels), which will reduce blood flow to the site of injury. Never ice for more than 20 minutes at a time.

• Compression: Wrap the strained area with a soft-wrapped bandage to reduce further swelling and promote lymphatic drainage.

• Elevation: Raise the leg onto a foot stool for example – keeping the strained area as close to the level of the heart as is possible. This promotes venous blood return to the heart and good for circulation for the injury and removing toxins from the area

(Javinen et al., 2007)

Your Physiotherapist may implement hands on interventions to help optimise your recovery. Manual therapy includes massage, joint mobilisations and trigger point release which 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.

Your Physiotherapist will provide you with a bespoke exercise rehabilitation plan, tailored to your goals and activity levels. Exercises are selected in a graded, methodical fashion which is specific the phase of healing. The exercises will help restore smooth movement and range of motion, increase strength and help you transition back to a safe return to sport/activity. Below is a detailed example of how your rehabilitation plan may look.

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.

Phase 1

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

Phase 2

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

Phase 3

More functional strengthening can now start to be incorporated such as squats and static lunges – on your feet and replicating every day life!

Phase 4

Explosive muscle strength and activity specific. Our Physiotherapists at Pure will cater this to your lifestyle. We want to replicate the loads your injured area experiences in 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.

Phase 5

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!

• If you are experiencing constant pins & needles or numbness which is worsening.

• Redness or swelling in the calf.

• Significantly reduced function – unable to put weight through the injured leg.

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.