hamstring problems,assesment and treatment

What is a pulled hamstring or hamstring strain?

A hamstring strain or a pulled hamstring as it is sometimes called is a tear in one or more of the hamstrings muscles. Strictly speaking there are three hamstring muscles (Semitendinosus, Semimembranosus and Biceps femoris) which are known as the hamstring muscle group

The role of the hamstring muscles is to bend (flex) the knee and to move the thigh backwards at the hip (extend the hip). Understanding how the hamstrings work give vital clues as to their modes of injury. Mild to severe hamstring strains are extremely common in sprinters and hurdle jumpers and in all sports that involve sprinting activities, such as football and rugby.

Symptoms of a Pulled Hamstring:

• A sudden sharp pain at the back of the leg during exercise-most probably during sprinting or high velocity movements.
• Pain on stretching the muscle (straightening the knee whilst bending forwards).
• Pain on contracting the muscle against resistance.
• Swelling and bruising.
• If the rupture is severe a gap in the muscle may be felt.
• Click here for information on how a hamstring strain is assessed.

Severity of a Pulled Hamstring:

Strains are graded 1, 2 or 3 depending on severity. Grade 1 consists of minor tears within the muscle. A grade 2 is a partial tear in the muscle and grade 3 is a severe or complete rupture of the muscle.

Grade 1: What does it feel like?

• May have tightness in the posterior thigh.
• Probably able to walk normally however will be aware of some discomfort
• Minimal swelling.
• Lying on front and trying to bend the knee against resistance probably won't produce much pain.

Grade 2: What does it feel like?

• Gait will be affected-limp may be present .
• May be associated with occasional sudden twinges of pain during activity.
• May notice swelling.
• Pressure increases pain.
• Flexing the knee against resistance causes pain.
• Might be unable to fully straighten the knee.

Grade 3: What does it feel like?

• Walking severely affected- may need walking aids such as crutches
• Severe pain- particularly during activity such as knee flexion.
• Noticeable swelling visible immediatel

Treatment of a Pulled Hamstring:

What can the athlete do?

It is vitally important that treatment for a pulled hamstring starts immediately following injury. The most important phase for treatment is the first 48 hours post-injury. In this time the following can be carried out by the athlete themselves:

• Use Cold Therapy (Rest, Ice, Compress, Elevate) technique
• Use a compression bandage to minimize intra muscular bleeding.
• Early mobilization of the injured lower limb is vital for the correct rehabilitation of the muscle. This includes stretching and strengthening exercises throughout the pain free range. These can aid with decreasing the swelling in the area. In addition, exercise will ensure that any new material will be laid down in correct orientation thus reducing the risk of subsequent injuries.
• See a sports injury specialist.

What can a Sports Injury Specialist do?

• Use sports massage techniques to speed up recovery- these are extremely important in the rehabilitation of the injury as massage breaks down the new collagen network allowing for correct fibre realignment and minimizing scar tissue. In addition massage can increase the blood flow to the injured area. Visit
• out sports massage page to learn specialized massage techniques for a pulled hamstring.
• Use ultrasound and electrical stimulation.
• Prescribe a rehabilitation program
• Advise on specific stretches
• Provide mobility aids such as crutches
• Provide an MRI scan to ascertain the amount of damage sustained
• In severe ruptures surgery may be needed to repair the damage

How is the Hamstring Strained?

During sprinting the hamstring muscles work extremely hard to decelerate the tibia (shin bone) as it swings out. It is in this phase just before the foot strikes the ground that the hamstrings, become injured as the muscles are maximally activated and are approaching their maximum length. A pulled hamstring rarely manifests as a result of contact -if you have taken an impact to the back of the leg it should be treated as a contusion until found to be otherwise.

Preventing a Pulled Hamstring:

One of the most important methods of preventing a pulled hamstring is to warm up correctly- this has been scientifically proven to reduce the risk of hamstring strain. This should consist of some light aerobic exercise followed by stretching and sports specific drills with gradually increasing intensity.

Other factors which increase the likelihood of suffering a hamstring strain include:

• Age: The older the individual the greater at risk to a pulled hamstring.
• Previous Injury: Prior injuries to the hamstrings or adductor muscles can greatly increase the chance of future injury.
• Flexibility: Research suggests that the greater the flexibility of the hamstrings the less prone they are to injury.
• Hamstring strength: Similarly studies have shown that lack of hamstring strength is strongly linked to hamstring injury.
• Lumbosacral nerve impingement: Nerve impingement in L5-S1 can lead to associated hamstring muscle weakness.
• Tiredness and fitness: When a player is fatigued he/she loses coordination between certain muscle groups. The biceps femoris muscle is known to become damaged due its two portions being innervated by two separate nerves. In states of tiredness, lack of synchronization between these two nerves can lead to a mismatch in firing resulting in a pulled hamstring.

Tight hamstrings

Many people suffer with tight hamstrings. Most of the time they will not cause a problem but can be more prone to bad tears and also limit sporting activity. The hamstring muscles consist of the semitendinosus, semimembrinosus and biceps femoris. Tight hamstrings can also be responsible for postural problems and other back problems as they will tend to pull the pelvis out of normal position. Why do I have tight hamstrings? Genetic reasons. You can be born with naturally short hamstrings when some people are naturally supple.In general women and children are more supple than men. Not enough stretching. If you participate in a lot of sport and do not stretch properly then you are more likely to have your hamstrings tighten up. It is especially important to stretch properly after exercise as this is when the muscles are warm and more receptive to stretching. If you tend to make a beeline for the bar after your game of football think about spending 20 minutes stretching first. Problems in your lower back can put pressure on your sciatic nerve which runs down the legs and cause muscles to tighten. What can I do about it? Learn which Sports Massage techniques can help improve muscle condition and flexibility. Even if you are not naturally supple you can still improve your flexibility by stretching. Types of stretching include dynamic, static, passive, PNF and CRAC. A full description of these can be seen here. Avoid ballistic stretching which is bouncing and forcing the muscle to go further than is comfortable and will damage it. Sports massage can help in loosening tight muscles. Have a regular sports massage on the legs. What problems can tight hamstrings cause? More susceptible to tearing. If you force a muscle to go further than it can normally go at speed it is likely to tear. Tight hamstrings can cause the hips and pelvis to rotate back flattening the lower back and causing back problems. If your muscles have tightened up then blood has been squeezed out of them therefore your muscles are working at less than 100 % of capacity and your performance will be down as a result. Regular sports massage and stretching to improve muscle condition will not only reduce the likelihood of injury but may improve performance. Hamstring Assessment Assessment of any injury should include questions concerning the patients general health, previous injuries and current injury. The aim of these questions is to determine which structure may be causing the pain and what treatment is appropriate. The therapist will then perform several tests and assessments, as shown in the videos below: Straight leg raise The therapist raises the leg off the couch as far as is comfortable for the patient, keeping the knee straight. This stretches the hamstring muscles and may reproduce the patients pain. The therapist should also observe how far the leg can be lifted. A normal range of motion is 80-90 degrees. Movement less than this and especially less than on the other side indicates that the hamstring muscles are tight Resisted knee flexion The therapist provides resistance as the patient bends their knee. This causes the hamstring muscles to contract which will be painful in most hamstring strains. The strength of the movement should also be compared to the other side as weakness may also suggest a hamstring strain > Slump test The slump test can be used to determine if there is neural involvement. The patient bends the head down, straightens one leg and points the toes up to the ceiling. The therapist will then push the patient forwards to increase the stretch. Pain shooting down the leg or reproduction of any other symptoms are a positive result Palpation The therapist will feel or 'palpate' the muscles, observing areas of pain, tension or gaps within the muscle