Hamstring Strain Rehabilitation Tips
Don’t let a hamstring strain turn into a recurring injury!
Dr. Braulio Espinosa
Chances are if you play a sport that requires repetitive kicking then you are familiar with the term hamstring strain or “pulling a hamstring”. Hamstring strains account for 12–16% of all injuries in athletes with a re-injury rate reported as high as 22–34%. Hamstring strains are a very common and nagging injury typical seen in athletes who perform high speed sprinting, repetitive kicking and explosive movements associated with acceleration and change of direction. This injury accounts for 38% and 28% of the lower extremity injuries seen in high school and college football respectively and makes up the highest percentage of total injuries in rugby. The high incidence of injury in this muscle group may be partly due to the fact that the hamstrings cross over two joints (the hip and the knee) and are therefore subject to much greater reaction forces at multiple points along the lower extremity chain. The hamstrings are a colloquial term used to describe three distinct muscles, two on the medial side (semimebranosus, semitendinosis) and one on the lateral side (biceps femoris). All three muscles are responsible for bending the knee and extending back the hip, two actions that are crucial for sprinting, jumping, and kicking. These muscles originate from the hip and turn into tendons that with two attaching to the inside of your leg bone and one attaching to the outside, crossing the knee joint. A muscle strain is a term used to describe damage or a tear to the muscle/ tendon. Like most injuries, a strain can range from a simple overstretch injury all the way to a complete tear of the muscle.
How do they happen?
What most of the literature agrees upon is that hamstring strains are typically caused by a non-contact injury secondary to forceful stretching. Building off this point; when analyzing running technique it has been shown that peak stress on the muscle occurred during a terminal swing phase of the sprint (see image), suggesting that this period may pose the greatest risk for injury. It is during this phase that the hamstrings are working to decelerate the leg while also controlling the degree to which your knee straightens. What this essentially means is that the type of contraction the hamstrings have to perform must switch extremely rapidly from slowing down the leg while it is straightening (the point of peak stress and stretch to the muscle) to then actually driving your hip back to propel you forward. Several research studies support that this rapid change from deceleration to acceleration by the hamstrings is when the muscle is most vulnerable to injury.
Severity of Strains
The severity of muscle strain injuries is generally categorized as Grade I: very mild tear of the muscle with minor strength loss, Grade II: partial tear of the muscle with mild bruising and significant strength loss that limits functional performance, and Grade III: complete tear of the muscle/tendon and severe disability with day to day activities. Complete tears like a grade III are rare, constituting about 1% of all hamstring strains. What is commonly observed with grade I and II strains is that in the middle of sprint, hurdle, jump, or kick the athlete will feel a tightness or pulling type pain in his posterior thigh that will cause him to stop physical activity.
Do not let this become a chronic issue!
The scary thing about hamstring strains is that the rate of re-injuring the muscle is very high, meaning that it can easily transition to a chronic problem if not correctly addressed. Across the board, the absolute biggest risk factor for having a hamstring strain is…. a previous hamstring strain. In fact, a study done on 500 amateur soccer players showed that a previous hamstring strain has been shown to increase the risk of a recurrence up to six times as much. The logical question is why does this happen? Since the symptoms of a grade I and grade II hamstring can be uncomfortable /annoying but tolerable during activities of daily living, the athlete often prematurely returns to activity after rest. This may lead to repeatedly unsuccessful efforts to return to sports without letting the muscle heal adequately. Thus, the muscle is not strong enough to tolerate the usual demands of sport which leads to another strain, or worse, a complete tear.
How can physical therapy help?
Risk factors shown to correlate with an initial hamstring strain are decreased hamstring flexibility, poor muscular strength/ endurance, poor core stability, lack of proper warm-up, inability to disassociate the trunk from the lower extremities, and poor lumbar posture. Our board-certified Doctors of Physical Therapy at Fox Physical Therapy will be able to identify any of these aforementioned deficits during the biomechanical evaluation. From there a plan of care will be implemented to correct the impairments quickly and efficiently. Remember the biggest risk to recurring hamstring strains is having that first hamstring strain, so even if you are not injured we can help to identify possible risk factors ensuring you stay at peak performance levels. Don’t wait until you break down to seek treatment. That’s the equivalent of letting your car break down on the side of the road before finally getting an oil change.
In the event that you do sustain a hamstring strain, physical therapy becomes of the utmost importance to guide and progress the athlete through his/her rehabilitation and prevent an acute injury from becoming chronic. Current literature supports that clinical diagnosis of a grade I/II strain by an experienced physical therapist is as reliable and valid as ultrasound and MRI, meaning that one does not necessarily have to wait to go to a doctor and then wait again to get an MRI in order to begin the rehabilitation process. In Florida, anybody can directly access their Physical Therapist without the need for referral.