Know your Injuries – Part 5: Hamstring Strains
Dr Meenakshi presents her hamstring injuries in Part 5 of her Sports Injury Management Series.
Another muscle group prone to injury in physical activity, exercise and sports is the hamstring group.
Why are the three muscles in this group collectively called hamstrings? Well, it is reported, the word “ham” comes from an Old Teutonic word “ham” meaning crooked – or, the crooked or bent part of the leg – knee. It came to be associated with the meaning of the leg of an animal around the 15th century. The “string” refers to tendons. Thus, the hamstrings are the string-like tendons felt on either side of the back of the knee.
A hamstring injury occurs when you “strain” or pull one of the three muscles in the group of three muscles that run along the back of your thigh – starting from the outer edge, biceps femoris, semitendinosus and semimembranosus.
The hamstring muscles run from the pelvis and femur to the back and side of the knee. You can feel the hamstring tendons behind the knee on either side. The hamstring muscles, tendons and their bony attachments together stabilize the hip and knee as also enable their movements.
The injury – the strain, really – as expected, may take place at the weakest part of the hamstring unit. These strains are of three types:
- Grade 1 or mild: A sightly pulled muscle without any tear in it or tendon or bony attachment. There is no reduction in strength.
- Grade 2 or moderate: Tearing of the muscle fibers or tendon or at the attachment to the bone. In such case, strength will be reduced.
- Grade 3 or severe: The muscle – tendon – bone unit may be ruptured with separation of the muscle fibers. In very severe cases, surgical repair may be the only option.
Meenakshi breaks down her explanation in terms of –
- symptoms,
- causes,
- prevention,
- first aid,
- basic rehab movements
Symptoms
A hamstring injury usually causes a sudden, sharp pain in the back of your thigh. You might also feel a “pop” or even a tearing sensation. Swelling and tenderness / soreness usually develop within a matter of few hours of injury. You may also experience discoloration along the back of your leg/ Muscle weakness or an inability to put weight on your injured leg is also common.
Signs include –
- Pain while moving the leg
- Spasm in the injured muscle
- Swelling in the injured area
- Inflammation of the muscle sheath
- Weakened leg especially in Grade 2 and 3 strains
- Crepitation or a feeling of “crackling” when the injured area is pressed.
- Chronic injuries may lead to calcification of the hamstring muscle and / or tendon.
Causes
Generally, any strain to the hamstring muscle/s and their tendons or bony attachments will be defined as a “hamstring injury”. You may be more prone to get a hamstring injury while playing football or soccer, basketball, American football, tennis or any other sport that involves sprinting with sudden accelerations and decelerations. Of course, these injuries can occur in runners and in dancers as well.
Generally, any strain to the hamstring muscle/s and their tendons or bony attachments will be defined as a “hamstring injury”. You may be more prone to get a hamstring injury while playing football or soccer, basketball, American football, tennis or any other sport that involves sprinting with sudden accelerations and decelerations. Of course, these injuries can occur in runners and in dancers as well.
The hamstring strains can be injured in several ways:
- Sudden acceleration or deceleration
- Changing direction rapidly
- Stopping suddenly
- Slowing down while running
- Landing from a jump incorrectly
- Direct contact or collision, such as a football tackle
It is pertinent to note that the risk of hamstring injury increases with –
- Contact sport
- Running, jumping and sports involving sudden acceleration and deceleration
- Medical history of any bleeding conditions
- Obesity
- Poor nutrition and hydration
- Previous injuries to hip or knee joint and pelvis
- Poor muscle condition
- Poor flexibility
- Muscle imbalance. Some experts suggest that a muscle imbalance may lead to hamstring injury. When the muscles along the front of the thigh — the quadriceps — become stronger and more developed than your hamstring muscles, you may be more likely to injure your hamstring muscles.
One interesting finding is that men soccer players were 64% more likely than women soccer players to sustain a hamstring strain. Men had significantly higher rates of hamstring strains than women during both games and practices. There were no differences between men and women in injury rates during the preseason, but men were significantly more likely to sustain a hamstring strain during the in-season. Men had a significantly higher proportion of recurrent hamstring strains compared with women (men, 22%; women, 12%).
Source: Comparison of hamstring strain injury rates between male and female intercollegiate soccer athletes. [Kevin M Cross 1, Kelly K Gurka, Susan Saliba, Mark Conaway, Jay Hertel.] https://pubmed.ncbi.nlm.nih.gov/23408592/#:~:text=Results%3A%20Men%20were%2064%25%20more,CI%2C%201.06%2D1.68).
Prevention
Prevention is better than cure! The precautions to be taken are common to all sports and exercise injuries. But it is worth reminding the reader!
- It is essential to engage in a physical conditioning that involves appropriate strength and flexibility building movements prior to playing sports.
- Stretch the thigh and lower leg muscles as also the tendons prior to physical activity.
- Improve functional movement and dynamic stability of the knee joints.
- Improve technique of sports movement or exercise like “calf raises” with external resistance in the weight training studio.
- Try to be in shape to play your sport; don’t play your sport to get in shape!
First Aid
Follow the P.R.I.C.E. drill –
- Protect the injured part, not allowing any further damage.
- Rest the injured part.
- Apply ice or cold treatment for 15-20 minutes.
- Compression: use of mild to moderate pressure to the injured area with bandages / crepe bandages is advisable.
Current international standards have replaced P.R.I.C.E. with P.O.L.I.C.E.
- P – Protection of injured part
- O/L – Application of Optimal load (local injury factors) / Training load
- C.E. – as mentioned earlier (ice + compression+ elevation)
Follow up on First Aid
- The doctors will perhaps recommend an elastic bandage or a splint or even a cast from the ankle to the groin in order to immobilize the injured knee.
- Continued use of ice packs three or four times a day, 15 to 20 minutes per session is advisable.
- After 72 hours, the doctors may recommend application of heat therapy, liniments or ointments.
- Massage therapies as also hydro-therapies will be certainly enable quicker recovery.
Nutrition plays a big role in the recovery process and the injured person must consult a certified sports nutritionist.
Exercises to prevent injuries and strengthen the hamstrings
Dr Meenakshi (P. T.) recommends these rehab exercises to help recover from hamstring injuries. Watch her demonstrate these exercises.
- Active pain free knee extension in the acute phase, hamstring curls in standing position
- Hamstring stretch
- Bridging exercises
- Static hamstring exercises
- Reverse lunges
- Hamstring curls with a Swiss ball
See your doctor if your symptoms persist over 10 days or pain worsens despite treatment.