Robert J. Snyder, MD
A hamstring strain (or pulled hamstring) is an injury to one or more of the muscles at the back of the thigh. One of the muscles gets extended, overloaded and partially or completely tears. Most hamstring injuries respond well to non-invasive, non-surgical treatment .
The hamstring is comprised of three muscles that run along the back of the thigh. Their primary job is to enable you to extend your leg straight back and also bend your leg at the knee. When it is severely injured, movement can be compromised.
A hamstring strain can be a pull, a partial tear, or a complete tear. A pull means that the muscle has been overstretched and will likely heal quickly. A partial tear means that the muscle has a slight shredding somewhere in its fiber. The healing process is typically longer because it will need more time to regenerate and reconnect the muscle fiber. A complete tear means the tendon has completely disconnected from the bone. In the most severe injury, the tendon pulls a piece of bone away with it, depending on the location of the injury.
What causes hamstring injuries?
Muscle overload is the main cause of hamstring injuries. Overload can happen when the muscle is stretched beyond its capacity or compromised by a sudden load. Sprinting is a major cause of a sudden load due to the mechanics of the body, placement of weight and forward motion. One is likely to suffer a hamstring strain during activities that involve a lot of running and jumping or quick starts and stops. Hamstring injuries are common in athletes, particularly those who participate in sports that require quick sprints, such as soccer, basketball, running, and skating.
What are risk factors?
Tight muscles are always vulnerable to strains. Daily stretching is recommended for all of us, but it is crucial for athletes to prevent injury.
Muscle imbalance – It is important to strengthen complementary muscle groups at the same rate. An imbalance can lead to strain. This often happens with the hamstring muscles because the quadriceps (the muscles at the front of the thigh) are naturally more powerful. During high speed activities, the hamstring can become fatigued faster, leading to strain. Also, when the quads are tight, they pull your pelvis forward and can tighten the hamstrings. Glutes need to be strong and stretched as well. If the glutes are weak, the hamstrings can be overloaded and strained.
Poor conditioning – if muscles are weak, they are more injury prone due to the inability to endure the stress of exercise.
Muscle Fatigue – We all need to rest our bodies after exercise. Tired muscles are more susceptible to injury because their energy absorbing capabilities are compromised.
What is the treatment for a hamstring strain?
Treatment of hamstring strains depends on the type of injury you have, the severity, and your own needs and expectations. Luckily, mild to moderate hamstring strains usually heal on their own or with simple non-surgical treatment.
RICE: To help the healing along, we recommend the RICE Protocol:
Rest – Behavior modification. Take a break from the activity that caused the injury. Your doctor may recommend the use of crutches to allow rest
Ice – used intermittently (20 minutes at a time, several times a day) for the first 24-48 hours. Never put ice directly on the skin
Compression – light bandage or ACE wrap to prevent swelling
Elevation – To reduce swelling, recline and put your leg up higher than your heart while resting
Immobilization – Your doctor may recommend you wear a knee splint for a brief time to keep your leg in a neutral position to help it heal.
Physical Therapy – Once the pain has subsided, a physical therapist can help you strengthen and work on range of motion.
Regenerative Medicine – For partial tears, Regenerative Medicine (RM) may be an option. Stem Cell Therapy and Platelet Rich Plasma Therapy mimic the body’s natural healing process, so they may be able to help the muscle tissue regenerate and be stronger than before. We offer both therapies at OSC, so please contact us if you would like to learn more.
Surgery is often performed when the tendon has pulled away from the bone. The hamstring muscle will be pulled back into place then reattached to the bone. A complete tear (not from the bone) is sewn back together using stitches.
Most people who suffer a hamstring injury will recover full function after completing a rehabilitation plan. Your physician will tell you when it is safe to return to previous activities. To prevent re-injury, please follow your doctor’s instructions. Re-injuring the hamstring greatly increases the risk of causing permanent damage.