Hamstring Pull (Strain)

What Muscles Comprise The Hamstrings?

Figure 1

Three muscles in the back of the thigh are collectively called the hamstrings:

  1. biceps femoris
  2. semitendinosus
  3. semimembranosus (see fig. 1)

The two general attachment sites for the hamstrings are the:

  1. bony prominence felt under each “cheek” when sitting (ischeal tuberosity) and
  2. the back of the knee.

What Is The Function Of The Hamstrings?

Contraction of the hamstring causes:

  1. the knee to bend, and
  2. the thigh to move backwards relative the trunk, although these actions usually do not occur simultaneously.    

The hamstrings play a vital role in walking, running, jumping, and controlling movements of the trunk.

What Is A Hamstring Strain?

A hamstring strain is an excessive stretch or tearing of muscle fibers and related tissues. Hamstring strains can occur at one of the attachment sites or at any point along the length of the muscle. They are classified as either 1st, 2nd, or 3rd degree depending on the severity.

First Degree:

Excessive stretching or minor tearing of a few muscle fibers. The pain can often be localized with one finger. Some stiffness and weakness will also be present. If exercise is attempted, the pain and stiffness may decrease during the activity, but return after, often with much greater intensity.

Second Degree:

Moderate tearing of muscle fibers with pain generally covering a larger area than the 1st degree strain. Stiffness and weakness will be felt and the painful area may appear black and blue due to bleeding within the injured muscle. Significant limping may also occur when walking.

Third Degree:

A complete tear of the muscle. Wide-spread bruising will be present and a “balling up” of the muscle may be seen or felt with you hand. 3rd degree strains are a rare occurrence.

How Do Hamstring Strains Occur?

A hamstring strain can occur during an isolated athletic activity (acute) or result from persistent repetitive stress (chronic). Often an acute strain occurs as a result of a chronic condition which has rendered the muscle weak and vulnerable . An example of this is the softball player who, rather than miss a game to allow adequate healing of a minor recurrent strain, has “babied” the injury throughout the season until sprinting to first base one day causes further injury.

As in the case of the softball player, hamstring strains often occur while sprinting. They also can occur during jumping and other activities where quick starts and stops are required. High risk sports for hamstring strains are: soccer, football, baseball, basketball, and many track and field events. Runners are especially susceptible to chronic hamstring strains due to the repetitive nature of the sport.

What Is The Treatment For A Hamstring Strain?

First Degree:

Like most recent athletic injuries, the RICE (Rest, Ice, Compress, and Elevate) method of treatment, in the early stages, is most beneficial. Rest from the activity which caused the muscle strain allows for healing to occur. Immediately following the muscle strain, ice should be applied over the painful area for 10-15 min. Periodic icing (2-3 times per day) will help to control swelling and reduce pain. Heat should not be applied to the area during the first 3-4 days since this may increase swelling and bleeding within the muscle. An elastic wrap or compressive stocking may be applied to the area to assist with swelling control. If the compressive device causes increased discomfort or “pins and needles” in any part of your leg, it is probably too tight. Lying down periodically with your leg elevated allows gravity to assist with your effort to control the swelling.

Though some experts believe early stretching to be valuable, caution should be taken early on to avoid aggressive stretching (stretching beyond the point of mild discomfort) which may hinder healing. Gentle stretching and light resistive exercise (see figures 2, 3, and 4), during the first few days, will help to properly align the healing muscle tissue. Following exercise, the application of ice while maintaining a stretch, not only helps to control swelling, but also helps the muscle to maintain flexibility (see fig. 5). Within a pain-free range, walking, biking, and a chair/stool pull (see fig. 6) may be implemented during the first few days. Progress these exercises, using pain during or after activity as your guide, to running, sprinting, jumping, and full athletic competition. When beginning more advanced activities such as running, avoid quick starts and stops or other ballistic movements which can cause re-injury Remember to properly warm-up and stretch before participating in athletics, and then conclude with a good stretch The most effective stretching occurs when the muscle is warm from exercise and when the stretch is held for long duration (min 30 sec.).

Figure 2: Hamstring Stretch

Rest your injured leg on a supporting surface while keeping the knee from bending. Lean forward toward your toes by bending at the waist and keeping your back straight.

Firmly attach one end of an elastic tubing to a door knob or an other stable structure and attach the other end around your ankle. While sitting in a chair, bend your knee and then allow it to slowly straighten against the resistance of the elastic. To increase the resistance, move the chair away from the door knob.

Figure 3: Hamstring Strengthening Exercise

Figure 4: Hamstring Stretch

The injured leg rests against the wall without bending the knee. To increase the stretch, move closer to the wall and/or lift the injured leg (held straight) away from the wall.

Figure 5: Application of Ice in a Stretched Position

Sit on a chair or stool that has wheels. Pull yourself in the chair across the room by repeatedly placing the injured leg out in front and then bending the knee to pull the chair forward (your foot does not slide on the floor, rather the chair moves toward your foot). Increase the difficulty by doing this excercise on a carpeted surface.

Figure 6: Hamstring Strengthening

Chronic hamstring strains are usually first degree in nature and are often associated with improper warm-up or overuse. If proper warm-up and stretching techniques are being followed, resting the strained muscle by decreasing the intensity, duration, or frequency of the activity may be sufficient to resolve the problem. If the strain persists, a thorough evaluation by a trained professional is advised.

Second Degree:

For most second degree hamstring strains the treatment is the same as with first degree strains, however the speed of progression must be slowed and recovery will be longer (possibly 2-3 weeks).You may wish to seek professional care for a second degree strain where specialized techniques are used to enhance healing and recovery.

Third Degree:

Seek immediate medical attention if suspected. Crutches will most likely be prescribed and the RICE treatment, as previously described, will be necessary for 4-6 weeks.

Seek assistance for second and third degree strains, or any apparent hamstring injury that doesn’t show improvement with self-treatment within a reasonable amount of time(2-3 weeks).

This may be the sign of a more serious strain, improper mechanics or alignment during activity, or an entirely different condition producing symptoms in the area of the hamstrings.

When Can I Safely Return To My Sport?

As a general rule of thumb, any activity that elicits pain at or near the injured site may be causing further injury and will only hamper your recovery effort. Don’t be amongst the foolish many who attempt to play through a painful hamstring strain only to turn what might have been a short recovery into a painfully chronic one!

How Can I Prevent Another Hamstring Injury From Occuring?

A gradual conditioning program, specific to your sport, will prepare the hamstrings for the high demands placed upon them during athletics. Don’t forget to incorporate a proper warm-up and stretching session into your conditioning program and athletic competition.