Hamstring Injuries

Hamstring injuries can be the source of a lot of pain or discomfort for many of us. Issues may range from stiffness to tears and everything in between. In this blog, we will explore not only the cause and treatment of hamstring injuries but also the ways in which we can work to prevent them. The hamstrings are composed of 3 muscles; the semimembranosus, semitendinosus and the biceps femoris. These muscles work together to perform the movements of knee flexion (bringing your heels to your bum) and hip extension (going from sitting to standing).

Cause

The causes of hamstring injuries are numerous. They can range from your own biomechanics to the sport you play but to name a few. Let's explore the most common causes of Hamstring injury below.

Pelvic tilt

A pelvic tilt is the angle at which your pelvis sits. This may be anterior or posterior. If you have an anterior tilt this leads to over stretching of the hamstrings over a long period of time and subsequently, muscle weakness. This weakness leaves the hamstrings open to an increased chance of injury.

Muscle imbalance

If one muscle group is stronger than its opposing muscle group, a muscle imbalance can occur. In the case of the hamstrings, the opposing muscle group is the quadriceps at the front of the thigh. During activities requiring high speed the hamstrings may fatigue a lot faster than the quads if an imbalance is present. This too can lead to a strain.

Previous injury

Ankle sprains can lead to a change in body biomechanics and make you more susceptible to hamstring strains. Our bodies work on a balance of mobility and stability. Our hips and ankles take care of mobility, whereas the knee and foot work on stability. If any of these areas become injured it may compromise the muscle function and thus lead to strain.

Type of physical activity

Anyone can experience hamstring strain, but those especially at risk are:

● Sports that require kicking and sprinting: football, soccer, basketball

● Runners

● Dancers

● Older athletes whose exercise is primarily walking

● Teenagers athletes who are still growing

Treatment

Similar to all types of muscle strains and sprains, the course of treatment and time spent in rehabilitation will vary depending on the individual and the grade of the injury.

All muscle injuries should follow the “ PEACE & LOVE” protocol. This is the updated version of the traditional RICE. Check out our blog detailing “PEACE & LOVE” here.

Your physiotherapist will guide you through a personalized rehab programme that you will be required to follow in clinic and at home. In general, it is recommended to stop running and stretching for three weeks or so, you will need to let the scar tissue lay down over the tear without disrupting it. If you stretch the muscle immediately it leads to difficulty for the hamstring muscle fibers to knit back together effectively. It is very rare we ask a patient to stop activity, however in the case of a strain, best available evidence suggests that this is the most effective and time efficient way to return to sport and reduce re injury risk.

Once your physio feels you have gone through the healing phase then the fun rehab can begin and eventually get you back out running, kicking, jumping or dancing. How long this lasts varies and is based on individual factors and you will have to reach certain checkpoints before the physio lets you back 100% but on average it’s a few weeks.

The main areas of strengthening and soft tissue work in the case of a hamstring strain is not only the hamstrings themselves but also the core and glutes due to their proximity to each other. Physiotherapists can carry out a number of different techniques at various stages during your recovery. These include but are not limited to:

● Manual therapy

● Soft tissue work

● Joint mobilisations

● Trigger point dry needling

● Taping

● Active release techniques

● Biomechanical assessment and gait analysis

Prevention

There is no fool proof method for preventing the occurrence and recurrence of hamstring injuries. Simple steps you can take to decreasing your chances of sustaining a hamstring injury are:

● Continued stretching. Even once your injury is better, it is important to maintain flexibility.

● Staying strong. Ensuring strong hamstrings helps with muscle imbalances occurring.

● Take your rest days. Fatigue can be a huge risk factor.

● If your hamstrings start to feel achy, don't push them. Our bodies do a great job of letting you know when you’re pushing things too far, so you just need to hear the call.

References

Hamstring strain (no date) Physiopedia. Available at: https://www.physio-pedia.com/Hamstring_Strain (Accessed: November 1, 2022).