A Physiotherapist’s guide to Hamstring Injury Management

Oct 30, 2020 | Blog, Physiotherapy

Hamstring Muscles and related injury

Hamstrings are a group of muscles comprised of Semitendinosus, Semimembranosus (the medial hamstring muscles), and biceps femoris (lateral hamstring). This muscle group is found in the posterior part of our thigh. They originate from the Ischial tuberosity (lower part of buttocks) and cross over the knee joints into the medial and lateral condyle of tibia and fibula. Their primary role is in inward bending of the knee and hip extension. They also help in controlling the movement of pelvis when bending forward.

Tear or strain in the posterior thigh muscles are pretty common injuries related to sports, be it recreational or professional, and among general public too. Often, such injuries are reported in sports involving rapid acceleration and deceleration, jumping, pivoting or kicking. It is usually caused by rapid extensive contraction or a violent stretch of the hamstring muscle. Here in this article, we discuss more about Hamstring tears and its management.

Predisposing factors of Hamstring Tear

There are various risk factors that may contribute to tears in the back muscles of the thigh. Some of them are

  • Growing age
  • Previously unhealed strain in the hamstring or Calf / Knee area
  • Reduced flexibility in the hamstring or calf muscles or the iliopsoas, also known as the inner hip muscles
  • Overexertion/ fatigue
  • Poor core strength
  • Muscle/ strength imbalance
  • Lumbar spine abnormalities

Signs and Symptoms of Hamstring strain

Symptoms can vary from person to person and depends on the extent of injury.

Grade I injuries are with mild symptoms and patient will be able to walk normally where as in Grade II injuries nearly half of muscle fibres are torn. Patients suffering from Grade II injury may experience more pain and swelling and have a difficulty in walking. In Grade III injuries, more than half of muscle fibres are torn with extreme difficulty in walking.

Usual symptoms are:

  • A popping or tearing impression
  • Minimal to severe pain in the posterior thigh
  • Swelling and ecchymosis
  • Tenderness
  • Loss of motion
  • Difficulty in walking

Diagnosis of Hamstring Injury

An experienced and qualified physician or physiotherapist will be able to diagnose hamstring tears based on history and physical examination. Occasionally, a doctor may advise an MRI to know the extent of damage in the thigh area and other structures involved. However, caution is required as there are other medical conditions with similar symptoms.

Some examples of other conditions with similar complaints are:

  • Adductor strains or groin area injury
  • Piriformis syndrome or spasms in the buttock muscles
  • Lumbosacral referred pain or pain in the lumbar spine
  • Sacroiliac dysfunction involving pain in the area linking pelvis and lower spine
  • Sciatica, a radiating pain branching out from the lower back running down the hips and buttocks down a leg
  • Ischial bursitis, also called Tailor’s Bottom, is an inflammation in the fluid filled sac that cushions your bones and tendons in the pelvic area
  • Strained popliteus muscle/ gastrocnemius – difficulty in extending or flexing the knee
  • Posterior Cruciate Ligament or PCL tear involving the ligaments in the back of the knee

Treatment of Hamstring related injuries

Management of hamstring tears are complex and takes a lot of time and effort for complete recovery. It also depends on the extent of damage.

 

  • First phase of treatment focuses more on protecting the area and reducing the pain and swelling. Different modalities like Cryotherapy, Ultrasound and TENS may be used. Doctors may advise Mild isometric and ROM exercises.
  • Second phase of rehabilitation starts once the patient is pain free and the swelling has reduced. The patient gradually progresses with exercises under monitoring to avoid further damage of the healing tissue. Various types of exercises such as isometric, concentric strengthening are part of the regimen. While eccentric exercises are more effective, they are also stressful and need to be performed carefully. Other exercises such as for proprioception, treadmill, stationary cycling, core strengthening etc can be performed. Increase in flexibility is the focus at this stage.
  • Third phase of rehabilitation targets primarily on regaining fitness and return to sports. In this phase advanced strengthening exercises like dead lifts, Nordic hamstring training etc are introduced. Strengthening involves both the extreme ranges of knee flexion and extension. Plyometrics, Agility training, running and all types of sports specific exercises need to be done.

Treatment of Hamstring related injuries

Hamstring injuries can be prevented with proper evaluation and training. To avoid a tear or strain in the back-thigh muscle areas, you can talk to a physiotherapist who can help identify the risk factors and design appropriate programme for injury prevention.

Written by
Mr Nithin Krishna K, MPT, Physiotherapist & Coordinator, RxDx SportsMed, Whitefield, Bangalore.

Edited by
Ms Anindita Choudhury, Content Writer & Communication Specialist, RxDx Healthcare

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