Hamstring injuries are a common issue of many players. Most players follow many preventive methods to avoid from these kind of muscle injuries. Among hamstring injuries, Hamstring strain takes a large portion of hamstring injuries. Hamstring injuries are most frequent in sports, such as football, rugby, soccer, basketball, and track and field. It is important to say that sometimes dancers are also vulnerable group of having hamstring strain. So, you should know about hamstring strain thoroughly and its rehabilitation protocol. because without proper rehabilitation process, you can’t reach your previous performance level without re-injury.

What are Hamstring muscles?

Hamstrings are posterior thigh muscles which cross both hip joint and knee joint. These muscles are also called biarticular muscles. Hamstring muscles are Biceps femoris (except short head), Semimembranosus, Semitendinosus. All of these muscles originate from ischial tuberosity of pelvis and distally attach to the tibia and fibula.

What is a hamstring strain?

Most probably, Hamstring strains occurs at the musculotendinous junction of the Biceps femoris muscle. Semimembranosus muscle is more prone to damage apart from the Long head of biceps femoris muscle. Mostly, people get hamstring strains due to indirect trauma which tend to occur during non-contact activities and running is the primary activity. Here, the maximum eccentric contraction period identified as the greatest risk for muscle injury. Mechanism for injury as increased force generated during eccentric action of the muscle as opposed to a concentric contraction.

What causes Hamstring strain?

Moreover, we can identify few common risk factors which lead to hamstring strain. Among them some are controllable factors. So, it is good to know these factors to avoid from hamstring strain

  • Lack of adequate flexibility
  • Strength imbalances in the hamstrings
  • Lack of adequate warm up
  • Muscle fatigue
  • Poor core stability
  • Previous calf and knee injuries

Clinical Presentation

  • Acutely when the athlete experiences sudden onset of pain in the posterior aspect of the thigh
  • An audible click
  • hematoma or ecchymosis in the posterior region of the thigh
  • Inability to continue with physical activity
  • Antalgic gait
  • Decrease hip extension and knee flexion

Clinical Examination

Minor hamstring strain may produce no physical findings. But severe tear may produce extensive bruising, swelling, tenderness and possibly a palpable defect and also knee flexion and hip extension are painful. In the palpation, patient should be lying prone and entire length of the hamstring muscles should be palpated by the examiner. Examiner also did few special tests to identified and confirm the grade of your hamstring strain. eg: Slump test

Classification

  • Garde I strain: overstretching of the muscle resulting in disruption of less than 5% of the structural integrity
  • Grade II strain: Partial tear with a more significant injury but an incomplete rupture of the musculotendinous junction
  • Grade III strain: Complete rupture of the muscle with severely torn, frayed ends

How to heal hamstring Strain fast?

In severe cases, your orthopedic surgeon recommends a surgery for you. But Sometimes hamstring strains are healed without any treatment. But if you want to recover soon with regaining the maximum functionality and prevent further hamstring injuries, you should have followed a really effective rehabilitation program. Hamstring strain rehabilitation protocol should be referred by a Physical Therapist after clearly diagnose your condition. So, Let’s focus on typical hamstring strain rehabilitation program which may help you to get better idea about this process.

Medication

Medications can play a role during the initial stage of a hamstring strain to control the pain and inflammation. Non-steroidal anti-inflammatory drugs (NSAIDS) are prescribed by the doctor. Apart from NSAIDS, some clinicians prescribe corticosteroid injects for decreasing the inflammatory response. But still these are controversial since lack of scientific evidence. However, some studies suggest that corticosteroid injection may decrease the recovery time minimizing the chance of re-injury

Phase 1: Acute stage (first 5 days after injury)

During the first five days physical therapist mainly focus on reduce the pain and edema, so PEACE method can be applied. and also, immobilization is used to limit hemorrhage.

What is PEACE?

P-protection: Stop activities and movements

E-Elevation: Injured limb must be elevated higher than the heart level

A-Avoid anti-inflammatories: avoid getting NASIDS

C-Compression: reduce swelling by covering it.

E-Education: Educate the patient about healing process

Phase 2: sub-acute stage (Day 3 to week 3)

GoalTreatment
Prevent muscle fiber adhesions (after 5 days)Passive range of motion exercises in pain free range Gentle stretching Wall slides Heel slides Hamstring stretching  
Return to normal gait by avoiding antalgic gaitFirst use crutches then try to be independent
Control pain and edemaIce, compression
Maintain cardiovascular conditioningWell leg stationary bike
Full active Range of motionPain free passive and active range of motion exercises
Increase collagen strengthPain free submaximal isometrics

Ice application

Cryotherapy(ice) is another effective way of reducing pain and inflammation at the acute stage. Physical therapist prescribes best method of ice application after examining the condition but typically, it is better you can apply ice for 10-20 minutes.

Phase 3: Remodeling (week 1 to week 6)

GoalTreatment
Maintain cardiovascular conditioningWell leg stationary bike
Control pain and edemaIce and compression
Increase collagen strengthProne concentric isotonic and standing concentric exercises Rolling stool
Increase hamstring flexibilityPelvis tilt hamstring stretching
Increase eccentric loadingProne/ standing eccentric exercise(Nordic)

Phase 4: Functional phase (week 2- month 6)

GoalTreatment
Return to sport without re-injuryWalking, Jogging, Sport specific skills
Increase hamstring flexibilityPelvic tilt hamstring stretching Spine hamstring stretching
Increase hamstring strengthProne concentric and eccentric exercise
Avoid re-injuryMaintenance stretching and strengtheing  

Credits for featured image: People photo created by jcomp – www.freepik.com

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