Your hamstring is a group of three muscles (and their corresponding tendons) in the back part of your thigh that all work together. If you do something that causes one or more of those muscles/tendons to tear, that is called a hamstring injury. Hamstring injuries are among the most common injuries that occur in the lower body, and are experienced especially frequently by athletes that run a lot, such as soccer players or track competitors. Hamstring injuries have a high rate of recurrence; after suffering from a hamstring injury, you’re 2-6 times more likely to injure your hamstring again. The most severe cases of hamstring injuries sometimes require surgery, but physical therapy is usually able to manage most of them.
What are Hamstring Injuries?
The three muscles that make up your hamstring are the:
- Biceps femoris
These muscles are primarily responsible for controlling the motion of your hip and knee. When you apply extreme pressure on these muscles, such as when a runner abruptly stops or changes direction, you are likely to suffer a hamstring injury. Other maneuvers that often lead to hamstring injuries are sprinting, hurdling, heavy lifting and kicking, all of which can cause your muscles to be stretched too far.
Hamstring injuries usually involve the following components:
- The hamstring muscles and tendons themselves
- The bursa, a sack filled with fluid that is meant to buffer friction between the bones and soft tissue, which is often irritated by recurring hamstring injuries
- The ischial tuberosity, often referred to as your “sitting bones,” which is the bone on which weight is usually placed when you’re sitting
Factors that put you at risk for hamstring injuries include:
- Previous hamstring injuries
- An imbalance of muscle strength (especially in the hamstrings)
- Tight muscles/reduced flexibility
- Not taking the time to warm up prior to your activity
- Muscle fatigue
What Are Symptoms of Hamstring Injuries?
The severity of your hamstring injury usually determines the degree of symptoms that you’ll experience. People who suffer from mild hamstring strains often complain of a pulled or cramping feeling—sometimes they don’t actually even realize they’ve pulled their hamstrings until a day later, when there’s visible evidence of the injury, such as bruising. If a hamstring is more severe, the symptoms can be significantly more painful, including:
- Sharp, shooting pain in the buttocks or back of the thigh
- Feeling or hearing a “pop” when the muscle tears
- Bruising at the point of injury either hours or days afterward
- Discomfort or difficulty trying to sit, lifting the leg, or straightening the knee
- Inability to walk properly, causing a limp
How Are Hamstring Injuries Diagnosed?
When you go to your physical therapist, he or she will likely ask you a number of questions regarding your health history and how you injured yourself. These questions may include:
- Whether or not you’ve had a similar injury previously
- What you were doing when the pain started
- Whether or not you felt/heard a “pop,” and where you first felt the pain
- Whether or not you experienced any swelling or bruising within the first 24 hours of being injured
- How you’ve been able to function since the injury, as far as moving your leg/getting around is concerned
Your physical therapist will then perform a clinical evaluation, which will include:
- Observing any discoloration or bruising at the point of injury
- Determining your current pain level, and movements that increase/decrease the pain
- Palpation, which allows your therapist to pinpoint where your pain originates, and the size of the affected area, determining the severity of your injury
- Testing your range of motion by comparing your injured leg to your healthy leg
- Testing your muscle strength by having you bend and straighten your knee and hip
- Observing your gait to see if you’re limping or in pain while walking
Hamstring injuries are usually classified as Grade I – III, depending on the injury’s severity.
- Grade I – a mild strain with a minimal degree of tearing; feels like a cramping/pulled muscle
- Grade II – a moderate strain with partial tearing; feels like a burning or stinging sensation that runs along the back of the thigh
- Grade III – a severe, complete muscle tear; there may be a visible ‘lump’ at the back of the thigh at the point where the muscle has torn
When physical therapists encounter Grade III hamstring injuries, they will usually refer the patient to an orthopedic physician, who will perform medical diagnostic tests, such as an x-ray or MRI, for a full evaluation of the injury. Surgery is sometimes recommended if the patient has fractured his or her ischial tuberosity, or has completely ruptured the hamstring muscle.
How Can a Physical Therapist Help Your Hamstring Injury?
As with many other injuries, your physical therapist knows a number of treatment methods specific to hamstring injuries, and will build a personalized recovery program for you based on his or her evaluation of your injury.
During the first 24-48 hours, your physical therapy may include:
- Resting your injured area, and avoiding walking or working out, which may aggravate the injury. Crutches may be an option if you’re having serious difficulty walking.
- Applying ice to the affected area, 3-4 times per day, for no more than 15-20 minutes at a time, with a towel or other barrier between the ice and your skin
- Using compression wraps on the area to minimize pain and swelling
- Referring you to another specialist for further testing if necessary
Afterward, your physical therapy will likely focus on:
- Range of Motion: after an injury, it’s to be expected that your muscles and joints may be stiff. As the pain begins to go away, your physical therapist can help you slowly integrate light flexibility exercises into your routine.
- Muscle Strength: strengthening your hamstring will be a key component of your recovery. Your physical therapist will use your healthy leg as a comparison against your injured leg, and instruct you to perform exercises that will target the weakest parts of your injured leg, to bring it back up to par with the healthy one.
- Manual Therapy: this involves your physical therapist using his or her hands to manipulate your muscles and joints to improve your motion, flexibility, and strength. Physical therapists often use manual therapy to target areas of weakness that aren’t very easy to work on yourself.
- Functional Training: as we explained earlier, hamstring injuries have a frequent recurrence rate. When your strength and flexibility begin returning to normal, your physical therapy routine will focus on training your body to move in ways that will avoid putting unnecessary stress on your hamstrings. Your physical therapist’s experience will allow him or her to construct a plan for you that caters to your specific physical activities.
Can Hamstring Injuries be Prevented?
Yes! You can avoid injuring your hamstring by:
- Being sure to always warm up before you play sports or participate in other physical activity
- Avoiding abruptly beginning any physical activities; allow your body to adapt gradually to new activities by increasing the frequency and intensity of your participation over time
- Taking care of yourself after physical activities by stretching, icing, or resting as necessary—don’t ignore your body when it tries to tell you what it needs
- Using proper form when participating in physical activities, such as lifting and squatting techniques