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Hamstring Injuries Physiotherapy

A hamstring strain injury happens when 1 or more of the 3 hamstring muscles or tendons (at the back of the thigh) is torn, either partially or completely.

In fact, hamstring injuries are one of the most common injuries of the lower body, particularly affecting athletes participating in sports involving high-speed running, such as

• football
• soccer
• track

After tearing a hamstring muscle, the patient is 2 to 6 times more likely to suffer a subsequent hamstring re-injury. In most cases, hamstring strain injuries are successfully managed with physiotherapy.

What are Hamstring Injuries?

The hamstring muscle group includes 3 muscles along the back of the thigh that connect the pelvis to the leg. They are the primary muscle group responsible for straightening (extending) the hip and bending (flexing) the knee.

The 3 hamstring muscles are:

• Semitendinosus
• Semimembranosus
• Biceps femoris

The anatomy of muscles includes the muscle “belly,” the portion that contracts (tightens) or relaxes to move a limb, and the tendon, the portion that connects the muscle belly to the bone. Hamstring strain injuries occur when there is damage to the muscle belly caused by excessive force being generated while the muscle is being stretched.

This type of injuries typically happens during high-speed running, with sudden starts or changes in direction, or when the muscle is overstretched by activities such as sprinting, hurdling, kicking, or heavy lifting.

Risk factors for hamstring strain injuries include:

• A history of prior hamstring strain injury
• Hamstring weakness
• Increasing age
• Poor flexibility of the quadriceps and hip flexors (muscle tightness)
• Inadequate warm up before activity
• Muscle fatigue

How Does a hamstring injury Feel like?

When a person experiences a hamstring strain injury, they will feel/experience a sudden pain at the back of the thigh.

Hamstring pulls and injuries happens very quickly and causes the individual to stop performing an activity. The symptoms caused by a mild injury may only last for a few days; symptoms of a more severe hamstring injury can last for weeks.

Common hamstring injury symptoms include:

• A sudden, sharp pain in the back of the thigh or in the buttocks
• A feeling of a "pop" or tearing in the muscle
• Bruising within hours or days after the injury
• Tenderness to touch in the affected area
• Difficulty sitting comfortably, lifting the leg when lying down, or straightening the knee
• Difficulty walking or running, resulting in a limp

How Is hamstring injuries Diagnosed?

Diagnosis of a hamstring strain injury starts with a thorough understanding of your health history and the cause of the injury. The questions our senior physiotherapists may ask include:

• What were you doing when you first felt the pain, and did you feel a “pop"?
• Where do you feel the pain now?
• Did you notice any bruising after the injury?
• What were you not able to do immediately following the injury, and how have you been functioning since the injury (eg, walking, sleeping, lifting your leg)?
• Have you had a similar injury before?

We will also perform a clinical evaluation, including some of the following tests and measures to determine the nature of your injury:

• Observation, to note any discoloration or bruising
• Pain assessment, to identify your current pain level, and the activities that make your pain better or worse
• Palpation (gently pressing with the fingers), to pinpoint the location and size of the tender area through touch, which will help determine the severity of the injury
• Range-of-motion test, to compare the motion of your injured leg with your healthy leg
• Muscle-strength test, to determine the strength of the hamstring muscles when bending or straightening your knee and hip
• Gait analysis, to note any limping or changes in how you are walking

Typically, hamstring strain injuries are classified as Grade I, II, or III depending on how mild, moderate or severe the injury is:

• Grade I: Mild strain with minimal tearing; usually feels like a pulled or cramping muscle.
• Grade II: Moderate strain with partial tearing; may cause a stinging or burning sensation at the back of the thigh.
• Grade III: A severe, complete muscle tear; may result in a “lump” on the back of the thigh where the muscle has torn.

If we suspect a severe injury (Grade III), you will likely be referred to an orthopedic doctor for medical diagnostic imaging, such as an X-ray or MRI, to evaluate the extent of the injury.

In the event of a fracture of the ischial tuberosity (the “sit-bone,” part of the pelvis) and/or a complete rupture of the muscle, surgery may be recommended.

how our senior physiotherapists can help

Immediately after experiencing a hamstring strain injury, seek help from our senior physiotherapists. Before the physical therapy session with us, you can:

• Rest the injured area by avoiding aggravating activities, such as walking or working out. If you are having notable difficulty walking, you may need crutches. Do not over-stress the injured area.
• Apply cold therapy to the injured area 3 to 4 times a day for 15 to 20 minutes (with a towel placed between your skin and the ice).

We will design an individualized treatment program specific to the exact nature of your injury and your goals. Your treatment may include:

Manual therapy

We are trained in manual (hands-on) therapy to gently move and manipulate muscles and joints to improve motion, flexibility, and strength. We may gently massage and move the affected area to encourage healing. These techniques can target areas that are difficult to treat on your own.

Range-of-motion exercises

Although it is common for your hamstring muscles to feel stiff after an injury, it is important not to stretch these muscles early in the recovery process. We will indicate when it is safe and appropriate to begin gentle flexibility exercises, and will guide you through how to do them in the clinic and at home.

Muscle strengthening exercises

Hamstring strengthening will be an essential part of your rehabilitation program. We will compare the strength of the muscle groups in each leg, and prescribe and teach you specific exercises to target areas of weakness.

Functional training

As you regain the strength in your hamstrings, your movement quality will need to be assessed so you no longer put excessive stress on the previously injured area. We will develop a functional training program for the hamstring muscle group, with a gradual progression back to more demanding activities.

In the event that the severity of your hamstring strain injury requires surgical treatment, our senior physiotherapist will guide your postoperative hamstring physiotherapy rehabilitation. We will communicate with your surgeon to ensure complete and consistent postoperative care.