Hamstring Injuries

an article by physiotherapist Dr Leon Mao.

Hamstring strains are one of the most common sporting injuries seen by our physios at Hawthorn Physiotherapy Clinic. This is also the most frequently sustained AFL injury sustained in the last decade. On average, each AFL club had an average of 15 matches missed due to a hamstring strain.

Look no further than Nat Fyfe of the Dockers who has missed the last 3 games and been ruled out of the 2022 semi-finals and Josh Kennedy of the Swans who had his 2^nd hamstring injury of the season in August, jeopardising his hopes of playing in the finals as well. If you’re reading this right now, there’s a chance that you’ve injured your hamstring. Our physiotherapists have written this guide to provide clarity and assist you with our approach to hamstring injuries. With over 70 years of accumulated practice experience, our clinic has successfully treated countless hamstring strain injuries.

What is a hamstring strain injury?

Hamstring strains go by many other names. Pulled hamstring, hamstring tears and torn hamstrings are all phrases used to describe it. Contrary to popular belief, these terms all describe the same injury. Based on our exercises, the hamstring is one of the most frequently strained muscles during any running activity.

A strain injury is used to describe a tear of the muscle fibres. It typically occurs during activities that overload the hamstring muscle, such as running and kicking. The severity of a strain injury depends on several factors, such as the size and location of the tear. As a result, the rehabilitation and recovery timeline will vary person-to-person.

Hamstring Strain Grading

Hamstring injuries are sometimes graded depending on the severity. They are classified into 3 grades and are outlined below [1].

Grade 1 hamstring strains are mildly severe injuries. Most of the strength and flexibility of the hamstring is preserved as only a small portion of muscle fibres are torn or overstretched.

Grade 2 strains are moderately severe injuries. Pain, swelling and bruising will occur as approximately half the hamstring’s muscle fibres have been torn. A substantial loss in flexibility and strength can happen.

Grade 3 strains are complete rupture or tear of the muscle fibres. The hamstring muscle(s) are completely separated, which means that flexibility and strength are completely disrupted.

Grading of hamstring strains can be determined through a physical assessment by a physiotherapist and/or imaging investigations, such as an ultrasound or MRI.

Hamstring Anatomy and Overview

The hamstring is a massive collection of muscles that help with any activities that require the movement of the hips and knees. There are 3 main muscles that make up the hamstring, which includes the:

Semimembranosus
Semitendinosus
Biceps femoris

Where is the Hamstring?

The hamstring muscles are located at the back of the thigh that run across both hip and knee joints. All 3 muscles start at a bony area underneath the bottom called the ischial tuberosity or the linea aspera – this is known as the hamstring origin. They then span along the length of the thigh to the back of the knee at the tibia or fibula – also known as the hamstring insertion.

Hamstring Function

Given the size and location of the hamstring, it plays a pivotal role in driving leg movements. The multiple functions of the hamstring include:

Bending the knee (also known as knee flex)
Moving the hip backwards (also known as hip extension)
Transference of weight through the legs when walking, jogging or running
Providing stability around the hip and knee joint
Eccentric control of the limb during the late swing phase of running or sprinting [2]

Hamstring Strain Signs and Symptoms

Hamstring symptoms often occur during forceful activities, such as sudden stretching, kicking, sprinting, or changing directions. A popping and/or tearing sensation can be felt immediately after sustaining a hamstring injury. Common signs and symptoms include:

Sudden onset of hamstring pain, felt along the back of the thigh
Hamstring bruising and swelling
Weakness of the hamstring muscle(s)
Limping

Hamstring Strain Treatment

Hamstring injury treatment will depend on several factors, including the strain’s severity, location, and time since it occurred. The majority of people suffering from hamstring strains can be rehabilitated through physiotherapy. There will be rare circumstances where orthopaedic specialists may be involved.

Early Hamstring Strain Management

Recovery and preventing physical deterioration will be the priority during the first few weeks after sustaining a hamstring injury. Some self-care tips include [3]:

Elevating the leg to help reduce bruising and swelling
Wearing compression stockings
Resting from vigorous activities
Temporarily using a crutch if you are limping and need assistance.
Using ice within the first 24-48 hours or only as required. Some degree of inflammation is necessary to encourage the healing process.

Rehabilitation and Physiotherapy

Starting hamstring strain rehab with physiotherapy is crucial for proper recovery, return to sports and preventing future injuries. While muscular strains heal naturally over time, people are often left with weaker and tighter hamstrings. This leads to injuries recurring which means more time away from physical activity. Research has shown hamstrings can re-tear up to 63% of the time after the first one [4].

If you suspect a hamstring strain, you should aim to see your physiotherapist straight away. Treatment and rehabilitation should be commenced immediately to ensure a quicker return to pre-injury fitness. They will provide you with a short-term and long-term action plan to help you reach your goals. Examples of treatments include:

Rehabilitation exercises (please see our hamstring strain exercises below).
Pain management (e.g. hands-on treatment, dry needling, electrotherapy, etc.).
Guided increases in aerobic activity and movement.
Education about the best way to help manage your hamstring strain recovery.
Confirming when you can safely return to sport.

Orthopaedic Specialist Referral

While rare, those who sustain significant tears or do not respond to the usual treatment may require a referral to an orthopaedic specialist. Depending on the specialist’s opinion, surgery may be required. Our physiotherapists will then liaise with the surgeon to guide post-operative rehabilitation.

Hamstring Strain Recovery

The duration of your healing process will depend on the severity, location and what your goals are. As a result, recovery can range anywhere between 4 weeks to 12 months. Mild grade 1 hamstring strains can heal as soon as 4-6 weeks. In contrast, grade 3 injuries may require surgery and 6-12 months of recovery. Recent research has indicated that elite football players who have sustained hamstring strain injuries take on average 23-43 days to return to sport [5].

Recovering from hamstring strains can be a long and challenging journey. Prioritising a quick but safe recovery should be prioritised to prevent re-injury and a winning outcome. As one of the oldest physiotherapy clinics in Victoria, we have successfully treated hundreds of clients with hamstring strains.

Whether you’re looking for a face-to-face or online appointment, our dedicated therapists at Hawthorn Physiotherapy will help find a solution for you.

Start your hamstring rehab today by making a booking here.

References