Have You Been ‘Hamstrung’? A Hamstring Injury Help Guide

‘Hamstrung’ – a figurative verbal expression from the noun hamstring (the muscle and tendon on the back of the thigh), originating in the 1500’s where soldiers would slay their enemy across the back of their thighs rendering them disabled, crippled, lame, or useless.

If you have ever strained or torn a hamstring muscle (albeit in a less violent manner!), you probably felt the same.

Hamstring injuries are the most significant injury in football, rugby, running (more commonly sprinting), basketball, and baseball.

Apart from being debilitating at the time of injury, hamstring injuries can be frustratingly slow to heal. Often taking an average of 3-4 weeks to recover, even up to 6 months to return to full sporting ability.

What’s worse is that there is a 20 to 50% chance that you will re-injure your hamstring in the same season! Hamstring injuries can be strains that are a pulled or torn muscle, or an overuse injury called hamstring tendinopathy.

The hamstring is a powerful group of three muscles that run down the back of your thigh from your buttocks to just below your knee. They work over two joints, both bending (flexing) the knee and extending (straightening) the hip.

The hamstrings work throughout each stride, but are especially active when you are bending the knee and extending the hip at the same time, for example when going up hills or powering to the finish in a run.

Often injuries to the hamstrings happen with sudden changes in running direction, sudden acceleration, explosive speed, or when trying to contract the muscle whilst it is being stretched, for example a football player with an outstretched leg, attempting a high kick all at the same time.

Risks

Social athletes or sportspersons of any level are at risk of straining their hamstrings. However, people who sit for long periods of time during work or at home are also at risk of injury. They most likely have weak and tight hamstrings, due to the static nature of their day, and shortened position of the hamstring whilst sitting.

Whether this is you, the office worker who is convinced to play a quick friendly game with mates after work; or get roped into the parents 100m dash at the school sports day; or a weekend warrior; ‘tearing’ your hamstring (or at least injure the tendons) can happen.

Hamstring tendinopathy is an overuse or overloading of the hamstring muscle tendon attachments either at the knee or on the ischial tuberosity (sitting bone) deep in your buttocks. This may come about from an increase in training load, for example more hill running, increased speed work, unaccustomed deep lunges, yoga or deadlifts. Tendons have poor blood flow that makes healing and recovery slow, especially without physical therapy.

When the hamstrings contract, the quadriceps muscles relax. And vice-versa. It’s a not-so-delicate game of tug-of-war. When they are out of sync, injury can happen that can extend beyond the muscle groups themselves. Several factors, often in play at the same time, can cause a strained hamstring, however many of these factors are modifiable, suggesting one can prevent a hamstring injury to a certain degree.

Strength imbalances, muscle fitness and endurance, warming up, underlying back problems, technique, conditioning of the muscle to acceleration and deceleration – these risk factors can all be addressed. Sadly, a previous hamstring injury and age are two risk factors that can’t be altered. Increasing age increases injury risk. It’s something to be aware of and possibly take extra caution to prevent a hamstring injury!

Symptoms

Your symptoms may vary depending on how severely you strain your hamstring or injure the tendons.

They may include:

• Pain behind the leg and into the buttock immediately at the time of injury or afterwards, with difficulty running or walking.
• Muscle spasm and tightness in the muscle, swelling, bruising (which can spread down into the calf area) and tenderness.
• Associated pain in the buttocks and back. If the tendons are involved there may be pain on, or just below the sitting bone (ischial tuberosity).
• Chronic stiffness in the back of the legs aggravated by sitting and driving, deep lunges and hamstring stretches.
• Sharp, stabbing pain even an audible popping or snapping sensation when the injury occurred.
• With a complete tear, you may feel a ‘ball’ of muscle in the back of your thigh.

Management

Treatment and rehabilitation

• As soon as you can follow R.I.C.E. protocol for a few days. That is, rest, ice (up to 15 minutes at a time), compression and elevation, and then go and see an Osteopath or Sports Therapist after about 2-3 days. You may want to rest the leg and use a crutch to reduce loading on your injured leg.

Once this acute phase has passed treatment can progress to:

• Physical therapy, which helps to promote healing and ensure minimum scar tissue formation. This will include massage, and soft tissue mobilisation to release the surrounding structures of the hamstrings as well as addressing underlying back or hip issues. Ultrasound may also be used to help promote healing.
• If you have tendinopathy arising from below the buttock sit as little as possible, use a cushion under your buttock to relieve pressure on the tendons attached to the sitting bone.
• Correcting muscle strength and flexibility imbalances. Including strengthening the pelvis and core including the gluteus (buttock) muscles as they work with the hamstrings.
• Strengthening exercises such as squats, deadlifts and stretches to improve eccentric strength of the hamstring.
• Correction of sports technique and functional problems including leg length discrepancy or flat feet – a podiatrist will be able to advise whether orthotics would help.

Training

Complete rest may be advised depending on the severity of the injury. Otherwise reduce the intensity and volume of training. Avoiding speed and hill work and find a comfortable walking/running pace and distance that doesn’t cause pain, and stick with that 3 times a weeks with a rest day in between.

Walk/run on softer surfaces like grass. Gradually build up training load and intensity – be patient! Compression tights during or after running or sports can aid blood flow and recovery.

Also worth considering:

• Cross-train in sports that don’t place a heavy demand on the hamstrings e.g. upper body strength training, easy lap swimming, low resistance stationary cycling or cross trainer
• Observe the 10% rule: Do not increase exercise intensity, frequency or duration more than 10% a week.
• Regular massage may form part of a prevention strategy, keeping the hamstring muscle flexible and aiding in muscle recovery.

For optimal recovery and prevention of a recurrent hamstring injury it is essential you work through a treatment and rehabilitation program with your Osteopath or Sports therapist.

 Debbie Crumpton