Hamstring strains are very common in almost all sports. Moreover, participating in spring sports in the cool temperatures of NEPA presents additional challenges. Each March our clinic has many players limp in with pain in the back of their thigh when they pull or strain the hamstring muscle during track and field, baseball, and tennis. New research shows that these injuries can be prevented by following a specifically designed intensive training program.

Hamstring Strain

A hamstring strain is a tear of the muscle fibers of the muscle group in the back of the thigh called the hamstring. The hamstring muscle is a group of three muscles that run from the back of the hip (lower pelvis), crossing the back of the knee and attaches to the knee bone (tibia). The hamstring muscles work to extend the hip and bend the knee during running and walking activities. They are very active when an athlete changes direction, especially forwards and backwards or decelerating. This injury, like others, varies in intensity. Severe hamstring strain occurs when many muscle fibers are torn. In very severe cases, the boney attachment can be pulled so strongly that a small fracture can occur. Healing time can be as short as a few days or as long as weeks or even months.

Most Common Causes of a Hamstring Strain

• Overuse – every time the knee is bent the hamstring muscles must contract. If there is not adequate time allowed for rest between workouts or competition, then the muscles may be fatigued and become vulnerable to injury. Also, overuse of the same muscles without rest may make them irritated and inflamed.
• Inadequate Warm-up – a warm muscle stretches like a piece of gum warmed up in your mouth. When you pull the warm gum, it stretches. However, if you drink an ice cold drink with gum in your mouth and then stretch the gum, it will tear instead of stretch. A good warm-up will prevent tearing and prepare the nervous system for sudden movements and changes in direction.
• Sudden Movement – quick sprint, sudden change in direction, quick turn with an unexpected force or slip.
• Poor Body Mechanics – especially when moving or lifting a heavy load away from your center of gravity.
• Forceful Contact or Loss of Traction – when a leg is forced away from the body by an outside force (tackle in football) or slip on grass or ice.

Symptoms of a Hamstring Strain

• Pain - usually occurs gradually. However, a sudden onset can occur, especially associated with a sudden twist or fall. Movement of the hip or knee or a change in direction reproduces pain in the buttocks or back of thigh. Touching these areas reproduces pain.
• Swelling/Discoloration – swelling and black and blue coloration can occur in the buttocks or back of thigh after increase activity at the end of the day.
• Stiffness – in the buttocks, back of thigh and/or knee is more noticeable in the morning and improves with movement. However, overuse can create more pain and swelling and lead to stiffness also.
• Weakness – associated with pain in the buttocks, back of thigh and/or knee can lead to occasional buckling of the hip or knee when walking or climbing steps or getting in or out of a car.
• Loss of Function- is associated with pain, swelling, weakness and stiffness, which limit walking, stair climbing and participation in sports activities.

Diagnose a Hamstring Strain

Your family physician will examine the back of your leg to determine if you have hamstring strain. Sometimes, pain in the buttocks and back of the leg can be referred from you lower back if the sciatic nerve is inflamed. In more advanced cases, you may be referred to an orthopedic surgeon for further examination and treatment. An X-ray, MRI or bone scan will show the extent of the tear and if the bone is involved. The diagnosis will determine if your problem is minor, moderate or severe.

Treat Hamstring Strains

There are many conservative options. You and your family physician or orthopedic surgeon will decide which choices are best.

• Anti-inflammatory Medications: such as aspirin, acetaminophen or ibuprofen to reduce pain and swelling.
• Orthopedic Physical Therapy: such as heat, cold, ultrasound, electrical stimulation, joint mobilization, massage, range of motion exercises, strengthening exercises, and supportive compression strapping. Once painfree, a preventative training program is essential to prevent reinjury.
• Activity Modifications: if it is not the week of the district tournament, rest, avoid running or stretching/stressing of the thigh muscles.
• Supportive Devices: such as thigh wraps or sleeves, compression shorts (like those worn under basketball shorts) can provide compression and relief.

Prevent Hamstring Strains

A recent study in the British Journal of Sports Medicine determined that a training program specifically designed to prevent hamstring injuries is effective, especially for the competitive athlete. This program includes:

• High Intensity Training- regardless of the speed of your sport, high intensity, interval anaerobic training is critical. Interval sprints are the best example.
• Simulate the Demands of the Sport – when training, simulate the specific demands of your sport… “train the way you play.” For example, in football, the average play lasts 7-10 seconds. Therefore, sprint on a count from the line of scrimmage for 7-10 seconds. First, sprint in a straight line. Then, sprint and cut at 3-5-10 yards. Then, sprint, cut and spin. Then, sprint figure 8’s.
• Weight Train for Power and Strength/Weight Train for Speed and Endurance- traditionally, weight training is performed with high weights and low repetitions to increase power and strength and both arms or both legs are used at the same time. However, to prevent hamstring injuries, add a few sets of speed/coordination training by performing lifting with low weights and high reps. Also, alternate right and left legs to simulate a walking speed.
• Weight Training Using Negatives/Eccentrics – weight training with a concentration on lowering the weight against gravity, not raising it.
• All Muscle Groups – of the lower body, not just the quads and hams. Include: Hip flexion, extension, abduction, adduction, internal & external rotation.
  • Knee: flexion, extension
  • Ankle: flexion, extension, inversion, eversion
• Warm -Up: a preactivity slow jog or exercise bike and/or massage to the area to warm up the muscles prior to play.
• Stretching: Indian sit stretch, Hurdler stretch, Lying hamstring wall stretch
• Strengthening Exercises: weight training for legs, including inside and back leg muscles, use weights or resistance tubing for leg curls and hip extensions.
• Agility Drills: figure 8, cross-over, tire or disc running
• Compression Shorts: like those worn under basketball shorts
• Cool Down: use ice to the effected area after exercise or sport

SOURCES: Journal of Physical Medicine & Rehabilitation and American Academy of Orthopaedic Surgeons

Visit your doctor regularly and listen to your body.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.