This article addresses the cause(s), symptoms, treatment and expected results of injuring the hamstring muscle. Injury to the hamstring muscle is commonly thought of as only sports related, granted the largest number arise from sport. Hamstring injuries have been in many cases mischaracterized in the senior patient. This article addresses the cause(s), symptoms, treatment and expected results of injuring the hamstring muscle. Injury to the hamstring muscle is commonly thought of as only sports related, granted the largest number arise from sport. Hamstring injuries have been misdiagnosed in the senior patient. The patient has been told they have “sciatica.” Hamstring injuries are painful and the danger of recurrence is high.
Cause of Hamstring Injury
There are many causes of hamstring injury. It is important to note that the “hamstring” is actually made up of 3 muscles. The muscles start at the bottom of the pelvis at the bones you sit on. These muscles end just below the knee. The hamstring muscle flexes the knee and extend the hip (moves the thigh back with the leg straight) and are a primary knee flexor.
What happens when injury occurs? The muscles are stretched beyond the normal capacity of the muscle to handle the sudden stretch or weight load placed upon it. The muscle tissue tears and bleeding ensues at the area of injury.
Here are examples but not limited to what could injure the muscle(s):
- Failing to adequately stretch before work or sport competition
- Sudden acceleration such as jumping and running
- Fatigue of the muscle at work or sport
- Abnormal spine and lower extremity biomechanics – includes lower back, hip, knee, ankle and foot mechanics due to prior injury or osteoarthritis
- Slips and falls – sport or work surface
- Improper running posture or biomechanics
What Are the Symptoms of Hamstring Injury?
A classic symptom or comment is the injured person hears a “snap or pop” in the back of the upper leg. Depending on the extent of the injury, the athlete or worker may not even be able to stand let alone walk or continue the task. If you have seen an athlete injure the hamstring, you will recall they grab the upper leg and immediately start limping. The pain can be quite severe when the injury occurs. Putting pressure over the muscle becomes more painful the closer to the tear in the muscle. The muscle tightens up or goes into spasm to protect it from further damage. Shortly after the tear, you may notice “black and blue” discoloration. This is from the blood in the area of the tear. The tearing occurs usually at the tendon attachment of the hamstring to the area of the pelvic bone that you sit on.
There are 3 grades or classifications of hamstring strain. The muscle strains classification is as follows:
- Grade 1 – A sense of tightness is present in the back of the upper leg. Walking may not be affected, but you will be unable to run. Trying to bend the knee against resistance will be uncomfortable in the hamstring.
- Grade 2 – Difficulty walking will be present and there will be a limp. The muscle will be tender and swelling may be present. When active the muscle is painful.
- Grade 3 – Tearing of the muscle either partial or a full tear. Extreme difficulty walking and the use of crutches is recommended. Swelling begins within 12-24 hours and bruising will be present. MRI evaluation is reasonable for a suspected tendon rupture.
Treatment of Hamstring Injury
Immediate treatment is to reduce swelling and prevent further injury. Avoid activities that could aggravate or cause further problems to the muscle. It is commonly recommended after a grade 3 injury to use crutches to take the body weight off the muscle and prevent further injury. Rest is necessary and when lying down, elevate the leg and use ice to the area of injury for the first few days. Compression bandage around the upper thigh is helpful during the early stages of recovery.
Too long of inactivity must be avoided. Exercises to include stretching and the range of motion exercise must begin as soon as pain allows. As soon as there is a 25% reduction in pain these activities can gradually be instituted to begin the rehabilitation process. This prevents muscle atrophy and scar tissue to form. Scar tissue prevents full muscle function. By limiting the function of the muscle, it can limit athletic or work activities and contribute to re-injury.
Exercises are necessary to speed recovery and minimize re-injury. Exercises to strengthen the muscles that allow the knee to flex and extend but the calf, pelvic, and lower back muscles will need strength and balancing.
Balance exercises are helpful to improve proprioception, balance, and speed. There is a high incident of re-injury to this muscle once returning to sport or work. One third of re-injury to the muscle will occur within the first year. Often, this second injury is worse than the first. There is always a rush to return to work or sport. Dedication by the injured person to prescribed rehabilitation is necessary to minimize future problems.
Severe tearing injury to the hamstring muscle may result in surgical repair.
Resolving a hamstring strain depends on many factors. These include but not limited to the following:
- Physical Health of the Injured Person
- Prior Injury
- Work Requirements
- Level of Sport Competition
Return to work will be achieved earlier than return to sport in most cases. The sudden stopping and starting with sport puts a greater stress or load on the recently injured hamstring muscle. Unfortunately it is not an exact science when time wise for healing of the injury. Dedication to rehabilitation and a gradual return to work and sport is recommended. Working with your doctor, therapist, employer, and coach will assist in a safe return.
The doctors at Coon Rapids Chiropractic Office have experience in the care and treatment of injured hamstring muscles.