A hamstring strain (also known as a pulled hamstring) is an injury that results from damage to the hamstring muscles at the back of the thigh. This muscle injury occurs frequently in athletes. It is particularly widespread among athletes in sports requiring intense sprinting e.g. track, basketball, football and soccer.
Fortunately, most hamstring strains are treatable using conservative, non surgical approaches. However, in addition to the traditional R.I.C.E. treatment protocol, athletes who have suffered a hamstring injury are more liable to experience another such injury at some point in the future. To reduce the likelihood of reccurrence, athletes should pursue exercise programs to stretch and strengthen the hamstring muscles as well as those of the gluteal region (buttocks).
Although we usually refer to the hamstring as though it was just a single muscle, it is actually a group of three muscles that run along the back of the upper leg. The muscle group runs from the hamstring tendons just below the pelvis, cross the knee joint and end in the lower leg.
The hamstring muscles play a primary role in activities involving bending the knee or extending the leg straight back. These two movements are key to effective sprinting, which is why track sprinters are among the athletes most likely to experience a hamstring injury.
All hamstring strains belong to one of the following three categories:
At the most fundamental level, these strains are due to overloading of the muscles of the hamstring group.They usually occur when the muscle extends while it is weighted or loaded – a movement that doctors call an “eccentric contraction”.
When you sprint, your hamstring muscles undergo eccentric contraction as you straighten your back leg and use your toes to push off. In this position, your hamstring muscles are not only lengthened but loaded with your body weight as well as the force you will need to move forward.
The factors that can increase your risk of experiencing a hamstring strain are:
The typical symptoms of a hamstring strain include some or all of the following:
If you experience some or all of these symptoms, we would suggest making an appointment with a doctor (preferably one with a sports medicine background). The doctor will be able to examine the injury and diagnose the cause of the injury.
To understand the nature of your injury, your doctor may ask how it happened. He or she will also perform a physical examination of your hamstring for discoloration or other evidence of bruising. Your doctor may also feel or “palpate” several places at the back of the thigh and ask you about the pain you feel as a result. This will help him or her to understand the severity of the injury.
Your doctor may also request either an X Ray or MRI scan to help determine the severity of the hamstring injury. X Rays are particularly useful in detecting avulsion injuries. They can reveal the damage caused by the tendon that has detached from its adjacent bone.
If the doctor concludes that you have a grade 1 or 2 hamstring strain, he or she will likely suggest a conservative non invasive treatment plan. Mild or moderate strains usually respond well to this approach, and surgery is usually not required.
As a conservative treatment plan for your hamstring strain, your doctor may recommend following the R.I.C.E. protocol:
Once your pain has completely disappeared and you feel the same strength in the injured leg as you do in the other one, you can have a discussion with your doctor about when you can return to sports activity.
For a grade 3 injury, especially one involving avulsion, the above conservative approach will likely not work. Consequently, you may need to undergo surgery to correct your hamstring strain.
If avulsion has taken place, the surgeon will need to reattach the hamstring tendon to the bone using stitches or staples. Scar tissue may also need to be removed as part of the procedure.
Even without avulsion (i.e. if there is a tearing of the muscle itself) surgery may be necessary to repair the muscle damage.
The recovery time for a hamstring strain depends (obviously) on the severity of the injury and on your level of fitness. A mild strain may require just a few weeks of rest before you can return to normal activity.
However, a grade 3 injury including avulsion may require 3 or even 6 months for a full recovery. You should ask your doctor for advice on the timing of your return to regular physical activity.
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