Hammy strains are a common sports injury
We field so many questions about hamstrings. We endlessly hear about them in professional sports. And athletes of all levels live in fear of the dreaded twinge in the back of the thigh. But dreaded hamstring injuries do not need to be feared. A hamstring tear can be managed well, and in many cases avoided. Here is a rundown of some simple hamstring physio information we think athletes of all levels can benefit from.
What are the hamstrings and how are they injured?
The hamstrings are a group of three muscles located in the back of the thigh. These muscles are biceps femoris, semitendinosus, and semimembranosus. They are responsible for extending the hip and flexing the knee. Because of this, they play a crucial role in activities such as walking, running, bending and jumping. Hamstring tear and injuries can occur as a result of overuse or sudden movements. They are common in athletes, especially those who participate in sports that require a lot of sprinting and jumping, such as soccer, football, and basketball. Most commonly we see hamstring injuries after sprinting. This is due to a steep increase in hamstring activation between fast running and sprinting. Couple this with how infrequently many of us sprint, and it is no wonder the hamstrings sometimes strain.- Hamstring injuries can also occur in non-sporting activities such as gardening, or slips/falls.
Is it a hamstring injury or sciatica?
There is also a lot of overlap between hamstring injuries and referred pain. Irritated structures in the back (nerves, discs and facet joints) can create a referred or radiating pain that can mimic hamstring strains. Sometimes the two issues genuinely occur together. The hamstrings can spasm and strain to protect irritated nerve tissue from being overstretched. But that may be a blog for another day. Symptoms of a hamstring tear may include pain, swelling, bruising, muscle spasms, and difficulty walking or straightening the leg. The severity of a hamstring injury can range from a mild stretch or small tear in the muscle fibers (also known as a “grade 1” strain) to a complete tear of the muscle fibers (also known as a “grade 3” strain).Types of hamstring injuries:
It is important to seek medical attention if you suspect you have a hamstring injury. A healthcare professional, such as a physician or physiotherapist, can provide a proper diagnosis and treatment plan to help manage the injury and facilitate healing. There are three types of gradings used in hamstring physio assessment: Grade 1, 2, 3 tears.- Mild hamstring injury: This type of injury is also known as a “grade 1” strain and is the least severe. It involves a slight stretch or small tear in the muscle fibers. Symptoms may include mild pain, discomfort, and muscle spasms.
- Moderate hamstring injury: This type of injury is also known as a “grade 2” strain and is more severe than a mild injury. It involves a partial tear of the muscle fibers and may cause more significant pain and discomfort.
- Severe hamstring injury: This type of injury is also known as a “grade 3” strain and is the most severe. It involves a complete tear of the muscle fibers and may cause significant pain, swelling, and difficulty walking. In some cases there can be an avulsion – a tearing away of the tendon attachment of the hamstring. In some cases this requires surgery
Acute hamstring injuries management:
The treatment for a hamstring tear or strain is dependent on the grading. As mentioned above, suspected grade 3 tears often require imaging and an orthopaedic consult, and in rare cases – surgery. Management for grade 1-2 hamstring tears typically involves a combination of rest, ice, compression, and elevation (RICE). The objective here is to reduce swelling and pain. The focus is then on restoring movement and strength. Ultimately, we want to combine all of this for a restoration of function and return to sport / activity. Here are some general steps you can follow to help treat a hamstring strain:- Rest: Avoid activities that cause pain or strain on the hamstring muscles, such as running or jumping. Movement is fine, but in the early stages we want to avoid pushing through pain.
- Ice: Apply ice to the affected area for 20-30 minutes every 3-4 hours for the first 2-3 days to help reduce swelling and help with local pain relief.
- Compression: Wear a compression bandage or wrap around the affected area to help reduce swelling.
- Elevation: Elevate the leg above the level of the heart to help reduce swelling. With caution not to raise it so high that it places undue stretching strain on the hamstring muscles.
- Stretching: Gently stretch the hamstring muscles to help improve flexibility. It is fine to take gentle stretches to the point of discomfort. Stretching shouldn’t cause bad pain, nor lingering pain. Often we start the “stretching” as a movement through a full available range, rather than a prolonged hold.
- Strengthening: Strengthening can commence quite early after a hamstring tear. This may be in the form of active movement, or isolated hamstring work (prone leg curls etc), or as part of a bigger movement such as bridges, deadlifts or squats. The exercise selection will be dependent on the location and mechanism of injury of the strain.
Exercises we love for hamstring physio strength and rehabilitation
- Leg curls: This exercise can be done using a leg curl machine or by lying on your stomach and using a resistance band. This exercise isolates the hamstring quite well. Further, it is a great way to load the muscle without putting stretch through the tendon at its insertion. This makes it a useful start point for rehabbing upper hamstring strains.
- Glute bridges: This exercise can be done with or without weights. Start on your back with your knees bent and feet flat on the ground. Lift your hips off the ground by squeezing your glutes and pressing down through your heels. Hold for a few seconds, then slowly lower your hips back down to the starting position. The closer the feet are to the buttock, the more we will work glutes. The further away the feet are from the buttock, the more we will work the hamstrings. We love a variation of this with feet up on a bench using a slow lowering component.
- Single-leg deadlifts: This exercise helps to strengthen the hamstrings and glute muscles, and allows a focus on the slow lengthening component. Start by standing on one leg, and hold a weight in one hand (usually opposite to standing leg). Keeping your chest lifted, hinge forward at the hips and lower the weight towards the ground. Aim to keep your back flat and your knee slightly bent as you lower the weight. Lift the weight back up to the starting position. Working this exercise through a full, slow movement is a great way to improve hip / hamstring range of motion.
- Step-ups: This exercise can be done using a step or bench – simply stepping up and back repeatedly. We love to perform this on a low step, and with a relatively heavy weight. This ensures correct biomechanics, but allows a big increase in strength in muscles and angles that are key for running.
- Nordic hamstring eccentrics: This exercise really is the bee’s-knees for hamstring strength. It is the bread and butter of a hamstring physio program. Nordics require you to kneel with your feet hooked under a stable bench, bar, or held by a training partner. Keeping your hips forward, the objective is to lower your weight forward slowly. Resist the fall using your hamstrings to pull up into the bench / bar/ partner. This provides a great eccentric (lengthening) stimulus for the hamstring. This eccentric load is akin to the lengthening required in peak sprinting. This makes it a great prehab / rehab exercise for hammy issues. We recommend a small dose for this exercise – usually 2-3 sets of 5-6 reps.
