Hamstring Strain

with Rehab

The hamstring muscle and tendons are vulnerable to muscle or tendon tear (strain). Hamstring tears cause pain and inflammation in the backside of the thigh, where the hamstring muscles are located. The hamstring is comprised of three muscles that are responsible for straightening the hip, bending the knee, and stabilizing the knee. These muscles are important for walking, running, and jumping. Hamstring strain is the most common injury of the thigh.

Hamstring strains are classified as grade 1 or 2 strains. Grade 1 strains cause pain, but the tendon is not lengthened. Grade 2 strains include a lengthened ligament due to the ligament being stretched or partially ruptured. With grade 2 strains there is still function, although the function may be decreased.

SYMPTOMS

  • Pain, tenderness, swelling, warmth, or redness over the hamstring muscles, at the back of the thigh.

  • Pain that gets worse during and after intense activity.

  • A "pop" heard in the area, at the time of injury.

  • Muscle spasm in the hamstring muscles.

  • Pain or weakness with running, jumping, or bending the knee against resistance.

  • Crackling sound (crepitation) when the tendon is moved or touched.

  • Bruising (contusion) in the thigh within 48 hours of injury.

  • Loss of fullness of the muscle, or area of muscle bulging in the case of a complete rupture.

CAUSES

A muscle strain occurs when a force is placed on the muscle or tendon that is greater than it can withstand. Common causes of injury include:

  • Strain from overuse or sudden increase in the frequency, duration, or intensity of activity.

  • Single violent blow or force to the back of the knee or the hamstring area of the thigh.

RISK INCREASES WITH:

  • Sports that require quick starts (sprinting, racquetball, tennis).

  • Sports that require jumping (basketball, volleyball).

  • Kicking sports and water skiing.

  • Contact sports (soccer, football).

  • Poor strength and flexibility.

  • Failure to warm up properly before activity.

  • Previous thigh, knee, or pelvis injury.

  • Poor exercise technique.

  • Poor posture.

PREVENTION

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper exercise technique and posture.

  • Wear proper fitted and padded protective equipment.

PROGNOSIS

If treated properly, hamstring strains are usually curable in 2 to 6 weeks.

RELATED COMPLICATIONS

  • Longer healing time, if not properly treated or if not given adequate time to heal.

  • Chronically inflamed tendon, causing persistent pain with activity that may progress to constant pain.

  • Recurring symptoms, if activity is resumed too soon.

  • Vulnerable to repeated injury (in up to 25% of cases).

TREATMENT

Treatment first involves the use of ice and medication to help reduce pain and inflammation. It is also important to complete strengthening and stretching exercises, as well as modifying any activities that aggravate the symptoms. These exercises may be completed at home or with a therapist. Your caregiver may recommend the use of crutches to help reduce pain and discomfort, especially is the strain is severe enough to cause limping. If the tendon has pulled away from the bone, then surgery is necessary to reattach it.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be recommended. However, these injections should only be used for serious cases, as they can only be given a certain number of times.

  • Ointments applied to the skin may be beneficial.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Hamstring Strain

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

STRETCH - Hamstrings, Standing

  • Stand or sit, and extend your right / left leg, placing your foot on a chair or foot stool.

  • Keep a slight arch in your low back and your hips straight forward.

  • Lead with your chest, and lean forward at the waist until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.)

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Hamstrings, Supine

  • Lie on your back. Loop a belt or towel over the ball of your right / left foot.

  • Straighten your right / left knee and slowly pull on the belt to raise your leg. Do not allow the right / left knee to bend. Keep your opposite leg flat on the floor.

  • Raise the leg until you feel a gentle stretch behind your right / left knee or thigh. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Hamstrings, Doorway

  • Lie on your back with your right / left leg extended and resting on the wall, and the opposite leg flat on the ground through the door. Initially, position your bottom farther away from the wall.

  • Keep your right / left knee straight. If you feel a stretch behind your knee or thigh, hold this position for __________ seconds.

  • If you do not feel a stretch, scoot your bottom closer to the door and hold __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Hamstrings/Adductors, V-Sit

  • Sit on the floor with your legs extended in a large "V," keeping your knees straight.

  • With your head and chest upright, bend at your waist reaching for your left foot to stretch your right thigh muscles.

  • You should feel a stretch in your right inner thigh. Hold for __________ seconds.

  • Return to the upright position to relax your leg muscles.

  • Continuing to keep your chest upright, bend straight forward at your waist to stretch your hamstrings.

  • You should feel a stretch behind both of your thighs and knees. Hold for __________ seconds.

  • Return to the upright position to relax your leg muscles.

  • With your head and chest upright, bend at your waist reaching for your right foot to stretch your left thigh muscles.

  • You should feel a stretch in your left inner thigh. Hold for __________ seconds.

  • Return to the upright position to relax your leg muscles.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Hamstring Strain

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never get worse during these exercises. If this pain does get worse, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH - Hip Extensors, Straight Leg Raises

  • Lie on your stomach on a firm surface.

  • Tense the muscles in your buttocks to lift your right / left leg about 4 inches. If you cannot lift your leg this high without arching your back, place a pillow under your hips.

  • Keep your knee straight. Hold for __________ seconds.

  • Slowly lower your leg to the starting position and allow it to relax completely before starting the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hamstring, Isometrics

  • Lie on your back on a firm surface.

  • Bend your right / left knee approximately __________ degrees.

  • Dig your heel into the surface, as if you are trying to pull it toward your buttocks. Tighten the muscles in the back of your thighs to "dig" as hard as you can, without increasing any pain.

  • Hold this position for __________ seconds.

  • Release the tension gradually and allow your muscles to completely relax for __________ seconds between each exercise.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hamstring, Curls

  • Lay on your stomach with your legs extended. (If you lay on a bed, your feet may hang over the edge.)

  • Tighten the muscles in the back of your thigh to bend your right / left knee up to 90 degrees. Keep your hips flat on the bed or floor.

  • Hold this position for __________ seconds.

  • Slowly lower your leg back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 pound/0.5 kilogram increments.