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Hamstring Strains and Preventing Recurrence
C. Schurman, MS, CSCS 9/9/03
A hamstring strain may be a tear, excessive stretch, pull, or complete rupture of one, two, or all three of the large muscles in the back of the thigh. Strains frequently occur with eccentric contractions (i.e. landing from jumps) or excessive range of motion (as in dashing for a bus if you don’t normally run). Given the large size of the muscle group, a hamstring strain can be one of the most debilitating of sport injuries as well as one of the hardest to rehabilitate. It is far easier to prevent hamstring injuries in the first place by making sure you include sufficient warm-ups, stretches, and strength exercises.
Strains can happen when a deconditioned person increases speed rapidly, as in running after a child, dashing across the street, or playing that first softball or frisbee game of the season. By always including several weeks of preparation prior to participating in any activity that requires rapid change of direction or acceleration and deceleration, you can adequately prepare your body for an injury-free season. Strains can also occur during overly aggressive stretching, as may happen in a yoga class that is too advanced, during an active stretch or ballistic movement that takes you farther into the range of motion about the hip or knee than your muscles comfortably allow, or trying to do an exaggerated heel hook on an overhanging climbing route. Strains are more likely to occur if: a) you neglect your warm up; b) you have tight or weak hamstrings compared to the quadriceps (more often the case in runners and cyclists); c) you have leg length inequalities, d) you suffer from poor posture, or e) you suffer from “weekend warrior” syndrome, turning out to exercise only once or twice a week at game time.
Strains range from mild to severe; a mild “pull” behind the thigh (first degree) may leave you able to continue the exercise, with a little soreness the next day, but little interruption of normal activity. Recovery time is usually short, 1-2 weeks. A second-degree strain may feel like more of a “twang” that requires rest from the activity. In 3-6 days you may experience bruising, and movement may be painful. Recovery time may be 3-4 weeks. The most severe (third degree) strains usually require crutches; the athlete may collapse following trauma to the hamstring and bruising can be severe within four days. Recovery time can be up to ten weeks if there is no recurrence of strain.
As for any strain, the best way to treat hamstring pulls is REST, ICE, COMPRESSION and ELEVATION immediately following the injury and for 3 days afterwards. Consider wearing an ACE wrap or neoprene sleeve over the thigh to keep the area compressed and warm when moving around. Acetaminophen can help for pain, or for relief of pain and inflammation, take ibuprofen or aspirin. If you suffer from a third-degree strain, use crutches until you are able to walk without a limp.
Following a first-degree strain, include hamstring stretches the first day after occurrence to prevent any scarring (this makes the muscle less flexible.) Examples of such stretches include yoga poses such as triangle pose and downward dog, or a supine strap hamstring stretch: lie on your back on the floor with uninjured leg bent (and foot on floor) and the injured leg as straight as comfortable, with the band or towel around the heel, and use the strap to gently pull the leg closer to the chest. DO NOT go to the point of strain or pain or you can re-injure the leg. Work up to being able to hold the stretches for a minute each.
As soon as the pain subsides and you are comfortable walking, you can add gentle cardiovascular exercise including swimming, biking, elliptical cross training or gentle walking on flat terrain. 3-5 days after a first-degree strain, begin slowly adding some home strengthening exercises such as bridging (lying on your back with heels close to butt and lifting hips off the floor), quadruped exercises (balancing on hands and knees, extend the injured leg straight behind you without compromising the lower back), 1-leg hamstring curls (using leg resistance to start or ankle weights) or those pictured and described at www.bodyresults.com/e2hamstrings.asp. Begin with a set of 8 repetitions per exercise in the pain-free range and gradually increase to 3 sets of 10-12. In the case of a second- or third-degree strain, include stretching and strengthening within a week or two of initial injury as pain allows.
RETURN TO ACTIVITY
When point tenderness is gone and you are capable of fully tensing the hamstring without feeling any residual pain, begin your gradual return to flat ground jogging in increments of 3-5 minutes or to your tolerance. If you are a sprinter or participate in any high-velocity cutting movements (i.e. football, soccer, rugby, softball, etc.) gradually re-introduce sport-specific drills such as carioca side-steps, high-knee jogging, butt-kicks, or short straight ½ to ¾ effort sprints (NEVER all out until drills and ¾ effort sprints are TOTALLY pain free). If you feel any recurring twinges, reduce the intensity of effort; wear a thigh sleeve to support the muscle and provide warmth.
Micheli, Lyle, MD. Sports Medicine Bible (1995), pp. 155-157.
Schenck, Robert C. Jr. MD (ed.) Athletic Training and Sports Medicine (1999). American Academy of Orthopaedic Surgeons, pp. 405-413.