Hamstring Injuries

In this month’s bulletin read about the causes of hamstring injuries, how to recognise the severity of an injury and advice on prevention and recovery.


The ‘Pulled’ Hamstring 

We’ve all heard this term before, and more than likely used it to explain the nagging pain experienced at the back of the thigh.  But what are the hamstrings, and why are they so commonly injured in runners?

The group of muscles known as the Hamstrings is comprised of 3 muscles: biceps femoris, semitendonosus and semimembranosus.  Their long tendons, found in both humans and animals originally made them ideal for hanging joints of ham in the butcher’s window – hence the name! 


Locating the Hamstring Muscles

The hamstrings sit at the back of the thigh and bring about two main movements as they contract – bending (flexion) of the knee, and straightening (extension) of the hip.  Running places alternating demands on these two functions of the hamstrings, as we stride out and then propel our bodyweight over the planted leg.


Hamstring Function in Running 

Although designed for this function, modern lifestyles place additional stress on the hamstrings, predisposing injury.  Prolonged sitting places the hamstrings in a shortened position causing gradual changes to the overall length.  Poor spinal postures also strain the hamstrings through their attachment to the pelvis. 

Running with short or ‘tight’ hamstrings can overstretch these muscles during the stride phase of running.  As the muscle stretches rapidly it triggers a protective contraction in the muscle.  The two opposing forces lead to tearing of the muscle fibres that make up the muscle bulk. 


Hamstring Injury Signs & Symptoms

Like all muscle injuries, hamstring tears can be graded on a scale of 1-3, with grade 3 being the most severe.   

Grade 1 Hamstring strain - the signs may not be present until after the activity.  There may be a sensation of cramp or tightness in the hamstring.  This is protective to prevent further damage.  If the muscles are stretched or contracted the result is increased local discomfort at the point of the tear.

At this point listen to your body.  A few days rest, followed by gentle self massage and hamstring, calf, and low back stretching will improve the quality of the resulting scar tissue.  Gentle resistance exercises and stretching are important at this stage as they help to align the scar tissue that forms during the healing process. 

Grade 2 Hamstring strain - there is immediate pain which is more severe than the pain of a grade one injury. It is confirmed by pain on stretching and contraction of the muscle. A grade 2 Hamstring strain is usually sore to touch.  Apply ice locally for the first few days, and then gradually apply the principles for a grade one injury.  Let your pain be your guide.  You will probably require 3-4 weeks of modified training.

Suitable rehabilitation exercises include:

  • Gentle hamstring, low back, and calf stretches (20-30 second hold x 3)
  • Bridging (see below) x 10 x 3 repetition
  • Low resistance controlled hamstring curls in standing or prone laying

  •  Bridging exercis

Grade 3 Hamstring strain - is a much more severe injury. There is an immediate burning or stabbing pain in the back of the thigh, and the runner is often pulled up suddenly (cast your mind back to the emotional images of Derek Redmond in the 1992 Olympics!).  

Afterwards you will experience pain on walking.  The muscle is likely to be completely torn and at this point you should visit a suitably experienced Chartered Physiotherapist or medical professional.  A complete rupture of one of the Hamstring muscles may have to be repaired surgically, followed by a lengthy rehabilitation period of around 3 months.


Preventing Hamstring Injury 

To maintain healthy extensible hamstrings you should engage in regular developmental stretching to increase the length of the hamstrings and reduce their tone (resting contraction state).  This will also maintain a mobile sciatic nerve which can be involved in recurrent hamstring problems. 

Undertake gentle back stretches and mobility exercise to alleviate stress on the pelvis.  Core strength and stability exercises can also improve muscle function across the trunk and pelvis, reducing the risk of Hamstring injury. The bridging exercise given previously is an example of a core stabilising exercise.  Once Core strength and Hamstring strength are improved, then you may begin to increase your running speed and distance.  

A thorough warm-up is crucial to increase pliability of the muscles.  Do not stride out until you are suitably warm.  Avoid training when fatigued as this can lead to technical errors and overuse of the hamstrings.

Listen to your body and work with it, not against it.  You may be surprised by the improvements in your performance! 

Until next time, happy and healthy running!

Ross

Ross Clifford MCSP is a practising Physiotherapist with a specialist interest in sport and exercise Physiotherapy.  He also holds a Sports Science degree and has taught in the area of Sports Injuries.  He is a keen runner and cyclist.

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Posted

this is really useful advice thanks

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