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5 Things to Know About Hamstring Strains

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Posted by Ryan Schreiter, DO

Hamstring strains are a common musculoskeletal injury. Although we hear about them most often in athletes, don’t be fooled. Anyone can pull (or strain) their hamstring.

The hamstring is a group of three muscles that run from the back of the hip to below the knee. Like other muscles, when they’re not strained or injured, we’re barely even aware of them or the work they do. But when they sustain an injury, even simple movements can cause problems.

Hamstring injuries happen when one of the muscles becomes strained, pulled, or twisted or sustains a tear. In my practice as a musculoskeletal specialist in sports medicine at Temple, I see patients with these kinds of strains and tears on a regular basis. I know that hamstring strains can often be frustrating for my patients. Though the injuries typically respond well to simple treatment, it takes time — and patience — for a hamstring strain to fully heal.

Here are five facts about hamstring injuries that I typically share with my patients:

1. Not all hamstring injuries are the same.

The hamstring consists of three muscles: the semitendinosus, the semimembranosus, and the biceps femoris. Any one of these muscles can be affected when a person gets a hamstring injury, and the symptoms of a hamstring strain or tear can differ based on the problem's severity.

  • Grade 1 injuries are mild muscle strains that cause sudden, radiating pain down the back of the leg. The leg may feel stiffer and harder to move, especially after it’s rested.
  • Grade 2 injuries are partial muscle tears that cause increased pain, swelling, and bruising. The tear will also cause some weakness in the leg.
  • Grade 3 injuries are complete muscle tears that cause severe pain in the back of the thigh or lower buttock, tenderness, swelling, bruising, and weakness. Both grade 2 and grade 3 injuries may even cause a limp. Many people who sustain a grade 3 hamstring tear report hearing a “popping” sound when the injury happens.

Regardless of the degree of the injury, hamstring strains and tears occur when the muscle is stretched too far or stretched without being properly warmed up. This overstretching can happen during activities like climbing, jumping, lunging, or sprinting, especially if the movement happens suddenly. A direct blow to the area — like being kicked in the hamstring — can also cause a strain or tear.

2. Hamstring injuries can happen to anyone.

Many patients who come to Temple’s Sports Medicine Program with hamstring injuries play sports that involve a lot of sprinting and sudden movements, like track, soccer, dancing, basketball, and even water skiing. Adolescent athletes are particularly prone to hamstring strains because their hamstring muscles and surrounding bone are growing at different rates.

But you do not have to be an athlete or even participate in a particular sport to strain your hamstrings. You may be at risk for these injuries if you:

  • Have tight muscles or engage in physical activity without performing regular stretches
  • Have quadriceps (the muscles in the front of the thighs) that are much stronger than your hamstrings. This can cause the hamstrings to tire out faster than the quadriceps during activity, resulting in a strain due to the imbalance
  • Push yourself too far during an activity that uses the hamstrings, like dancing or climbing a ladder, which can cause the hamstring muscles to tire out and become more susceptible to injury
  • Are an older athlete who primarily exercises by walking

3. Treatment for a hamstring injury depends on severity.

Most patients with hamstring injuries will fully recover with the right care. For mild hamstring injuries, treatment usually involves following the RICE method:

  • Rest. You should take time off from the activity that caused the injury. Some patients may need to wear a knee splint to immobilize their leg or use crutches to avoid putting weight on the leg.
  • Ice. Place cold packs on the injured area for 20 minutes at a time, several times daily. Wrap the cold pack in a kitchen towel to avoid placing it directly on your skin.
  • Compression. Wearing an elastic compression bandage around your thigh can prevent additional swelling.
  • Elevation. Reclining and putting your leg up can also help keep swelling at bay.

Over-the-counter anti-inflammatory medications can also help ease the pain and discomfort associated with a hamstring injury.

In some cases, your doctor might also recommend going to physical therapy. A Temple physical therapist can show you how to do gentle exercises, including resistance exercises, to help improve the strength and flexibility of your hamstring muscles. They will also teach you stretches that will increase your range of motion.

Some patients ask whether they'll need to have surgery for their hamstring injury. Fortunately, the answer is usually no, but surgery may be needed if the injury is very severe.

4. Pulled hamstrings need time to heal fully.

Some very mild hamstring strains can resolve within a few days. But most injuries take weeks or months of recovery time to fully heal. In some cases, recovery could take as long as a year.

Many patients with hamstring injuries ask me why the healing process tends to be so slow. I tell them it's because you can never rest your hamstring muscles completely for long periods. Whenever you move your hips and knees — even just to walk across the room or bend down to grab your shoes — your hamstring muscles are working. The injured area is under near-constant stress and strain, even while it's trying to repair itself.

This long recovery can be frustrating for patients, especially athletes who are eager to get back to playing their sport. But it's important to take it easy until the area is fully healed. And even then, it’s essential to ease back into your usual activities instead of diving in full force. Going from zero to 60 too quickly, or before your provider says you are ready to do so, can lead to reinjury or even cause the hamstring to sustain permanent damage.

5. You can reduce your chance of hamstring injuries.

Hamstring injuries aren't always preventable. But there are a few simple steps that can protect your hamstring muscles and make them less prone to straining or tearing. I advise my patients to:

  • Warm up for at least 10 minutes before engaging in physical activity. Try gently swinging your lead leg and the opposite arm at the same time.
  • Spend three to five minutes stretching after physical activity. In addition to stretching the hamstring muscles, dedicate some time to stretching the hip flexors and the quadriceps in front of the thighs. These muscles all work together.
  • Perform strengthening exercises two to three times a week. Bodyweight exercises, like squats and lunges, get the job done. Single-leg bridges are also good for strengthening the hamstrings and supporting muscles, like your abdominals and glutes. For these, you lie on your back with your arms by your side, knees bent, and feet flat on the floor. You raise one leg while lifting your hips as high as you comfortably can. Then, lower your hips and leg and do the same exercise with the opposite leg.
  • Ease into higher-intensity activities. Do not go from walking to trying to run a 5K in a few days.
  • Avoid overdoing it. Don’t ignore exhaustion — stop when you are tired. Pushing your muscles to exhaustion makes them more prone to injury.

Get expert advice

If you have sustained a hamstring injury, make an appointment with your primary care provider at Temple. If necessary, your provider can refer you to one of our experts at Temple Health Orthopaedics and Sports Medicine for a thorough evaluation and specialized treatment. Call 800-TEMPLE-MED or request an appointment online.

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Ryan Schreiter, DO

Dr. Schreiter is a sports medicine specialist with interests in throwing injuries, overuse injuries and sports-related concussions. He is also Assistant Professor of Orthopaedic Surgery and Sports Medicine at the Lewis Katz School of Medicine at Temple University, and team physician for Temple University athletics.

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