Hamstring Strain? Pain? Tear?
Hamstring strains can quite literally be a pain in the butt. This is what we call a high hamstring strain, but the hamstring group extends from the hip to the knee and could be damaged anywhere along the muscle belly or tendons. It is composed of three separate muscles, similar to how our quadricep group is composed of four separate muscles. The hamstring group consists of biceps femoris, semimebranosus, and semitendinosis. Biceps femoris is the most commonly strained of the three. The hamstrings act to flex and/or extend the hip, therefore collectively the hamstrings are in their most lengthened position when the body is in maximum hip flexion and knee extension or straightening.
There is a high likelihood you strained your hamstring if you were sprinting or doing something to challenge either the strength, power, or length of the backside of your leg. It’s not fun to imagine (let alone experience, speaking from personal experience) but you may also feel the muscle pop or tear within your body. Do not recommend. Often with hamstring strains you will feel a sudden sharp, intense pain in the back of your leg anywhere from the knee up to your butt. The pain can stop you in your tracks, potentially causing you to limp or even fall immediately after the injury.
Hamstring strains are common in dynamic sports and activities that involve sprinting, jumping, contact, quick eccentric control of the hamstrings, and potential forceful extension of the knee. Examples of these types of activities include soccer, football, and water skiing. It’s also quite possible to damage your hamstring doing other acuities; my injury occurred while rock climbing, with my left hip completely bent/flexed, nearly all of my weight on that leg, and forcefully trying to extend and push off through that leg.
Hamstring strains, like all muscle strains, are quantified based on severity as one of three grades:
Grade I
Mild muscle strain, “pulled muscle”
Stiffness, minor pain, normal range of motion
Strong but painful with muscle testing
Grade II
Moderate muscle strain, partial muscle tear of about half of muscle fibers
Pain, swelling, functional loss, walk/gait impacted
Weak and painful with muscle testing
Grade III
Severe muscle strain, more than half of muscles fibers to complete tear
Significant pain and swelling
Weak and pain-free with muscle testing
Depending on the severity of your strain, it can take anywhere from a few days to many months to be fully healed. It is common to re-injure the hamstring within one year of returning to sport post-injury; in approximately ⅓ of cases re-injury occurs and unfortunately it is usually worse the second time. This statistic isn’t meant to instill any fear in returning to the sports you love or not trusting your body, but rather to reiterate the importance of proper rehab of the initial injury as well as prehab to prevent a sequential injury from occurring.
Research shows eccentric strengthening of the hamstrings with long length exercises has a positive effect on preventing recurrence of a hamstring injury. Eccentric exercises involve the contraction and control of a muscle as it lengthens, not as it shortens which is what we typically think of with muscle contraction. Take an example of a dumbbell bicep curl: when you bend your elbow to bring the weight up towards your shoulder, this is the concentric contraction or shortening of the muscle. Eccentric contraction of the bicep would be fighting gravity and load to control the slow lower of the dumbbell back down to your side versus just letting it release quickly.
The same concept can be applied to any muscle group or muscle action in the body. Remember what the hamstrings collectively do? Knee flexion and hip extension. A wonderful way to address eccentric hamstring strength is deadlift variations, where we focus on the slow controlled lowering of load towards the ground; here the hamstring is lengthening and strengthening under tension as the hip moves into relative flexion as we descend towards the floor.
In addition to eccentric focused exercises, research has also shown that progressive agility drills and trunk stabilization are crucial for proper rehab and prehab of hamstring injuries. There is a lack of published research on dry needling for hamstring strains but there have been many reports of it reducing pain in the short-term. If you are unable to access physical therapy immediately, here are a few things to do at home safely (especially if your injury is mild-moderate):
Ice for pain (but avoid ice to reduce swelling initially, as the body needs to go through its inflammation process to heal)
Soft tissue for pain and flexibility: gentle massage gun, foam roll, etc.
Gentle stretching and range of motion at the hip and knee
Stationary biking
Walking to tolerance
As someone who has personally experienced a moderate hamstring strain, I can empathize with the impact it has on both participating in the things you love but even just in your daily life. Know that in all cases, our goal is to make you feel heard and validated in your injury and pain experience. We also understand it can be reassuring to know that your provider has been through a similar experience as you. Have more questions about your hamstring strain or pain? We would be happy to chat further about how Loon State Physical Therapy can be your teammate in getting you back to moving and feeling your best! Call us at (612) 405-8503 or book with us online at www.loonstatephysicaltherapy.com for an in-person or virtual appointment.
Bailey Van Oosbree, Doctor of Physical Therapy
Loon State Physical Therapy