The Hamstrings are the group of three muscles that run down the back of the thigh:

  • Semitendinosus (most medial / toward the inside of the thigh with long thin tendon)
  • Semimembranosus (also toward the medial/inside side of the thigh)
  • Biceps femoris (on the lateral / toward the outside side of the thigh) 

They originate at the bottom of the pelvis on the ischial tuberosity (bottom bone) and attach at the top of the tibia and fibula (shin bones). The picture above shows the back view of the right hamstring muscles.

The Hamstring muscles have two actions; they help to extend the leg straight back, and to bend the knee taking the heel towards the bottom. As they cross two joints they are at an increased risk of injury than those muscles only crossing one joint.

Hamstring injuries or ‘strains’ can occur frequently in sports that require sprinting. There can be a number of causes (See our post on Causes of Muscle Strain).

What are the common symptoms?

If the hamstrings are strained the individual can notice a sudden, sharp pain in the back of the thigh. It will likely cause you to stop running and be less able to bear weight through that leg. You may notice:

  • Swelling during the first few hours after injury
  • Bruising or discolouration
  • Weakness that can persist for weeks

 

Are Imaging tests required?

  • MRI or Ultrasound: can provide images of the soft tissues to help determine the grade of muscle strain and any associated injuries / inflammation.
  • X-rays can help determine whether there is a hamstring tendon avulsion – when the injured tendon has pulled away a small piece of bone. This would only be indicated in severe cases.

 

What does treatment involve?

Most lower grade hamstring strains heal very well with non-surgical treatment.

After RICER has settled the initial pain and swelling the aim of physiotherapy treatment is to restore range of motion and regain strength.

  • Modalities such as: Interferential, Ultrasound, Soft Tissue Release, Ice and Cold therapy.
  • Gentle stretches to improve range of motion
  • As healing progresses, exercises will be added to gradually load the muscle and strengthen the tendon.

The focus then shifts to sport / task specific activities to return to you to the desired activity.

 

How can we prevent hamstring injuries occurring or re-occurring?

  1. Expose the hamstring muscle to high speed running / sprinting at training. If the only time you hit high speed running is when you are actually competing / playing the game – your risk of hamstring injury is significantly increased.
  2. The above applies to a gradual and thorough warm up before game time. You need to progressively increase blood flow to the muscle and expose it to the demands you will when under pressure within the game.
  3. Re-strengthen your hamstrings. Specifically, under high loads with eccentric contractions (when the muscle is contracting as it is lengthening) – Come into clinic if you’d like a demonstration of helpful exercises such as ‘Nordics’ and ‘Romanian deadlifts’. This specific strengthening needs to be done at least once a week.
  4. Strengthen your glutes! The glutes and hamstrings are both hip extensors. If the glutes are weak, the hamstrings are asked to do more work which may increase their risk of injury.