How to Recover from a Hamstring Injury

Hamstring Muscle Injury

How to Treat A Hamstring injury

A hamstring injury is a common sports injury. Maybe you were playing football today and tweaked your hamstring whilst playing. Now it is sore and you want to know why it happened, how to heal a pulled hamstring and how to reduce your risk of getting it as soon as you start playing sport again. Don’t worry you’re not alone there would have been many others who hurt the back of their leg playing a game today.

This article is a follow-up to the previous one I wrote on the most common way you injure your hamstring. In this article I want to give you even more juicy detail. Don’t worry it is all in an easy to digest overview beginning with the anatomy of the hamstring muscle, the worst sports for a hamstring injury, your risk factors and finally 7 tips how to treat a torn hamstring muscle.

Anatomy of the Hamstring

So you have a pain in the back of your thigh. You think it is a pain coming from the hamstring muscle. This pain could be high up near your buttocks and hip area, or in the middle or side of the thigh, maybe it is very sore behind your knee and you feel you have a knee injury. Let me start by showing you what is a hamstring muscle.

The hamstrings are made up of the following four muscles:

  1. Semitendinosus,
  2. Semimembranosus,
  3. Long head of biceps femoris,
  4. Short head of biceps femoris.
Hamstring Muscle Anatomy

The Four Hamstring Muscles

The hamstring is actually made up of a collection of muscles in the back of your thigh. These muscles insert at the hip and pelvis and finally attach with strong tendons at the back of knee joint.

The action of the hamstring muscles are to help bend the knee, called knee flexion. They also help move the hip joint backward into hip extension. These are medically known as its concentric muscle contraction or shortening contraction.

The other importance of the hamstring is to tighten as it is being stretched. So it also helps controls hip flexion and knee flexion from the quadriceps muscle. This is medically known as an eccentric muscle contraction or lengthening contraction.

As I mentioned in my previous hamstring article, the most common way an athlete would injury their hamstring is via this eccentric muscle contraction movement.

All the above muscles are supplied by the tibial division of the sciatic nerve. The exception is the short head of biceps femoris muscle, which is innervated by a different nerve, the common peroneal nerve.

Where the Injury Happens Matters

Another reason why you need to know the human biology of the hamstring muscle is:

“Where you hurt the muscle affects your recovery time.”

An injury higher up the back of the thigh the longer it may take to get better (i.e closer to the buttocks is worst). The reason for this is a muscle can heal itself better in the middle rather than near the tendons. This is also the case with a high hamstring strain near what is called the ischial tuberosity (i.e your sitting bones).

A general rule is a high injury should be treated like a hamstring tendonitis, a lower injury near the middle should be treat like a hamstring strain.

The Worst Sports List

Like I said, a torn hamstring is a common sports injury in all types of sports. This is so in games requiring maximum running speed and rapid acceleration from a stand still position.

There is nearly everyday some professional sportsperson out of action with a hamstring injury. Research done on the rate of occurrence for hamstring injuries found that the most common sports related to injury are:

  • Football (soccer),
  • Athletics (especially in sprinters),
  • Cricket,
  • Australian Rules Football,
  • Hurling,
  • Touch rugby,
  • Rugby Union,
  • Rugby League.

Remember how many injuries English footballer Michael Owen has had over his career.

A pulled hamstring can be very costly for players and sports clubs both in money lost and recovery time away, especially for professional sports like the soccer stars. That’s why I recently tweeted:

This was a study over many FIFA world cups including the recent South Africa World Cup 2011.

Different Types of Hamstring Strains

When a tear occurs in muscle fibres it is called a strain injury.

There are three types of hamstring tears:

  1. Grade 1 Strain – A mild tear with no visible bruising and mild discomfort when moving the hamstring.
  2. Grade 2 Strain – A moderate tear causing change in walking gait and pain when moving the leg.
  3. Grade 3 Strain – A severe tear which is very sore, but sometimes no pain a complete tear occurs through the muscle. Here there will be visible bruising and associated muscle weakness. You will walk with a protective limp.
Grade 3 Hamstring Bruise

Severe Bruise on the Back of Thigh

I know what your thinking “Ouch, that must have hurt”.

These are some of the different symptoms of a hamstring strain. A grade 1 or grade 2 hamstring strain is the most common out of the three types.

Right you still with me? Now to tell you what puts you at risk of suffering a hamstring injury in the first place.

Sports Injury Risk Factors

Did you know that:

“Your greatest risk for getting a damaged hamstring is within the first two weeks of returning to sporting activity after a hamstring injury.”

In that research I mentioned they found on average that 30% of Australian Rules Football players will re-injure their hamstring muscle on return to competition. So having hurt your muscle will put you at great risk of another is what they are saying.

There are some other risk factors for getting a pulled hamstring muscle which are:

  1. Not a Good Enough Warm-Up:
    The rule is a cold muscle is more at risk than a warm one. A poor warm-up prior to exercise could contribute to that pulled hamstring injury. By the way any positive effects of a warm-up for your muscles could be gone by just 20 minutes of sitting down. This means be careful if you’re a substitute on the bench and did a warm-up before the game started.
  2. Age is a Factor:
    Older elite athletes  have a greater risk. Any muscles innervated by the L4-5-S1 spinal nerves, but mostly the L5-S1, are at greater risk to be injured than those muscles supplied by L2-3-4 nerves.What this means is the L4-5 and L5-S1 sections of the lower back are where you are likely to get degenerative changes. Therefore, you would have more risk of irritating the nerves at these spinal levels. Degenerative spinal changes occur with age, which could explain the hamstring injury risk in older sportspeople.
  3. You Have a Muscle Imbalance:
    The two major thigh muscles, hamstring and quadricep, help control each other. Meaning the muscles in the back of the thigh help control those in the front of thigh and visa versa. Therefore if your hamstring muscles are too weak to control that eccentric muscle contraction i told you about then you can create a strained muscle.
  4. Muscle Flexibility:
    Hamstring length needs are sport specific. For example, a dancer needs more hamstring flexibility than say a front-row rugby player. Do more flexible hamstrings lower the risk of injury, this is still undecided. However, having tight quadriceps and hip flexing muscles can raise the chance of a pulled hamstring. This links into my Chiropractic student research years ago which showed stretching does not lower the risk of injury.
  5. Muscle Fatigue:
    If you have tired muscles you have a greater chance of a strain injury. Muscle fatigue can be local in the muscle tissue and in the nerve controlling the muscle. Did you know also fatigue is also a reason for one of the types of muscle cramp.
  6. Sport Specific Activities:
    Certain sports increase your risk, remember the list above. Sport requires specific sequence of movements. A cricket fast bowler is the one linked to hamstring injuries. A fast bowler as a teenager is at risk of something called a spondylolisthesis in their lumbar spine. One of the symptoms of this condition is tight hamstrings.
  7. Your Running Technique:
    A forward lean position during running is bad for the hamstrings. Leaning forward is counter-productive to fast running. Do you try push your head forward when sprinting? Maybe this is a time to consider the barefoot running technique maybe with some Vibram five fingers.
  8. How’s Your Mind:
    Psychological stress creates a physical change in your body. You know how you get butterflies in your stomach, or increased sweating. Anxiety and stress put you in a pro-inflammatory, degenerative state. Mental pressure leads to increased tension in muscles which negatively effects athletic performance like balance and fine motor control. This is a simple way to control stress.

Treatment List

Well done for getting to this point. You are super knowledgeable and basic anatomy, diagnosis, and reason why you hurt your hamstring. Now to getting yourself better.

How long will it take to get better? Hamstring injury recovery time frame can range from a few days to weeks or months. It is dependent on the severity of the injury and if it is in the belly of the muscle or a tendon injury.

Here is a list of 7 treatment tips:

  1. R.I.C.E
    R.I.C.E is an acronym which stands for rest, ice, compress, elevate. This is the first treatment tool to perform in order to help a strained hamstring. You may need to rest the muscle form sport for 1 day maybe for 6 weeks. Icing can be done with a bag of frozen peas in a tea towel or a soft blue gel ice pack for 20 mins at a time on the pain area. You could wear an elastic thigh support around the muscle for compression. When you can lay down and out your foot higher than your heart level for elevation. The goal is to reduce the effects of acute inflammation.
  2. Take Omega 3 Oils
    Omega-3 oils are essential fatty acids. They are a natural anti-inflammatory. Inflammation is natural process in order to promote healing and protective scar tissue. Omega-3 oils are also linked to helping nerve pain, if there is some sciatic nerve irritation.
  3. Take Vitamin C
    Taking 500mg to 1g of Vitamin C may help collagen formation and repair. It could be a simple solution to create a nutritional base to help speed up repair and avoid hamstring injury scar tissue. Like Omega-3 oils, Vitamin C supplementation could help nerve pain.
  4. Hamstring Exercises
    Start rehabilitative exercises for the hamstring first with isometrics then isotonics. Isometric is contracting the hamstring without moving the leg (i.e. only tightening the muscle). Isotonic means moving the hamstring muscle through its actions. This is first shortening, remember concentric muscle contraction above, the muscle by performing the heel to your buttocks movement. Then when ready being lengthening the muscle under pressure, remember eccentric muscle contraction above. For example doing squats where pushing up is the lengthening under pressure situation. Supervised rehabilitation exercises are best to watch your form, guide you through the stages and make sure your ready to return back to action.
  5. Hamstring Stretches
    First thing most people think of is stretching the hamstring to speed up healing. I did say early on that very flexible hamstrings do not help prevent a strain injury if not needed for your sport. However saying that, doing gentle hamstring stretches can help prevent excessive scar tissue in the muscle. You could start in a seated position doing the Slump test maneuver. For a standing hamstring stretch I would do the hip hinge movement. These are better than other stretch positions where you try to cheat by using your spine to bend and not from the hips to isolate the hamstring muscle. If it is a static stretch where you reach and hold, hold the stretch for at least 30-60 seconds in a slight stretch feeling repeating 10-20 times.
  6. Anti-Inflammatory Medication
    You might need to take a NSAID which is an acronym for non-steroidal anti-inflammatory drug. Especially if you have done a grade 2 or grade 3 strain you’ll be in a degree of pain. NSAID’s can help pain levels, but don’t help your body heal faster in fact they could do the opposite. It has been suggested that for pain control a better option could be paracetamol which is not an NSAID so not associated with the risks. Remember, always discuss with your GP or pharmacist before taking any pain relief medication.
  7. Professional Help
    Did you know that 14–19% of all hamstring injuries no muscle damage is seen on an MRI scan. This figure could be as high as 45%. This means you may have pain in the hamstring muscle, but no physical signs of muscle tears. In this case I believe poor body movements and posture stressed the fascial system causing joint locking, sciatic nerve irritation and hamstring muscle spasm. Remember the older athlete with L4-5-S1 nerve risks. It has been suggested that to help treat and prevent hamstring injuries you could use spinal manipulative therapy. Your local chiropractor could do an assessment on your body posture and movements which is called bio-mechanics. Chiropractors working on professional athletes not only use spinal manipulation to treat a patient, but other soft tissue tools like dry needling, active release technique, kinesio taping and cold laser therapy. Other professional help could be your local physiotherapist or osteopath.

The Bottom Line

There are many reasons why you hurt yourself today and ended up with a sports injury. However, you can get better as fast as possible with the right diagnosis and early treatment when you have a hamstring injury. It could be as simple as home TLC or needing professional care like that from a chiropractor.

Image Credit: Some rights reserved by lululemon athletica
Image Credit: arthursclipart.org
Image Credit: By Daniel.Cardenas (Own work) [CC-BY-3.0], via Wikimedia Commons