Recovering from a Hamstring Strain

What is a hamstring strain?

The hamstring muscle is a group of 3 muscle groups running down the back of the leg from the bottom of your pelvis down to just under the knee. A strain means that you may have overstretched the muscle fibres and possibly torn it. Hamstring strains are a common upper leg injury seen especially among runners, field sport athletes and anyone who performs activities that require sudden accelerations or changes in direction. They mostly happen at a point when the hamstring is in maximal stretch while contracting. For example, in the late swing phase of your running gait when the hamstring is outstretched lengthened out in front and needs to contract to bring the leg back as you swing the other leg forward.

Hamstring strains have grades depending on level of severity:

1.        Grade 1: mild strain, overstretching/minimal tearing of muscle, can usually walk with some discomfort

2.        Grade 2: partial tear, immediate sharp pain and limping

3.        Grade 3: full tear/rupture, severe pain and often inability to weight-bear

Management

Each stage may vary in length depending on the severity of the strain and individual recovery rates.

Stage 1: Early management

The goal for the initial stage is to protect the injured tissue and reduce further damage

Do:

·      Resting: avoiding activity that can provoke the pain such as running and stretching of the hamstring

·      Ice: 20mins at a time, every 2-3hrs

·      Compression: compression bandage/taping

·      Elevation: keep the leg slightly elevated above the heart if possible

·      Use crutches if the injury is more severe and you are struggling to weight-bear

Don’t:

·      Stretch aggressively – a torn muscle can be further damaged if stretched

·      Massage directly on the injury site

·      Push through pain 

Stage 2: Gradual return to movement

Once the acute pain has settled after a couple of days, you want to start doing some gentle exercise to reintroduce movement without aggravating the injury

Focus on:

·      Pain free range of movement exercises such as heel slides

·      Light comfortable walking

·      Gentle isometric contraction exercises such as double leg heel bridge holds

Stage 3: Strengthening

When able to do so, strength training is important in return to activity and prevention of injury. It’s important that the strengthening stage is done progressively and safely under the guidance of a professional so that you can have the best outcome without the uncertainty of whether you are progressing yourself too slowly or too quickly. If you have had a high-grade strain, there may be a prolonged period of rest and gentle mobility exercises, meaning that the muscles can weaken. Therefore, strength work under guidance is especially important as with any injury.

Examples:

·      Bridge progressions:

-              Isometric: holding at top range

-              Isotonic: going through the whole range

-              Eccentric: emphasis of slow controlled loading as the muscle lengthens

·      Hamstring curls starting at low load in shortened ranges and then increasing both slowly

Eccentric strength work basically means training your muscle’s ability to control load while it is lengthening. This type of strength work is very important when it comes to prevention of injury.

Stage 4: Return to running and sport

Returning to sport/running too early is one of the biggest reasons why hamstring strains reoccur. A professional can cater the rehab program to your specific activity or sport to help build not only your muscles strength but confidence in returning.

Before returning you should:

·      Have full, pain-free range of motion of the muscle

·      Regain similar strength to the uninjured side

·      Be able to sprint, accelerate, decelerate and change directions without pain

·      Have had gradual progression from walking to jogging to running to sprinting in different directions

Stage 5: Preventing injury

Hamstring strains have a high recurrence rate, but the risk can be significantly reduced with the right approach and preventative measures:

·      Maintain regular hamstring strength work especially eccentric work

·      Warm up properly before exercise

·      Address possible muscle imbalances between both legs

·      Progress loads when training gradually

Bottom Line

Hamstring Injuries are common but often preventable. With the right guidance and strength program from a professional, most people will make a full recovery and even come back stronger as long as they complete their rehabilitation. If you aren’t injured but want to start strength exercise for prevention, it is recommended to focus on eccentric exercises.