Hamstring Injuries – Incidence and Treatment

March 10th, 2017

Hamstring injuries can be a challenge to both the athlete and therapist when attempting to rehabilitate, recover, and return to prior activity level.

This is due in part to a number of factors including the high incidence rate of this type of injury, slow healing process, and persistent symptoms. It has been found that nearly 1/3 of hamstring strains recur within the first year following return to sport without a proper and comprehensive rehabilitation program.

Hamstring injuries can occur in a variety of sports. Hamstring injuries that result from high-speed running as in track and football generally occur during the end swing phase of the gait cycle. In this type of injury the lateral hamstring tendon, or biceps femoris is generally the most often injured. Hamstring strains can also occur during activities such as dancing, kicking, and water skiing. These injuries result from simultaneous hip flexion and knee extension, which places the hamstring in an extreme stretch position. This type of injury typically presents in the semimembranosus, or most medial tendon.

The primary goal of hamstring rehabilitation is to return the athlete to his/her prior level of performance with minimal risk of injury recurrence. Factors that must be considered during rehabilitation include hamstring weakness, fatigue, lack of flexibility, and muscle imbalances between the hamstring and quadriceps muscles. In addition, limited quadriceps flexibility and strength and pelvic, core and trunk strength deficits may contribute to hamstring injury risk and should be addressed.

Hamstring injuries are generally classified according to the amount of pain, weakness, and loss of motion present. They are categorized by the extent of muscle fiber or tendon damaged, resulting in grades of I (mild with minimal damage), II (moderate with minimal disruption of fibers without a tear), and III (severe with complete tear or rupture). Regardless of the grade of your injury rehabilitation is crucial to making a full recovery and reducing the likelihood of reinjury.  Our physical therapists will perform a thorough evaluation during your initial visit. The evaluation will include a battery of tests that measure range of motion, strength, and pain. This will help to provide a reasonable estimate of rehabilitation duration and a basis for beginning treatment.

An appropriate treatment regime for your return to full activity and sport participation is necessary. Not all hamstring injuries are created equal and therefore each injury requires individualized treatment.  Once an injury has occurred in the hamstring, the body begins the healing process with the production of scar tissue.  Although scar tissue is a necessary process of healing, it is important for scar tissue presence to be managed and maximized for healing and not to impede the function of the muscle.  The physical therapists at The Training Room use techniques such as massage, Graston Technique, Active Release Technique, and Dry Needling to manage scar tissue and muscle restrictions.   Exercises should include a combination of eccentric strengthening, neuromuscular control drills, quadriceps flexibility and strength and core stability. At The Training Room, the treatment program is tailored to promote the goals of the patient.  Whether your sport requires kicking, cutting/pivoting, or jumping, there is a specific progression for your recovery.  Progression criteria is based on factors such as pain response, strength and flexibility improvements, and activity progression. Agility activities, plyometric exercises, and return to sport-related activities will be incorporated when deemed appropriate and based on an appropriate progression.

Proper rehabilitation is vital following hamstring injuries to ensure a successful return to prior activity level. The Training Room can provide you with the proper treatment to assist you in your return and prevent reinjury in the future.