Hamstring Tears: Management of Hamstring Strains.

Hamstring injuries are common in sports involving sprinting and kicking. They are the most common injury in elite football,
representing about one-third of all time-loss injuries.

The hamstring muscles run down the back of the leg from the pelvis to the back of your knee.  An injury can range from minor strains to total rupture of the muscle. Early treatment of an injured hamstring can help to speed recovery and minimise the symptoms.

What are the Symptoms of a Hamstring Tear?

• A sudden sharp pain in the back of the leg during exercise, most commonly sprinting.
• Pain on stretching the muscle.
• Pain on contracting the muscle against resistance.
• Swelling and bruising.
• Discomfort with walking.
• If the rupture is severe a gap in the muscle may be felt.

Severity of Hamstring Tears:

Strains may be minor or very severe. Strains are broadly graded 1, 2 or 3 depending on severity, where grade 1 tears are low grade injuries within the muscle and grade 3 is a severe or complete rupture of the muscle.

Grade 1: What does it feel like?

• May have tightness in the back of the thigh.
• Probably able to walk normally, however, will be aware of some discomfort.
• Minimal swelling.
• Little if any pain on resisted knee bending.

Grade 2: What does it feel like?

• Walking will be affected, limp may be present.
• Occasional sudden twinges of pain during activity.
• May notice swelling.
• Site of tear will feel tender to touch.
• Flexing the knee against resistance causes pain.
• Might be unable to fully straighten the knee.

Grade 3: What does it feel like?

• Walking severely affected, may need walking aids such as crutches.
• Severe pain particularly during activity such as knee flexion.
• Noticeable swelling or bruising may become visible.

What is the Acute Management of a Hamstring Tear?

It is vitally important that treatment for a pulled hamstring starts immediately following injury. The most important phase for treatment is the first 48 hours post-injury. Early management will have you back on the field faster. Suggestions for immediate treatment of a pulled hamstring include:

• Stop your activity.
• Rest the injured leg.
• Use icepacks every two hours, applied for 15 minutes.
• Elevate the leg above heart height whenever possible.
• Avoid exercise, heat, alcohol and massage in the first 48 hours, as these can all exacerbate swelling and tissue damage.

Professional Help

If the pain from a low grade hamstring tear that you are managing yourself has not improved after a day or so, or it is a more severe grade 2 or 3 tear, it is best to seek medical advice and consult with one of our physiotherapists to get an accurate diagnosis of the injury and suggest the most appropriate treatment plan.

Physiotherapy Provides Rehabilitation and Support

Physiotherapy treatment will depend upon the severity of the injury. The success rate of treatment is largely dictated by patient compliance. Treatments may include:

• Hands on therapy for damaged tissues. Soft tissue therapy is excellent for reducing inappropriate scar adhesions while promoting faster healing conditions.
• A stretching program can be started as soon as the pain and swelling subside to encourage full range of pain-free movement.
• Management primarily involves rehabilitation and strengthening exercises to rebuild the strength of the injured muscle to prevent re-injury and to target overall leg strength.
• A lumbopelvic stability retraining program is highly recommended for improved load distribution.
• A progressive speed, agility and power program that prepares you for your sport is the best chance to ensure a successful outcome and full return to your pre-injury status.
• Correction of any predisposing biomechanical stressors (e.g. pelvic tilt) and muscle imbalances.
• Provide mobility aids such as crutches where appropriate in the acute phase.

Inadequate rehabilitation commonly results in recurrent and more severe calf strains.

Preventing a Pulled Hamstring

Suggestions to prevent hamstring strains:

• It is important to warm up appropriately before training or competition. This should consist of some light aerobic exercise followed by dynamic, sports specific drills, e.g. FIFA 11+ injury prevention program.
• One of the most important methods of preventing a hamstring tear is to increase the strength of the hamstring muscles. Consult with one of our physiotherapists for a suitable hamstring strengthening program. A hamstring tear is far more likely in athletes who have weak hamstring muscles that don’t meet the demands of their sport or activity.
• Adequate load progression with training/competition has been highly indicated for injury reduction, that is, not doing too much too quickly. Our physiotherapists can guide your training program to limit the effects of inappropriate load management.
• Include hamstring muscle maintenance in your workout routine (e.g. massaging, stretching, foam roller).

If you would like further information on management of a hamstring strain contact one of the physiotherapists at Jubilee Sports Physiotherapy who can guide you in your rehabilitation.