Your hamstrings are some of the largest and most powerful muscles in your entire body. They are used daily whether you are standing, walking, running, or lifting weights. This can put a great deal of stress upon them. As a result, hamstring strains are common, often due to lack of warm-up or overuse. Luckily, most muscle strains are not serious and can be cared for through home rehabilitation.

Hamstring Anatomy

The hamstrings are the muscles on the back of your legs. They flex your lower leg toward you, much like the way your biceps flex your arms.  The hamstring muscle group consists of three muscles. Medially (on the inside of your thigh), there are the semimembranosus and semitendinosus, and laterally (on the outside of your thigh) there is the biceps femoris, which has a short and a long head. They are called “bi-articular” muscles since they cross two joints (the hip and knee), which causes a phenomenon known as “Lombard’s Paradox.”

During a sprint, when in the high-knee position, the hip extends due to the pull of the hamstrings, while the knee extends due to the pull of the quadriceps muscles. This is a paradox, because in order for this to work the hamstrings must be shortening at the top (proximal) and also lengenthening at the bottom (distal). This is known as “Lombard’s Paradox,” and it produces immense straining forces within the hamstrings. These forces must be resisted or the muscles will tear.

During sprinting, the hamstrings lengthen a great deal: up to 110% of their resting length in the case of the biceps femoris, which is the most injured of the three muscles in your hamstrings. They must also deal with great forces, especially in the biceps femoris, toward the end of the swing phase. The muscle generates most of this force, but up to a third is due to the elastic coil of the tendon [1].

Muscle Strains

A muscle strain is caused by a twisting or pulling of a muscle or tendon. There are two types: acute and chronic. Acute strains are caused by trauma or injury, or by improperly lifting heavy objects and overstressing your muscles. Chronic strains are overuse injuries due to prolonged, repetitive movement of the muscles and tendons. There are also three grades:

In a grade 1 hamstring strain…

  • You may have tightness in your posterior thigh
  • You will probably be able to walk normally, but there will be discomfort
  • There will be minimal swelling
  • Bending your knee against resistance will not cause much pain
  • Healing occurs within two to three weeks.

In a grade 2 hamstring strain…

  • Your walking will be affected and you may limp
  • You may experience sudden spikes of pain during activity
  • You may experience swelling
  • Increased pressure to the area will cause more pain
  • Bending your knee against resistance will cause pain
  • You may be unable to fully straighten your knee
  • Healing occurs within three to six weeks

In a grade 3 hamstring sprain…

  • The muscle is completely torn and typically requires surgery
  • Your walking will be heavily affected and you may need crutches
  • You will experience severe pain during activites such as knee flexion
  • There will be noticeable swelling immediately
  • The healing period can be up to three months

When in doubt, go see a qualified health care provider. This is especially true if you’ve actually torn your hamstring. If you heard a popping noise while exercising or lifting something, if you are physically incapable of moving your leg(s), or if you are experiencing bruising/redness, swelling, pain, fever, or open cuts, you should go to an emergency room. You could be experiencing a grade 3 strain, which consists of a complete rupture of the muscle [2, 3].

Back Off to Move On

Your hamstrings may simply be experiencing wear and tear from so much training. If you aren’t already instituting “back off” weeks in your training, you should be. This is simply a week – or longer, if necessary – in which you are not training at your usual volume and/or intensity level. You don’t have to completely stop exercising – in fact, you shouldn’t. You could simply lift lower weights with higher reps, or simply do fewer sets.

If your hamstring pain is really crippling your squats and deadlifts – even if there is no debilitating pain otherwise (such as when walking) – you should probably discontinue these painful exercises until you have fully recovered. It is always a bad idea to continue to exercise when you are experiencing unusual muscular or skeletal pain (apart from the muscular/psychological discomfort that is normal when exercising intensely). You’ll be doing more harm than good.

Rehabilitation Techniques

Apart from the rehabilitation that your doctor will advise if your hamstring problems are serious enough (hopefully they are not), there are some simple home remedies that should have you back on track within a few weeks.

For most muscle strains, the RICE protocol is effective. RICE stands for Rest, Ice, Compression, and Elevation.

  • Rest. Temporarily discontinue the activity that caused the strain. Your doctor may recommend crutches, depending on the severity of the strain.
  • Ice. Use cold packs on the strain for 20 minutes at a time, several times per day. Do not put ice directly on your skin.
  • Compression. Wear a compression bandage in order to prevent blood loss and/or additional swelling.
  • Elevation. Recline and raise your leg higher than your heart while at rest. This will help reduce swelling [4].

Physical therapy for a muscle strain usually consists of static stretches. There are a number of static stretches you can do to target your hamstrings. The simplest can be performed as follows: sit down on the ground with your legs pointed straight out in front of you. While keeping your back straight, bend your upper body forward and pull your toes/feet backward with your hands. If you cannot reach your toes, just bend as far forward as you can, and flex your feet backward toward your hands. Hold the stretch for at least 30 seconds. Do this daily, or several times per day.

Trigger point therapy (or deep tissue massage) is also very helpful for injured muscles. It can also serve as a preventive measure regarding injuries. Getting someone to massage your hamstrings might be ideal, but it’s not always desirable or convenient. To do it yourself, you will either need a foam roller or something similar. The firmer the object is, the better. It also helps if it has nodules on it that will work into your tissue – similar to the fingers and thumbs of a masseuse. Using a soft foam roller is not as effective as something firmer because it will not manipulate your soft tissue as much. In a pinch, a piece of thick PVC pipe can actually give a great massage.

Whether it’s a firm foam roller with nodules (ideally) or a piece of PVC pipe, throw the thing on the ground and roll around on it. Sit on it and roll your glutes (i.e., your butt) over it, and aggressively roll it over your hamstrings like crazy. Do it to your calves, feet, and back as well. It might feel uncomfortable at first, but do it daily and eventually you won’t be able to live without it.

Here’s a good roller, in case you don’t want to go the PVC pipe route. (It’s not that bad, though.)

 

References:

1. http://www.athleticsweekly.com/coaching/the-good-the-bad-and-the-painful

2. http://www.sportsinjuryclinic.net/sport-injuries/thigh-pain/hamstring-strain

3. http://sportsmedicine.about.com/cs/injuries/a/sprains.htm

4. http://orthoinfo.aaos.org/topic.cfm?topic=a00408

One comment on “Hamstring Injuries and Rehabilitation

  1. A foam roller is cylindrical device constructed from dense foam. Originally, athletes used foam rollers to compress and massage very specific areas of muscle tension and pain. These areas, called trigger points (or more commonly known as a knot) develop over time and must be untangled to recover muscle to its original length. A muscular knot is a muscle that’s tangled-up in the fascia of our skin. Regular massage of trigger points sends signals to the brain to start a process called myofascial release, which frees your muscle from your surrounding fascia.

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