Introduction
Anatomy
Cause and Symptoms
Diagnosis
Non-surgical treatment
Surgical treatment
Rehabilitation
Prevention
Hamstring strain is also called pulled hamstring. This is one of the most frequent sports injuries especially in sprinting sports such as soccer and rugby. Athletes who had previous hamstring injury, older age and participate in high level of competitive sports are more prone to hamstring strain. Lack of hamstring power, muscle fatigue and inadequate flexibility are also significant predisposing factors.
Hamstrings are composed of three muscles at the back of the thigh, namely semi-membranosus, semi-tendinosis and biceps femoris. All three muscles originate from the ischium of pelvis and insert to the proximal part of tibia and fibula (leg bones). They serve as hip extensors as well as knee flexors. As hamstring cross both hip and knee joints, they are easily injured during violent eccentric muscle contractions. Most of the hamstring strain occurs at the junction between muscle and its tendon.
Indirect injury is more common which occurs when hamstring stretches beyond its limits leading to muscle strain. Direct blow to hamstring could also result in muscle tear. Athletes usually reported sudden pain at the back of thigh that seems someone had kicked them from behind. Sometimes there is an audible “pop” sound in severe grade of injury.
Hamstring strain could be diagnosed clinically with localized tenderness and swelling in the area of muscle involvement. There may be bruises at the back of the thigh representing underlying hamstring bleed at the injured site. For severe complete hamstring tear, muscle defect may be palpable. X-rays may be needed if avulsion fracture or other bony injury is suspected.
Ultrasound or MRI is sometimes used to provide more information about the location and extent of the hamstring injury, but physical examination is usually sufficient for the diagnosis
Most of the hamstring injury are strain, that means only part of muscle is torn and therefore non-surgical treatment is adequate. For acute hamstring strain, RICE regime with the use of analgesics such as non-steroidal anti-inflammatory drugs (NSAID) is the hallmark of treatment during the first few days of injury:
R means Rest
I means application of Ice
C means Compression by use of elastic bandage or stockings
E means Elevation of injured thigh
This helps in relieving the pain, reducing the swelling and controlling the underlying muscle bleeding. As the pain and swelling subsided by the first week, progressive functional physical therapy should be started. Crutches may be recommended, if the strain is severe and the patient is limping for a short period of time to reduce pain during walking.
Surgery is rarely needed. However, it may be indicated for avulsion injury or in cases with complete disruption of hamstring with loss of strength, especially in active athletic population. As delay in surgery increases the chance of sciatic nerve involvement and tends to have less favorable functional outcomes, early surgical repair is recommended if indicated.
Rehabilitation in terms of supervised physical therapy improves the range of motion as well as muscle strength. Return to sports is allowed when athletes achieve pain-free full range of motion with satisfactory hamstring power. The time needed will depend on the severity of injury, too early return to sports will predispose further hamstring injury and thus not recommended.
Ensure sufficient proper warm-up before exercise
Regular static stretching exercise improves flexibility.
Maintain muscle strength balance between quadriceps (thigh muscles in front) and hamstrings
Condition your muscles with regular program of exercise