Children Orthopaedic

Hamtring Injury / Pulled Hamstring

A hamstring strain is a common injury involving a tear in one or more of the hamstring muscles.  A pulled hamstring can range from mild to very severe involving a complete tear of the muscle.

Pulled hamstring symptoms

One of the most obvious symptoms of a hamstring strain is a sudden sharp pain at the back of the leg during exercise, most probably during sprinting or high speed movements. Depending on how bad the injury is the athlete will usually have to stop immediately and further participation in training or sport difficult or impossible. Often the athlete will try to play on with a pulled hamstring but this is one injury where it just isn’t possible.

Pulled hamstrings are graded 1, 2 or 3 depending on severity.  Grade 1 consists of minor tears within the muscle. A grade 2 is a partial tear in the muscle and grade 3 is a severe or complete rupture of the muscle.

Grade 1 Hamstring strain

With a grade 1 hamstring strain the athlete may have tightness in back of the thigh but will be able to walk normally. They will be aware of some discomfort and unable to operate at full speed. There will be little swelling and trying to bend the knee against resistance is unlikely to reproduce much pain.

Grade 2 Hamstring strain

With a grade 2 hamstring strain the athletes gait will be affected and they will most likely be limping. Sudden twinges of pain during activity will be present. They may notice some swelling and pain will be reproduced when pressing in on the hamstring muscle as well as trying to bend the knee against resistance.

Grade 3 Hamstring strain

A grade 3 hamstring strain is a severe injury involving a tear to half or all of the muscle. The athlete may need crutches to walk and will feel severe pain and weakness in the muscle. Swelling will be noticeable immediately and bruising will usually appear within 24 hours.

Hamstring strain causes

The hamstring muscle group consists of three separate muscles; the Semitendinosus, Semimembranosus and Biceps Femoris. During sprinting the hamstring muscles work extremely hard to decelerate the tibia (shin bone) as it swings out. It is in this phase just before the foot strikes the ground that the hamstrings become injured as the muscles are working hardest and approaching their maximum length.

A pulled hamstring rarely manifests as a result of contact. If you have taken an impact to the back of the leg it should be treated as a contusion until found to be otherwise. A strained or pulled hamstring as it is sometimes called is a tear in one or more of the hamstring muscles. Strictly speaking there are three hamstring muscles, the Semitendinosus, Semimembranosus and Biceps Femoris.

Problems with the lower back and pelvis may increase the likelyhood of suffering a hamstrings strain and should always be considered, particularly for recurrent hamstring injuries.

Pulled hamstring treatment

It is vitally important that treatment for a hamstring strain starts immediately following injury.

What can the athlete do?

The most important phase for treatment is the first 48 hours post-injury. In this time the following can be carried out by the athlete themselves:

  • Apply Cold Therapy immediately for 10-15 minutes and repeat this every hour for the first day. After this, every 2-3 hours is sufficient.
  • Use a compression bandage to minimize intra muscular bleeding and swelling.
  • Rest as much as possible with the leg elevated.
  • Stretching exercises should be done but only when pain allows. It is likely that strengthening exercises will be possible before the leg is ready for stretching.
  • Strengthening exercises should be done as soon as pain allows. Mobility exercises can help with decreasing the swelling in the area. Strengthening exercises will gradually increase the load through the muscle.

What can a Sports Injury Specialist do?

  • Advise on a full hamstring strain rehab program such as that developed for us by Premiership Football Physiotherapist Neal Reynolds.
  • Use sports massage for hamstrings to speed up recovery. Sports massage is important in the treatment and rehab of hamstring muscle injuries as massage helps correct new muscle fiber realignment and minimizes scar tissue. In addition massage can increase the blood flow to the injured area.
  • Use ultrasound and other forms of electrotherapy are often used as part of pulled hamstring treatment to aid the healing process and reduce swelling.
  • Provide mobility aids such as crutches particularly if the hamstring strain is severe. Resting it is important.
  • Provide an MRI scan to ascertain the amount of damage sustained.
  • In severe ruptures surgery may be needed to repair the muscle damage.

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