Injury Paper: Hamstring Strains

Located in the back of your thigh is a group of three muscles, the semimembranosus, semitendinosus, and biceps femoris muscles. These three muscles make up the hamstring. A hamstring injury occurs when you strain or tear at least one of your hamstring muscles. This type of injury is most common in sports that involve deceleration, acceleration, sprinting, and quick changes in direction. These types of sports include but are not limited to football, track, rugby, and soccer. Those types of movements can cause the hamstring to be placed in a position of extreme stretch. This type of movement is commonly known as eccentric contractions where the muscle is lengthened. Hamstrings act eccentrically when they slow down a movement. For example, when you are sprinting your hamstring will work to slow the forward extension of the leg to stop overextension of the knee. Stretching the muscles beyond their limits during these quick, explosive movements can easily injure the hamstring area, however hamstring injuries can also occur over a period of time, gradually and slowly due to overuse. The biceps femoris long head is most commonly injured when it comes to high-speed running. Outside factors that can lead to hamstring strains include, “muscle weakness, lack of flexibility, fatigue, inadequate warm-up, and poor lumbar posture.” (Predicting Hamstring Strain Injury in Elite Athletes) A study regarding posture in relation to hamstring injuries found that those with poor lower back posture were those with the hamstring injuries. (Sports Medicine) Nonetheless, there are underlying causes to hamstring strains that may not just arise from a sudden movement during physical activity. Instead you may strain your hamstring due to the fact that you didn’t properly stretch before your game, you have a weak core, or you never take the time to properly stretch and increase your flexibility.

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There are several signs and symptoms you can notice and look for when evaluating a hamstring strain. Most individuals that are experiencing a hamstring strain experience onset pain occurring in the posterior area of the thigh. Individuals may also describe their injury occurrence to be a hearable pop or they may specify that they have pain in their ischial tuberosity when they are in a sitting position. Tenderness and bruising can also be signs of a hamstring strain. It is very important to understand the occurrence of the injury to be able to properly diagnose and treat it. “The mechanism of injury and tissues injured have been shown to have important prognostic value in estimating the rehabilitation time needed to return to preinjury level of performance.” (Journal of Orthopaedic & Sports Physical Therapy) For example, injuries that involve the intramuscular tendon or the adjacent muscle fibers may have a shorter recovery period. This would be an example of the biceps femoris being injured during high-speed running. However, injuries involving the free tendon requires a longer recovery period. In summary, hamstring strains involving the free tendon requires a longer recovery period whereas hamstring injuries occurring within the muscle tissue do not need as long of a recovery period.

Once a hamstring injury is suspected a physical examination will be done to determine the location and severity of the injury. Hamstring strains can be classified into three categories. These categories are listed as mild (grade I), moderate (grade II), and severe (grade III) based on the extent of the injury. The extent is based off of the weakness, loss of motion, and the pain occurring. Mild would result in a small amount of damage and severe would results in a complete tear in the hamstring. With that being said, during the physical examination of the injury “strength in local and adjacent muscles, as well as range of motion at the hip and knee” need to be closely evaluated. (Journal of Orthopaedic & Sports Physical Therapy) Rehabilitation will be based of the type of hamstring strain you are dealing with. A mild or moderate hamstring strain will most likely heal on its own, however it is going to take time. Rest, ice, compression, and elevation are steps that can be taken when treating the injury. However, doing exercises to return to play can be the most important step to recovery. Unfortunately, hamstring strains are very known to reoccur. There has been a lot of speculation as to why hamstring strains have such as high recurrence rate. According to theory it is because of, “persistent weakness in the injured muscle, reduced extensibility of the musculotendon unit due to residual scar tissue, and adaptive changes in the biomechanics and motor patterns of sporting movements following the original injury.” (Journal of Orthopaedic & Sports Physical Therapy) A highly recommended form of rehabilitation is eccentric strength training. This is highly recommended because it is believed that reinjury can be caused from “a shorter optimum musculotendon length for active tension in the previously injured muscle.” (Journal of Orthopaedic & Sports Physical Therapy) Therefore, if you are rehabilitating using concentric exercises repetitively you could end up creating scar tissue at the musculotendon junction. Furthering, performing eccentric strength training after a hamstring injury has occurred it can help restore optimum musculotendon length. This can overall help reduce the chances of reinjuring the hamstring muscles.

In summary, hamstring strains can occur by stretching the muscles beyond their limits or by gradually straining the muscles over a period of time. The type of strain can range anywhere from a grade I to a grade III strain. It is a very common injury and the most common reoccurring injury. Understanding the mechanism of injury and discovering the location within the muscle is extremely important when planning your route to recovering for your hamstring strain. There are several different types of rehabilitation options when it comes to repairing a strained hamstring, however the most effective treatment process was eccentric strength training. It has been found that those who perform eccentric strength training are less likely to reinjure their hamstring. However, there are other methods. Eccentric strength training seems to be the most promising. Overall, hamstring strains can substantially change and limit your performance indefinitely if not properly diagnosed and treated.

Works Cited

Brockett, C. L., Morgan, D. L., & Proske, U. (n.d.). Predicting Hamstring Strain Injury in Elite Athletes. Retrieved from https://pdfs.semanticscholar.org/82bc/692b00a23631c3aaff10c62a42485ca9f0c8.pdf

Freckleton, G., & Pizzari , T. (n.d.). Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis. Sports Medicine. Retrieved from https://bjsm.bmj.com/content/bjsports/47/6/351.full.pdf

Heiderscheit, B. C., Sherry, M. A., Silder, A., Chumanov, E. S., & Thelen, D. G. (2010). Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 67–81. doi: 10.2519/jospt.2010.3047