Are you or have you been ‘HamStrung’?
‘Hamstrung’ – a figurative verbal expression from the noun hamstring (the muscle and tendon on the back of the thigh), originating in the 1500’s where soldiers would slay their enemy across the back of their thighs rendering them disabled, crippled, lame, or useless. If you have ever strained or torn a hamstring muscle (albeit in a less violent manner!), you probably felt the same.
Hamstring strains are the most significant injury in football/soccer, rugby, running (more commonly sprinting), basketball, and baseball. Apart from being debilitating at the time of injury, hamstring strains can be frustratingly slow to heal. Often taking an average of 3-4 weeks to recover, even up to 6 months to return to full sporting ability. What’s worse, is that there is a 20 to 50% chance that you will re-injure your hamstring in the same season!
The hamstring is a powerful group of muscles that arise in the hip and pelvis and insert as a strong tendon at the back, just below the knee joint. It is a two-joint muscle in that it works over two joints, both bending the knee and extending the hip. Most commonly injuries to the hamstring happen with sudden changes in running direction, sudden acceleration, explosive speed, or when trying to contract the muscle whilst it is being stretched, for example a soccer player with an outstretched leg, attempting a high kick all at the same time.
Social athletes or sportspersons of any level are at risk of straining their hamstrings. However, people who sit for long periods of time during work or at home are also at risk of injury. They most likely have weak and tight hamstrings, due to the static nature of their day, and shortened position of the hamstring whilst sitting. Whether this is you, the office worker who is convinced to play a quick friendly game with mates after work; or get roped into the parents 100m dash at the school sports day; or a weekend warrior; ‘tearing’ your hamstring can happen.
When the hamstrings contract, the quadriceps relax. And vice-versa. It’s a not-so-delicate game of tug-of-war. When they are out of sync, injury can happen that can extend beyond the muscle groups themselves. Several factors, often in play at the same time, can cause a strained hamstring, however many of these factors are modifiable, suggesting one can prevent a hamstring strain to a certain degree. Strength imbalances, muscle fitness and endurance, warming up, underlying back problems, technique, conditioning of the muscle to acceleration and deceleration – these risk factors can all be addressed. Sadly, a previous hamstring injury and age are two risk factors that can’t be altered. Increasing age increases injury risk. It’s something to be aware of and possibly take extra caution to prevent a hamstring strain!
Your symptoms may vary depending on how severely you strain your hamstring. They may include pain behind the leg and into the buttock immediately at the time of injury or afterwards, with difficulty walking. Muscle spasm and tightness in the muscle, bruising (which can spread down into the calf area) and tenderness, swelling, an audible popping or snapping sensation. With a complete (Grade 3) tear, you may feel a ‘ball’ of muscle in the back of your thigh.
Management may include early treatment with the RICER protocol, ask your therapist for advice about this for the first 48-72 hours. You may want to rest the leg and use a crutch to reduce loading on your injured leg. Massage is not advised in this acute phase (first 48 hours for a Grade 1 injury or up to 1 week for a more severe strain) as the increased blood flow to the area can increase bleeding in the muscle and increase inflammation. However, once this has passed, treatment can progress to:
- Gentle pain free massage therapy is advised in the early stages of a hamstring strain. Massage to the surrounding muscles, lower back, glutes (buttocks) and calf and quadriceps (front of the thigh) may all be beneficial.
- Massage can be beneficial to loosen scar tissue and prevent excessive build-up of scar tissue
- The increased blood supply can promote tissue healing
- Massage also promotes lengthening and flexibility of the hamstring and surrounding muscles.
- As the tissue heals so deeper massage techniques can be used to mobilise the muscle fibres and prevent adhesions
Keep this in mind:
- Cross-train in sports that don’t place a heavy demand on the hamstrings (upper body strength training, easy lap swimming, low resistance stationary cycling or elliptical trainer).
- Observe the 10 percent rule: Do not increase exercise intensity, frequency or duration more than 10 percent a week.
- Regular massage may form part of a prevention strategy, keeping the hamstring muscle flexible and aiding in muscle recovery
For optimal recovery and prevention of a recurrent hamstring strain it is essential you work through a treatment and rehabilitation program with a therapist. First prize, in an ideal world, would be preventing the injury completely. There are things you can start to do to prevent a hamstring strain.
Secrets to Preventing Hamstring Injury
Hamstring strains are one of the most dreaded injuries in sport and mastering how to prevent hamstring injuries has become one of the Holy Grails of sports medicine. There are a couple of reasons why hamstring injuries are dreaded, the first is they are a very frustrating and time-consuming injury to rehabilitate, and the second reason is that once they’ve occurred, they frequently recur.
This makes them a particularly important injury to rehabilitate properly, and generally does require proper physical therapy treatment. The ultimate prize of course would be preventing a hamstring injury in the first place, and this is completely possible to do if you follow a few simple tricks that we’ve outlined below.