Pain Profile: Hamstring Strain
The hamstrings are the most frequently strained muscles in the body (Anderson and Parr, 2009, p.547). The hamstrings are strained when rapid or ballistic contractions overload the muscle and a tear occurs within the hamstring muscles, the muscle fascia, or tendons. Many times the hamstrings suffer from recurrent strains and the problem becomes chronic. Treating the underlying causes of hamstring strains can reduce the risk of straining the hamstrings multiple times.
The hamstrings are mainly responsible for hip extension and knee flexion. They are also responsible for some medial rotation of the tibia and the femur. The hamstrings are made up of three different muscles:
Semimembranosus – the most medial (toward the middle of the body) of the three hamstring muscles. Attaches on the ischial tuberosity (hip bone), the medial tibia, and the femur.
Semitendinosus – a superficial (visible) muscle situated as the middle muscle in the hamstring group. Attaches on the ischial tuberosity (hip bone) and the medial tibia. The semitendinosus is sometimes used to replace the anterior cruciate ligament (ACL) in the knee.
Biceps Femoris – As the name implies, the muscle splits into two heads. One head attaches on the ischial tuberosity. The other attaches on the femur. The muscle inserts on the fibula.
How you orient your pelvis (hips) can put excess stress on the hamstrings and can put you at a higher risk of straining your hamstrings. There are two types of pelvic positions that we will discuss: anterior pelvic tilt and posterior pelvic tilt
An anterior pelvic tilt causes the ischial tuberosity to move superiorly (higher) which causes the hamstring muscles to lengthen. When the hamstrings are constantly in a lengthen state, this causes the resting tension in the muscle to increase. When there is a higher resting tension that creates an environment where the muscle can be strained easily because any sudden increases in muscular force can overload the muscle and cause it to tear. People who walk with an anterior pelvic tilt usually look their stomach is protruding, they have an increased lordosis (curve) in the lumbar spine, and they are always trying to stick their butt out. These people usually have tight hip flexors and quadriceps.
A posterior pelvic tilt causes the ischial tuberosity to move inferiorly (lower) which causes the hamstring muscles to shorten. This environment is also detrimental for the hamstrings because it causes the hamstrings to become tight and reduces the flexibility of the muscle. This reduced flexibility can limit the range of motion at the hip which can lead to more problems in the hip, spine, and knees. Tight hamstrings can be sprained more easily because when the hamstrings become lengthened quickly, tears can occur. People with a posterior pelvic tilt usually look like they are hunched over, have a very flat curve in the lumbar spine, and roll their shoulders forward. These people usually have tight hamstrings, complain of shoulder tightness and have a stiff thoracic spine (upper back).
The hamstrings are often improperly trained and do not receive as much attention as the quadriceps. The quadriceps is used more in everyday activities so if you are not specifically training the hamstrings you probably do not have proper muscle balance. Another training error most people fall victim to is only training the hamstrings with knee flexion. As stated earlier the hamstrings perform knee flexion AND hip extension. The proximal (closer to the hip) fibers of the hamstrings could be weak if you do not perform exercises that incorporate hip extension. Weak glutes also contribute to hamstring strains as well. The glutes and the hamstrings work synergistically to help with hip extension so if the glutes are weak then more stress is placed on the hamstrings.
Signs and Symptoms
Signs and symptoms of a hamstring strain include tightness, sharp pain with knee flexion and/or hip extension, bruising, and noticeable deformity throughout the muscles. One of the most common ways the hamstrings are strained is excessive eccentric loading of the hamstring. This could mean slowing down too quickly after running a sprint, cutting and changing directions, or lack of control of the weight while weight lifting. A “pop” may be felt along with sharp, debilitating pain.
As with any strain, use the RICE method. Rest the muscle as much as possible. Do not perform any activity that recreates the same sharp pain as the initial strain. Resting the muscle will help prevent the tear from becoming bigger. Crutches may be needed if you cannot walk normally or without pain.
Ice the area immediately after straining the muscle and at least once a day after activities that are difficult or painful. Try to ice the hamstrings in a stretched position by keeping the knee straight and elevating the leg as much as possible without eliciting any pain. Ice the muscle for 20 minutes at a time with at least 60 minutes between icing sessions.
Compress the joint with an ACE wrap bandage or wear compression shorts to push out any bruising and swelling in the joint. When applying a compression wrap to the hamstring, start at the knee and wrap upward toward the hip. Use about 75% stretch on the compression bandage. To find 75% stretch, take the bandage and pull the bandage as tight as possible then release the bandage until the bandage is 75% of the length it was when it was pulled as tight as possible. Try to use this amount of tension when wrapping the entire joint. Be sure not to wrap too tight; do not let any numbness occur around the wrap or in the calf and feet.
Elevate the joint to help relieve pressure on the muscle and to reduce swelling. When elevating the hamstring, it should be above the level of the heart so any excess fluid will be pulled back into circulation.
Gentle stretching of the hamstrings can begin once the pain has subsided. Do not force the stretch into a painful position. You can lie on the back and use a rope to pull a straight leg into the air until a mild stretch is felt. Slowly working your way back to activity is key. Do not try to return to weight lifting or running too quickly. This will only slow the recovery process. When you can do some activities without pain, start very easy and light. Take your max weights down to half and start there. If even half of your max weight is painful then more rest is required. If you do not see improvement within 2-5 days, then you should see a doctor to rule out any other conditions (Anderson and Parr, 2009, p.549).
Hamstring strains can be a debilitating injury that can take your weight lifting to a screeching halt. Fortunately hamstring strains can be avoided with some preventive measures like stretching, proper muscle balance, and good pelvic positioning. If you have any concerns about pain or problems in your knee, contact a doctor, physical therapist, athletic trainer or another qualified health care professional.
Anderson, M., & Parr, G. (2009). Shoulder Conditions. In Foundations of athletic training: Prevention, assessment, and management (4th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Note: This article is intended purely for educational purposes. It is not intended to diagnose, treat, or replace advice from a qualified healthcare professional. Every person with an injury is different and needs an evaluation by a physician, physical therapist, athletic trainer, or qualified healthcare professional to identify any problems. Please consult a qualified healthcare professional if you are experiencing any of the signs and/or symptoms described.