Hamstring injury

Hamstring injury, also called as a pulled hamstring is the strain produced on the muscles of the back of the thighs. Injury to the hamstrings usually occurs in the proximal and lateral ends. The injury can range from a minor strain or tear to a major rupture. Based on the severity of strain, hamstring injury can be graded as below:

  • Grade 1 which involves only a mild strain or pull
  • Grade 2 involves a partial muscle tear
  • Grade 3 involves a complete muscle tear

The symptoms of hamstring injury depend on the severity of the strain on the muscles.

Grade 1 Sudden pain and tenderness in the back of thigh Muscle strength is not affected
Grade 2 More severe pain and tenderness in the back of thigh Swelling and bruising at the back of the thigh Mild loss of muscle strength
Grade 3 Very painful, tender back along with swelling and bruising Inability to use the affected leg

The hamstring injury is caused due to the excessive and sudden stretching of the muscles. This is common with athletes who perform rapidly accelerating activities such as running or initiating running, etc. However, it can also occur during slower movements involving overstretching of the hamstring muscles.

They are common in people who play sports such as soccer, football, and track.

The below risk factors increase a person’s chance of having a hamstring injury.

  • Muscle weakness within the hamstring muscles
  • Inadequate warm up and poor stretching before strenuous exercises
  • Recurrent injuries even before the injured muscle completely heal from the previous damage
  • Muscle weakness between the hamstrings and quadriceps
  • Poor footwear

Recurrent injuries are quite common if a person with hamstring injury does not take adequate rest before resuming vigorous activities.

A pulled hamstring is diagnosed based on the medical history and physical examination. Circumstances of the injury give the type of injury while the grade of injury is obtained based on the physical examination.

Medical history includes questions such as previous injuries, arthritis of knee or back or hip, which can affect the range of motion and flexibility of the muscle. This increases the chances of another injury.

Physical examination includes touching of the muscles to check for tenderness and swelling. Based on the severity of the pain and the location, the extent of damage can be determined. Also, the range of motion of the affected leg is checked by moving the leg in different directions and positions. This gives an idea if ligament or tendon has been damaged and the point of the muscle affected.

Imaging studies are conducted in the case of a severe hamstring injury, where muscle detachment can occur from the pelvis or the shinbone. X-rays are used to check for fractures while MRI scan is used to visualize tears in the muscles and tendons.

Recovery from hamstring injury may take few days to weeks or even months, which depends on the severity. In the case of grade 3 injury, it will take several months during which playing sports is not allowed.

Initial management of hamstring injury involves the following home care steps:

  • Rest : Do not move your leg to the extent possible and avoid doing any kind of physical activities. You may use crutches in severe cases.
  • Ice : Apply ice wrapped in cloth for 15-20 minutes to the affected area. Repeat this every three to four hours every day. Do not apply direct ice to the skin.
  • Compression : Apply a compression bandage to avoid further swelling. The bandage should not be too firm causing pain nor too loose.
  • Elevation : To decrease swelling, the affected leg should be elevated above the level of the heart.

To reduce inflammation and pain, medications such as ibuprofen or acetaminophen may be prescribed. Grade 1 and 2 hamstring injuries heal without further treatment within a few weeks. However, if the symptoms persist, then you may have to undergo physical therapy. These exercises help to improve the strength and flexibility of the muscles.

In the case of grade 3 hamstring injury, if a bone fragment has occurred, reattachment is required. Muscle ultrasound and electrical stimulation therapy may be used to improve the blood circulation and allow for healing the muscles.