Hamstring strain

The hamstring is found along the back of the thigh and comprises of a group of muscles that extend the hip (backwards movement of the leg) and flex (bend) the knee. A hamstring strain, sometimes called a pulled hamstring, is very common in sports that involve sprinting such as football, rugby and hockey and it most often occurs at the junction of the muscle and its tendon.

Symptoms of a hamstring strain are:

  • Sudden sharp pain at the back of the leg, particularly during sprinting.
  • Reduced length of the hamstring during stretching and pain with stretching.
  • Swelling and bruising along the back of the thigh.
  • Moderate to severe tenderness over the area of the strain.
  • Difficulty walking and running.

Hamstring strains are graded according to severity. Features of a grade 1 strain are:

  • Tightness at the back of the thigh.
  • Some discomfort with walking.
  • Minimal or no swelling and bruising.

In a grade 2 strain:

  • The person may limp.
  • There may be sudden twinges of pain with activity.
  • More considerable swelling may occur and bruising may surface after a few days.
  • Bending the knee against resistance causes pain.
  • The person may have difficulty straightening the knee.

In a grade 3 strain:

  • There is severe pain.
  • Walking is severely affected and crutches may be needed.
  • Severe pain occurs when the knee is bent.
  • Swelling occurs immediately and there may be considerable bruising after a few days.

The first 48 hours following injury are critical. You should begin the RICE protocol immediately (rest, apply ice and compression and elevate the affected area). Rest is important to prevent further injury and give the muscle time to heal. A grade 1 strain should be rested for about 3 weeks, a grade 2 for four to six weeks while a grade 3 strain may take up to 3 months. Surgery may be indicated for a grade 3 strain. Ice should be applied for twenty minutes (never apply directly to the skin) every two hours while the leg is resting in an elevated position. A compression bandage helps reduce swelling and bleeding in the tissues.

Your physiotherapy treatment for a hamstring strain will be RICE for the first 48 hours, followed by gentle passive stretching exercises. We will then use massage techniques to help break down and remove scar tissue as well as to increase blood flow to the area, which will speed up the recovery process. We may use pain-relieving modalities such as ultrasound and electrical stimulation as well as acupuncture or trigger point therapy. If you need to wear crutches, we will train you in using these and get you started on a rehabilitation programme that will help you prevent further injury with specific hamstring strengthening exercises followed by cross-training exercises before a graduated return to running.

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