Have you ever experienced a shot of pain in the back of your thigh? People describe it as if someone kicked them but when they look around there is no one close to them. Or have you ever had a nagging dull ache in the back of thigh that typically bothers you when you’re moving around but goes away when you’re not? It could be your hamstring muscle.
The hamstring muscles are a group of muscles located in the back of the leg. It consists of 3 major muscles called semitendinosus, semimembranosus and bicep femoris (which has two aspects to it called the long and short head). The sciatic nerve controls all the muscles of the hamstring except the short head of the bicep femoris which is controlled by the common fibular nerve. These are long muscles ranging from the bottom of the pelvis on our sitting bones called the ischial tuberosity all the way down to under the knee. Their main function is bending (or flexion) the knee and bringing your hip backwards (or extension of the hip).
How Does Your Hamstring Get Injured?
Hamstring muscle injuries are the most common injuries in sports, occurring most frequently in soccer at about 37% of all soccer injuries. Other sports with a lot of hamstring injuries are: football, Australian football, track and field, and water skiing.
The reason these are the most common sports with hamstring injuries is because they all involve “deceleration of knee extension through an eccentric contraction in the final swing phase during the stride, when they are elongated by hip flexion and knee extension”. Sounds simple right!?!
What all that gibberish means is that our hamstrings are responsible for slowing down our leg when we bring our leg from behind us to in front of us while we do things such as kicking a soccer ball or running. In fact, hamstring injuries most commonly happen in non contact situations, like running. Generally, when the injury occurs, the person will report hearing an audible pop and/or sudden pain, followed by inability to continue with the activity, and difficulty with bending the knee or bringing the leg back. Swelling and/or bruising may or may not be present depending on the severity on the injury. The more severe the injury, the more swelling and/or bruising will be present. Additionally, the bruising may take a few days to appear depending on which of the hamstring muscles was involved.
The long head of bicep femoris is the most common location for a hamstring injury, however it could happen anywhere along the hamstring muscles. The closer to the muscle’s origin at the pelvis or the closer to the junction of where the tendon meets the bone, the longer it will take for the athlete to return to their sport. These kinds of hamstring injuries correspond to total of 12% of all hamstring injuries. Sometimes the injury is so sever that the muscle or tendon will pull a portion of the bone off of the pelvis! This is called an avulsion fracture. If this happens the individual may present with a gap you can feel, as well as difficulty sitting due to the location of the pain.
There are a number of risk factors that would predispose one to future hamstring injuries. The first is a previous history of a hamstring injury. The second most common would be any muscle imbalances. These could be strength or flexibility imbalances found either between the two legs or any imbalances in different areas of the injured leg. The muscle imbalances typically found on the same leg tend to be between the quad (front of the leg), and hamstring (back of the leg), where the quad is typically found to be much stronger than the hamstring. Other risk factors that may contribute would be tightness or shortening of the hip flexor muscles on the injured leg, or any imbalance between the strength of the abs and low back muscles which would cause pelvic anteversion, or too much arch of the low back.
The absolute best hamstring treatment has not yet been found however, just like most injuries, initial hamstring injuries are treated with RICE: rest, ice, compression and elevation. Anti- inflammatory medications may sometimes be prescribed for the pain control so that the individual may begin rehabilitation as soon as possible. Rehab for a hamstring injury will target stretching, soft tissue mobility, and strengthening. The strengthening will begin with concentric strengthening, followed by open chain exercises, which then will progress to eccentric strengthening, such as nordic flexion. Doing any kind of immobilization of the limb may lead to muscle atrophy and therefore, prolong the recovery. Most hamstring injuries recover fully however any kind of chronic symptoms, over time, may turn into sciatica.
Return to sport timeline depends on the extent of the injury and how many muscles are involved and it may range from 1-3 weeks. However, in general, according to Ernlund and Viera, 2017, the criteria for sports return are: absence of pain, ability to make the respective sporting movements without hesitation, recovery of strength and stretching of the involved muscle group, and the athlete’s own confidence for returning to physical activity.
If you are having any symptoms described in this article or have a new pain, numbness, stiffness or tingling in any part of your body, arms or legs, contact us today! With Direct Access in NJ we can get you in for an evaluation without you having to see your Doctor, probably quicker than you could get that appointment, while also saving you both time and money!
Please, call us to schedule your evaluation at one of BeneFIT’s locations, Bridgewater (908.203.5200) or Chester (908.879.5700) with one of our highly trained Doctors of Physical Therapy!
Ernlund, L., & Vieira, L. A. (2017). Hamstring injuries: update article. Revista brasileira de ortopedia, 52(4), 373–382. https://doi.org/10.1016/j.rboe.2017.05.005