Recently while playing, I ran up to hit a short ball and had tremendous sharp burning pain in my right hamstring that caused my leg to give out. After a few minutes the pain subsided and I was able to walk to the pool where I did some stretching and then applied ice. Hamstring strains and soft tissue injuries in general are difficult; frustrating injuries to deal with because they are persistent, heal slowly and the rate of reinjury is high. During the 1996 Olympics in Atlanta I had an opportunity to treat many of the track and field athletes, mostly sprinters. Hamstring injuries were by far the most common problem encountered. We had to aggressively treat these injuries to facilitate the athlete’s rapid return to training and competition.
The hamstrings are made up of three muscles, the Biceps Femoris, Semitendinosus and semimembranosus. These muscles are responsible for extension of the hip and flexion of the knee. They are the primary muscles used in activities requiring running, rapid acceleration and deceleration. Injuries to the hamstrings can range from a mild strain to a total rupture or avulsion of the muscle. A hamstring injury typically causes an intense sharp sudden pain in the back of the thigh while performing a sudden movement.
Hamstring tears are classified as follows:,
mild (grade 1)
- muscle stiffness, soreness and tightness
- minimal swelling (edema)
- normal gait and range of motion with mild discomfort
moderate (grade 2)
- altered gait with limping
- muscle pain and tightness with spasms
- limited and painful range of motion
Severe (grade 3)
- pain during rest
- difficulty walking without assistance
- noticeable swelling and bruising
The length of time it takes to recover from a hamstring strain will depend on how severe the injury is. A minor muscle strain (grade 1) may take a few days to heal, whereas it could take weeks or months to recover from a grade 2 or 3 strain. After a mild to moderate strain treatment should begin as soon as possible. R.I.C.E- Rest, Ice, Compression and elevation. Anti-inflammatory medication or NSAIDS can be used to reduce pain and inflammation. A grade 3 strain may require a visit to a physician for evaluation and treatment. Where there is a complete rupture or avulsion of the musculotendinous structure, surgical intervention may be indicated.
REHABILITATION AND PREVENTION
A stretching and strengthening program can be initiated as soon as the pain inflammation and swelling subside. Start slowly and build gradually to regain the strength and flexibility in the injured muscle. The risk of future hamstring injuries can be reduced by a regular stretching and strengthening program along with proper warm up. Deep tissue massage or trigger point therapy directly over the affected area will help dissipate metabolic waste and stimulate the healing process. Regular cardiovascular exercise such as cycling, swimming, walking and use of an elliptical machine can enhance overall fitness and help to stabilize the hamstrings and the other muscles of the lower extremities.
▲Hamstring Stretch: Lie on your back with the right leg bent. Wrap the rope around the arch or middle of the left foot. Lock the knee and contract the quadriceps muscle group (front of the thigh). “Climb up” the rope with your hands and hold for 2 seconds. Return the left leg to the floor. After 12-15 reps, do the other leg.
▲Hamstring Curls: This exercise is used to strengthen the Hamstring muscle group. Set the machine to fit your height and lie face down on the leg curl machine with the pad of the lever comfortably on the back of your legs just below the calf muscles. As with doing the leg extension, it is recommended doing each leg individually to obtain better isolation. It is preferable to use a leg curl machine that is angled as opposed to flat since an angled position is more favorable for hamstring recruitment. Keep the torso flat on the bench, stretch the legs fully and grab the side handles of the machine. As you exhale, curl your leg up as far as possible without lifting the upper leg or body from the pad. Once you hit the fully contracted position, hold it for a second. Inhale and bring the leg back to the starting position. Repeat for the recommended amount of repetitions, and then do the other leg. Start with light weights to perfect the technique and avoid injuring the hamstrings or lower back. Start with 2-3 sets and 15-20 repetitions.
▲Hip Extension: (lower back, hamstrings, gluteals) Lying with your hips and stomach over the stability ball place both hands on the floor under the shoulders and extend each leg for 15 seconds. Do 15 repetitions with each leg for three sets. For additional resistance hold for 30 seconds.
Dr. Alan Bragman is a Chiropractor living in Atlanta GA. He is a certified IPTPA coach, 4.5 level Pickleball player, a former Cat 3 cyclist, nationally ranked inline speed skater and table tennis player. He was on the medical advisory staff at Bicycling Magazine for over ten years and has written for numerous other sports publications