Surprisingly the hamstring muscle is not that active when standing, but they play an important role in other activities such as walking, running, climbing and jumping. The Hamstring isn’t a single muscle but is made of a group of three muscles that run along the back of your thigh. They allow you to bend your leg at the knee and straighten your hips. The most common injuries for the hamstring are a strain/tear which may be sudden onset (a result of activity and/or trauma) or hamstring tendinopathy which often presents with the gradual onset of pain and is less likely with acute trauma. Both injuries are discussed below.
Such is the importance of the hamstrings that in ancient history, knights used to slice their enemies across the back of the thighs rendering them immobile. Prisoners were also subject to similar treatment to stop them escaping.
Unfortunately, hamstring strains are both common and painful. They strike the weekend warrior and athletes of all sports – such as runners, hockey, football, soccer, netball and basketball players.
During a hamstring strain, one or more of the hamstring muscles gets overloaded. The muscles might even start to tear. Injury may range from a minor strain to a severe rupture (tear) with a minor tear (grade I) to a complete rupture (III).
You’re likely to get a hamstring strain during activities that involve a lot of running and jumping, or sudden stopping and starting. Getting a hamstring strain is also more likely if:
- You don’t warm up before vigorous exercising.
- You have a muscle imbalance ie. the muscles in the front of your thigh (the quadriceps) are tight which can pull on your pelvis and tighten the hamstrings.
- If you have weak glutes. Glutes and hamstrings work together. If the glutes are weak, hamstrings can be overloaded and become strained.
- Poor running technique
- Abnormalities of the lumbar spine or poor pelvic control that can cause nerve dysfunction and subsequent muscle weakness can predispose you to injury.
What Does a Hamstring Strain Feel Like?
Mild hamstring strains may not hurt too much. But severe ones can be agonizing, making it difficult to walk or even stand. Possible symptoms of a hamstring strain are:
- Sudden and severe pain during exercise, along with a snapping or popping feeling
- Pain in the back of the thigh and lower buttock when walking, straightening the leg, or bending over
- Spasms or cramping
On examination our chiropractors will look for signs of pain on hamstring contraction, reduced hamstring flexibility, tenderness or a palpable lump or gap within the hamstring muscle bulk. Pulled hamstrings are graded 1, 2 or 3 depending on severity.
Many patients with a hamstring strain start to feel better within a few days of the injury. However, there is often a high hamstring re-injury rate due to a poor rehabilitation process. Hamstring strains are one injury that professional guidance is recommended, for both an accurate diagnosis but also to provide you with the best chance of avoiding repeat injuries.
What’s the Treatment for a Hamstring Strain?
Luckily, minor to moderate hamstring strains usually heal on their own. You just need to give them some time. To speed the healing, you can:
- RICER (if it’s an acute injury) – Rest, Ice it for 10-20 minutes, Compress with an elastic bandage. Elevate the leg and seek referral to a qualified professional such as our chiropractors.
- Soft Tissue techniques
- Acupuncture or dry needling
- Shockwave Therapy
- Sports and kinesio taping
- Joint mobilisation
- Stretching, strengthening and rehabilitation exercises – appropriate timing based on degree of injury
- In severe cases where the muscle is fully torn, a referral to a surgeon for ongoing management may be required.
Proximal hamstring tendinopathy
Another injury of the hamstring is high hamstring tendinopathy; or technically known as Proximal hamstring tendinopathy. This is the term for an injury to the hamstring origin tendon at its attachment site into the ischial tuberosity of the pelvis (see diagram). You don’t have to be a professional athlete to develop tendinopathy. The incidence increases with age as muscles and tendons lose some of their elasticity. Improper technique in any sport is one of the primary causes of overload on tissues, including tendons, which can contribute to tendinopathy. Hamstring tendinopathy is most common in:
- Runners – hills, sprinting, middle and long distance
- Football, hockey, rowing, soccer
- Peri/post-menopausal women
- Forward lean occupations such as yoga instructors
What Does Proximal Hamstring Tendinopathy Feel Like?
Proximal hamstring tendinopathy often presents with the gradual onset of pain and is less likely with acute trauma. Sufferers’ often report:
- Deep buttock pain– constant and dull in nature that is worsened with activity
- Pain in the posterior thigh
- Pain can radiate down the thigh towards the knee along with the hamstring muscles.
The pain is related to loading the hamstring muscles and usually increases with repetitive action activities such as running and jumping. In some cases, pain can be produced with sitting, due to compression on the hamstring insertion. Factors that increase your risk of developing tendinopathy:
- Previous injury– loss of muscle strength and flexibility may predispose an athlete to injury.
- Weak Glutes– can increase the hamstring strength requirements during activity.
- Anterior pelvic tilt– can cause tightening of the hamstrings
- Core weakness– loss of core strength may result in increased loads through the hamstring tendon at the pelvis.
- Stiffness of the hip– loss of hip motion may increase the requirement of the hamstrings
- Load Changes to your training
- Training errors– inadequate rest between training sessions and poor technique
- Poor equipment– old or worn footwear
- Insufficient or inadequate warming up and recovery
- Fatigue– Injury risk can be significantly increased when the body is fatigued.
Proximal hamstring tendinopathy treatment has progressed significantly in recent years. Based on this, it is important to be assessed and treated by a practitioner such as our qualified chiropractors, who are up to date on treatment strategies.
Treatment and management here at Tweed Coast Chiropractic may include:
- Load management advice
– Avoiding high tensile loading
- Exercise therapy which is staged depending on the degree of tendinopathy
- Running retraining which is implemented via by running analysis
- Manual therapy techniques at Tweed Coast Chiropractic may include:
While every hamstring injury and the demands of your sport differ individually, general hamstring strain recovery times and programs, when followed, can help provide optimal recovery.For more information contact us on 0 266744032 or via our website