How to manage hamstring injuries

Last week in clinic an elite level sprinter visited the clinic for advice on a suspected hamstring injury. This is a very common injury we see in footballers and track athletes so, I will use this case study to discuss the best management for hamstring tears.

Where are the Hamstring muscles and why are they important?

The hamstrings are a highly complex system of large muscles positioned at the back of the thigh. There are actually 4 separate areas of the hamstring muscles as shown in the diagram below.

They are very important for any sports that involve fast explosive sprinting activities. The most important function of the hamstrings is actually to slow down the leg as it is accelerated forward by the strong quadriceps muscles. Not just bend the knee as commonly described in rehabilitation videos. This has very important implications when it comes to rehabilitation exercises, as described later.

The most common scenario I see in clinic is the patient describes instant severe pain often combined with an audible popping sound during a sprint movement.

The most common areas to develop pain are one of 3 regions as shown by arrows below:

What to do in the initial stages?

If there is a lot of bruising within 72 hours then it is advisable to get a scan on the injury in order to accurately diagnose the grade of tear and predict the likely time out of the sport. Ultrasound scans are excellent for detecting muscle tears and can help predict a return to play time.

Below is the image of a grade 2 hamstring tear as was seen in this case study.

Hamstring Injury Stage 1 (7-10 days):

If you suspect you have a hamstring muscle tear, the first 7 days are very important in order to recover optimally. The best advice is to apply ice regularly along with a compression bandage around the area of pain. It is recommended to apply ice to the hamstring for 10-15 minutes 3-4 times a day (do not to apply ice directly to the skin to avoid nasty ice burns!).

Hamstring Injury Stage 2 (10-21 days):

Once the initial pain has settled and you can walk without a limp (the time for this varies depending on how severe the initial tear was) the rehabilitation exercises can begin.

All the exercises below must be pain-free:

1. Exercise bikes and rowing machines can be a great way to keep up cardiovascular fitness and general leg strength without putting too much stress on the hamstring muscles.
2. It is possible to start light, slow jogging at this stage, as long as it’s pain-free, but certainly no moderate or high-speed running.
3. Some pain-free, gentle but active range of motion exercises for the hamstrings can also be useful. See this video for an example exercise.