What Exactly are the Hamstrings?
The hamstring muscles are situated at the back of the thigh. They consist of three major muscles (see image below). The hammies form part of the all important posterior chain (which also includes the calves and glutes), which when supple and strong keep us agile and game-ready.
(Shepard Pain and Performance Care)
These three major hamstring muscles work in conjunction to stabilise the pelvis, support the stability of the knee, and the extension of the hip.
What Causes Hamstring Strain?
Hamstring injury is one of the most common injuries in sport, most common in high impact sports that require a high degree of agility, power and speed (ie. soccer, football, basketball and tennis) (Sports Medicine Australia). Cyclists are also at risk of hamstring strain, with repetitive loading of the hamstring muscles, sometimes micro-damaging the muscle fibres (Total Women’s Cycling).
Sports Medicine Australia succinctly outlines what a hamstring strain looks like:
The major cause of hamstring injuries originates from an imbalance between the quadriceps muscle and the hamstring muscles (located at the front and back of the thigh respectively). The quadriceps are a very large, strong group of muscles which help to extend (straighten) the leg. These muscles may forcibly overstretch the hamstring, placing excessive tension on the hamstring muscles.
Acute hamstring strains occur due to a sudden movement or force being applied to the hamstring muscles. The player is immediately aware of the condition.
Proven risk factors:
- Previous hamstring injury.
- Increasing age of player.
- Sudden change in direction (acceleration or deceleration).
Suspected risk factors:
- Poor flexibility.
- Poor strength.
- Hamstring muscle fatigue.
- Muscle strength imbalance between the quadriceps and hamstrings.
- Inappropriate, inadequate or no warm up
What Does Hamstring Strain Feel Like?
If you’re unlucky enough to strain your hamstring, this is what it feels like:
- Mild hamstring strains (grade 1) usually causes tenderness and sudden pain at the back of the thigh. It might be painful but the strength of the muscle isn’t affected. This is known as a pulled hamstring.
- Partial hamstring tears (grade 2) are more painful and tender, with some swelling and bruising possibly at the back of the thigh, and perhaps loss of strength in the leg. Grade 2 and grade 3 are when the hamstring is torn.
- Severe hamstring tears (grade 3) are mostly very painful, tender, swollen and also bruised (ouch!). You may have felt a ‘popping’ sensation when the injury happened, and it’s not possible to use the leg.
How to Prevent Hamstring Strain
The Epworth Sports and Exercise Medicine group outlines a number of prevention exercises:
- Complete a thorough body warm up, including sport-specific muscle stretching as well as sport specific skill drills.
- Include appropriate speed work in training programs so hamstring muscles are capable of sustaining high acceleration forces.
- Maintain high levels of cardiovascular fitness and muscular endurance to prevent fatigue.
- Stretch and cool down after every training session and competition.
- Include stretching and strengthening exercises in your weekly training program.
- Undertake training prior to competition to ensure readiness to play, then gradually increasing the intensity and duration of training.
- Allow adequate recovery time between workouts or training sessions.
- Wear the right protective equipment including footwear.
- Check the sporting environment for hazards.
- Drink water before, during and after play.
- Avoid activities that cause pain. If pain does occur, cease the activity immediately and commence RICER within 48 – 72 hours (rest, ice, compression, elevation and referral).
How to Treat Hamstring Strain
Massage for hamstring strain should not be done in the acute stage as it may increase bleeding and prolong the healing process. However in all other stages, sports massage in particular is useful to loosen scar tissue and tight muscles, and stimulate blood flow which promotes healing and supports the muscles to stretch. (Mel Wright)
Premature return to sports increases the risk of injury, so it’s best to abide by the advice of your physical therapist and GP. Keeping in mind that recurring problems are most often due to re-injury rather than a single isolated episode (Dalton Myoskeletal)
While the exact Remedial Massage techniques used to treat the hamstrings may vary from therapist to therapist, mobilisation of the hip joint is a high priority after hamstring strain. Assessing restrictions within the muscle belly, fascia, ligaments and tendons of the large muscles in our legs will allow the therapist to target the exact culprit of restriction. Increasing the depth and firmness of pressure throughout a treatment will often be necessary, as strained hamstrings may initially be unable to handle deeper pressure following injury.
Once the surface level has been relaxed, the therapist may choose to begin working on the deeper tissues, all the while aiming to remove all tension from the area. Trigger points in the hamstrings commonly refer pain and tenderness to the region behind the knee, and these will usually be addressed with deeper pressure.
Postural advice may also heavily impact the results of treatment – for example, many of us experience tight hamstrings due to driving, or sitting at a desk.
Yoga exercises for hamstring injuries (excluding the acute stage when you need to be very discerning, with very gentle movements), include:
- All the forward folds! – Standing forward fold, wide leg forward fold, seated forward fold. Making sure that your knees are soft and feet firmly planted on the ground.
- Check out this blog for a description of techniques, and some other movement suggestions.
- Bridge pose works the hamstrings and glutes. The lovely Dutch yoga teacher and therapist, Ester Echkart explains the posture in this short video:
- Down Dog and its variations are very effective at targeting the entire posterior kinetic chain. Check out this video, also featured in our calf muscle article.
If you are experiencing symptoms of hamstring strain, first visit your GP to assess the underlying causes, then on the advice of your GP visit your physical therapist for targeted relief, and an ongoing treatment plan (including home exercises between appointments). A single appointment will most likely provide immediate relief but there is no magic bullet for chronic aches and pains. Long term improvements will happen only with ongoing therapy and an active treatment plan.
Book an appointment with a therapist today on 03 8598 9804 or online.