Hamstring strains are one of the most common sporting injuries. They generally occur when running or extending the leg in a kicking motion.
So what is the hamstring? The hamstring is a group of 3 muscles located on the back of your leg. The 3 muscles are the semimembranosus, semitendinosus and biceps femoris. The main action of these muscles is to bend the knee, pull your leg back behind you and assist in some rotation of the knee. The hamstring originates on the pelvis at the ischial tuberosity and you can feel this area by sitting on your hands and feeling the hard bump in your glutes. The hamstring then has 2 insertion points, semimembranosus and semitendinosus insert on the tibia and biceps femoris inserts on the fibula, as indicated in the picture below.
So why are hamstrings strains so common?
The reason hamstring strains happen so often can be explained due to their anatomy. The hamstrings are responsible for movement occurring at 2 of the most major joints in our body, the knee and hip. Because of this, they need to control 2 joints at the same time and this puts them under increased strain and stress. Thus putting the hamstrings at an increased risk of injury compared to their counterparts that only control one joint.
What are the Risk Factors for Hamstring Strains?
Past history of hamstring strains
Reduced hamstring strength
General reduced lower limb strength
Hamstring Strain Grade Guide
Grade I hamstring strains are usually the most common. These often just feel like a small strain or irritation in the hamstring and generally come on during the activity you are performing. For most people they will continue to play their sport or complete their chosen activity even though they may have a minor niggle in the back of their leg. Generally after completing the activity, symptoms will subside quickly and you won't really feel anything while walking around or performing daily activities. This can make grade I hamstring strains difficult to recover from as most symptoms won't come on till performing a specific action and there likely won't be any bruising or swelling and so many people will think it isn't anything major. But by continuing to play without proper rest or rehab, the hamstring isn't given time to heal and can potentially lead to a more serious strain as well as reducing performance in your chosen activity.
Grade 2 tears will likely produce slightly more symptoms than a grade 1 strain. You will have felt something during one specific movement likely when extending the leg. Walking will hurt and you will also most likely be limping. Generally you can expect to see some bruising and swelling in the area but you may also not see any. This is due to the muscle only being slightly strained or torn.
Grade 3 tears are generally more obvious. Most people will feel a 'pop,' 'crack,' or something 'go.' You won't be able to continue in your current activity and you most likely will be lying on the floor in quite a lot of pain. Many people will describe that they have felt like they have been 'hit' or even 'shot' in the back of the leg. With grade 3 tears there will be noticeable bruising and swelling due to the complete tear of the muscle.
Grade 1 and 2 strains will be managed conservatively and will start out with a period of active rest to allow your strain to heal. As the strain heals, exercises will be progressed to improve strength of the hamstring but also injury prevention exercises will be implemented. Gradually a reintroduction to sports will occur alongside the strengthening. Strengthening will then need to continue even when you return to your chosen activity and have completed your rehab to ensure the risk of re-injury is reduced.
Grade 3 strains will most likely need surgery depending on the severity and location of the tear. Rehab will generally be dependent on the surgeon but will initially start with rest to allow healing followed by a gradual re-introduction to strengthening as healing occurs.
How long will you expect to be out for?
Grade 1 strains will generally be anywhere from 3 - 6 weeks out.
Grade 2 strains will be anywhere from 6 weeks to 3 months
Grade 3 strains will be anywhere from 6 months to a year depending on surgery.