Sports Injuries, Synapse Physiotherapy
Introduction
Have you ever suffered from a hamstring injury? If so, you’re well aware of how painful and limiting it can be. Hamstring strains and tears are common, particularly among athletes and active individuals. However, there’s good news—physiotherapy is a highly effective treatment that can aid in your recovery and help prevent future injuries. Physiotherapy is essential in the healing process, as it focuses on alleviating pain, enhancing flexibility, and strengthening the muscles to reduce the risk of further injury. If you experience this type of injury, it’s important to seek out sports physiotherapy at a nearby clinic.
What is a Hamstring Strain?
Hamstring strains typically result from a sudden, forceful contraction or an intense stretch of the hamstring muscle group, leading to significant mechanical stress. This injury often manifests as a sharp pain in the back of the thigh, caused by the disruption of hamstring muscle fibers, without any direct impact to the area.
These strains are especially common in dynamic sports like sprinting, jumping, and contact sports such as Australian Rules football (AFL), American football, and soccer, where rapid eccentric contractions frequently occur. In soccer, hamstring strains are the most prevalent injury. They can also occur in recreational activities like water skiing and bull riding, where the knee is violently extended during the injury. Hamstring injuries are classified into three categories: acute (resulting from a sudden impact or traumatic event), overuse (caused by excessive training over time), and chronic or recurrent (involving repeated injuries due to diminished function and incomplete healing).
Causes
During the second half of the swing phase in running, the hamstrings reach their maximum length and generate the highest tension. At this point, the hamstrings contract eccentrically to slow down hip flexion and lower leg extension. This phase also marks a peak in muscle spindle activity within the hamstrings. A powerful contraction of the hamstrings, coupled with the relaxation of the quadriceps, is essential. According to “Klafs and Arnheim,” a disruption in the coordination between these opposing muscles can lead to a hamstring tear. The biceps femoris experiences the greatest musculo-tendon stretch, which may explain why it is more prone to injury than the other two hamstring muscles (semimembranosus and semitendinosus) during high-speed running.
Risk factors
- Older age
- Previous hamstring injury
- Limited hamstring flexibility
- Increased fatigue
- Poor core stability
- Strength imbalance
- Previous calf injury
- Previous significant knee injury
- During activities like running and kicking, the hamstrings lengthen as the hip flexes and the knee extends. This lengthening can push the muscle to its mechanical limits or lead to the accumulation of microscopic muscle damage.
- Uncoordinated contraction of the biceps femoris muscle, which could be related to its dual nerve supply.
Sign and symptoms
A hamstring strain typically results in sudden pain, ranging from mild to severe, in the back of the thigh. Some individuals may also experience a “popping” or tearing sensation. Swelling and bruising (ecchymosis) can occur, though they may not appear until several days after the injury. In rare cases, symptoms like numbness, tingling, and weakness in the lower leg may be present, which could indicate sciatic nerve irritation.
Grade of hamstring strain
Hamstring strains are categorized into three grades based on the severity of pain, weakness, and loss of motion:
- Grade 1 (Mild): Only a few muscle fibers are damaged or ruptured, which typically has little impact on the muscle’s strength and endurance. Pain and tenderness usually develop the day after the injury, with common complaints being stiffness in the back of the leg. Patients can generally walk without difficulty, and while there may be slight swelling, knee movement remains normal.
- Grade 2 (Moderate): Around half of the muscle fibers are torn, leading to acute pain, swelling, and some functional loss. The patient’s gait is usually affected. Pain can be triggered by applying pressure to the hamstring or by bending the knee against resistance.
- Grade 3 (Severe): This grade involves more than half of the muscle fibers being ruptured, potentially resulting in a complete muscle tear. Both the muscle belly and the tendon may be involved. This causes significant swelling and pain, with the hamstring muscle losing its ability to function and displaying marked weakness.
Physiotherapy rehabilitation
Rehabilitation for a hamstring strain is a multi-phase process designed to restore function, prevent further injury, and optimize recovery. The rehabilitation process involves the following phases.
Phase I (Week 0-3)
Goals:
- Protect the healing tissue
- Minimize muscle atrophy and strength loss
- Prevent loss of range of motion
Precautions:
- Avoid excessive active or passive lengthening of the hamstrings
- Prevent the development of an antalgic (pain-avoidance) gait pattern
Rehabilitation Plan:
- Ice Therapy: Apply ice 2-3 times daily to reduce pain and swelling.
- Stationary Bike: Use for low-impact cardiovascular exercise to maintain fitness.
- Sub-Maximal Isometrics: Perform isometric hamstring contractions at 90, 60, and 30 degrees of knee flexion.
- Single-Leg Balance: Practice balancing on one leg to improve stability and proprioception.
- Balance Board: Use a balance board to enhance coordination and neuromuscular control.
- Soft Tissue Mobilization (STM) / Instrument-Assisted Mobilization (IASTM): Utilize manual therapy to reduce muscle tightness and promote healing.
- Pulsed Ultrasound: Apply pulsed ultrasound (Duty cycle 50%, 1 MHz, 1.2 W/cm²) to stimulate tissue healing.
- Progressive Hip Strengthening: Focus on strengthening the hip muscles without straining the hamstrings.
- Pain-Free Isotonic Knee Flexion: Engage in gentle isotonic exercises that do not cause pain.
- Active Sciatic Nerve Flossing: Perform nerve gliding exercises to alleviate any neural tension.
- Conventional TENS: Use transcutaneous electrical nerve stimulation (TENS) for pain relief.
Phase 2 (Week 3-12)
Goals:
- Regain pain-free hamstring strength through the full range of motion (ROM)
- Develop neuromuscular control of the trunk and pelvis with a progressive increase in movement and speed, preparing for functional activities
Precautions:
- Avoid end-range hamstring lengthening if it causes pain
Rehabilitation Plan:
- Ice Therapy: Continue to apply ice post-exercise.
- Stationary Bike: Maintain low-impact cardiovascular exercise.
- Treadmill: Progress from moderate to high-intensity, pain-free running.
- Isokinetic Eccentrics: Perform eccentric hamstring exercises in a non-lengthened state.
- Single-Limb Balance Windmill Touches: Practice without weights to improve balance and coordination.
- Single-Leg Stance with Perturbations: Incorporate dynamic balance exercises to challenge stability.
- Supine Hamstring Curls on a Theraball: Strengthen the hamstrings with controlled movement.
- STM/IASTM: Continue soft tissue mobilization techniques.
- Nordic Hamstring Exercise: Engage in eccentric hamstring strengthening exercises.
- Shuttle Jumps: Begin light plyometric exercises to build strength and power.
- Prone Leg Drops: Work on controlled leg movements to enhance muscle activation.
- Lateral and Retro Band Walks: Strengthen the hip abductors and adductors.
- Sciatic Nerve Tensioning: Continue nerve mobilization exercises.
- Eccentric Protocol:
Once non-weight-bearing exercises are tolerated, introduce low-velocity eccentric activities such as stiff-leg deadlifts, eccentric hamstring lowers/Nordic hamstring exercises, and split squats.
Phase 3 (Week 12+)
Goals:
- Achieve symptom-free performance during all activities
- Restore normal concentric and eccentric strength through full ROM and speed
- Improve neuromuscular control of the trunk and pelvis
- Integrate postural control into sport-specific movements
Precautions:
- Train within a symptom-free intensity range to avoid re-injury
Rehabilitation Plan:
- Ice Therapy: Use ice post-exercise as needed.
- Treadmill: Continue moderate to high-intensity running as tolerated.
- Isokinetic Eccentric Training: Focus on eccentric training at end ROM (in hyperflexion).
- STM/IASTM: Continue soft tissue and instrument-assisted mobilization.
- Plyometric Jump Training: Incorporate jump training to build explosive power.
- 5-10 Yard Accelerations/Decelerations: Practice short sprints to improve speed and control.
- Single-Limb Balance Windmill Touches: Add weight and perform on an unstable surface.
- Sport-Specific Drills: Engage in drills that integrate postural control and progressive speed.
Eccentric Protocol:
- Introduce higher velocity eccentric exercises, including plyometrics and sport-specific activities.
Physiotherapy plays a vital role in effectively treating hamstring strains by guiding the recovery process, reducing pain, restoring strength and flexibility, and preventing future injuries. Through a structured rehabilitation program, patients can achieve full recovery and safely return to their activities. If you’re dealing with a hamstring strain, consider getting your rehabilitation done at Synapse Physiotherapy, where personalized care will support your healing journey.
Frequently Asked Questions (FAQs)
Recovery time varies based on the severity of the strain. For Grade 1 strains, it may take 2-3 weeks, while Grade 3 strains could require 6 months or more.
By addressing muscle imbalances, improving flexibility, and providing sport-specific training, Sports Physiotherapy reduces the likelihood of future injuries by teaching proper movement patterns.
Not always. While some Grade 3 strains may require surgery, many can be effectively treated with a comprehensive Sports Physiotherapy program focused on rehabilitation and strength-building.
This depends on the severity of the injury. In most cases, a modified training plan that avoids stressing the injured muscle is recommended. Always consult with your physiotherapist.
It’s best to start Sports Physiotherapy as soon as possible after the injury to prevent further damage and promote faster healing.
Conclusion
At Synapse, we understand that recovering from a hamstring strain can be a complex and difficult journey. That’s why our expert Sports Physiotherapists are dedicated to providing personalized, evidence-based treatments that cater to your specific needs. Don’t let a hamstring strain hold you back from achieving your best performance. Whether you’re an elite athlete or a weekend warrior, our team at Synapse will guide you every step of the way to ensure you recover fully and prevent future injuries. Contact Synapse today to schedule an appointment and start your journey toward pain-free movement and injury prevention. Let us help you get back on the field stronger and more resilient than ever before!
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