Hamstring strain is also known as the pulled hamstring. Aches and pains on the back of the legs may be a sign of a hamstring injury.
Pulled hamstring injuries are common in athletes participating in many sports. Field and track athletes are particularly at risk, as hamstring strain has been estimated to make up to 29% of all injuries in the sprinters.
Keep reading this blog to know more about the causes, symptoms and treatment of pulled hamstring.
What Are The Hamstrings?
Hamstrings are the collection of three muscles that are located in the back of the thigh to the bone. The hamstring muscle is the large muscle that pulls on these tendons.
It has become more common in layman’s terminology to refer to the long muscles at the back of the thigh as the hamstring or hamstring muscles.
Academic anatomists will refer to them as the posterior thigh muscles and more specifically the biceps femoris, the semitendinosus, and the semimembranosus.
These muscles of the thigh cross both the hip and the knee. They also begin just below the buttocks and arise from the bone on which we sit.
They also connect by the means of their tendon onto the upper parts of the lower leg bones. The origin of the word hamstring comes from the old English Hamm, which means thigh.
String refers to the characteristic appearance of the tendons that is just above the back of the knee. Although, the tendons are sometimes involved in injuries.
The hamstring muscles help to actively bend the knee. They also act and straighten or the hip as in the motion of moving the thigh backward. Surprisingly, these large muscles are not very with normal standing or walking.
However, hamstring muscles are extremely important for power activities such as climbing, jumping, and running.
Thus, the sedentary individuals can get by the quite week or the deconditioned hamstrings, whereas the athletes and the very physically active individuals absolutely depend on the health and also the good condition hamstrings.
The power advantage of strong hamstrings is known for a long time. In the past, a sword-wielding knight would disable an opponent by the slice across the back of the thigh.
Anatomy Of Hamstring
The hamstring muscles are run down the back of the thigh. There are three hamstring muscles such as :-
- Biceps femoris
These muscles start at the bottom of the pelvis at a place called the ischial tuberosity. The hamstring crosses the knee joint and ends at the lower leg.
The hamstring muscle fibers join with the tough and connective tissue of the hamstring tendons near the points where the tendons attach to bones in the body.
Hamstring muscles help you to extend your legs straight and you will be able to bend the knee as well.
Also, the cruel masters were known to be more severe than the hamstrings of the domestic slaves or the prisoners in order to make the escape less likely.
The origin of the term hamstrung is meaning to have been the crippled or to held back is driven from these practices.
(Also read: Hyperdontia – Type, Causes, Symptoms, And Treatment)
What Is A Hamstring Strain?
Hamstring injuries such as the tears and strain are common in the sports that require either a lot of running or the powerful acceleration and decelerations.
The hamstrings strain refers to an injury in which the muscle or tendon is torn or stretched. Muscle strains and tears are most commonly occur which is known as an eccentric contraction.
When a contraction if the muscle will occur then the muscle is trying to contrate while the another force. The forcing of the muscle in the opposite direction.
This creates a tremendous strain on the muscle. If this force is strong enough then it will tear the muscle fibers. Hamstring muscle injury is also the most common because muscle spasms occur at more than one point.
The origin of the hamstrings is on the lower part of the pelvis, and the insertion of this muscle is on the upper part of the shin bone.
The movements of both these joints can increase the forces acting on the hamstring muscles. Other muscles that cross more than one joint are also more prone to strain injuries.
The less severe strain is known as the pulled hamstring. A hamstring tear is also known as a rupture and infers a more serious injury. While some hamstrings are mild and they also improve during rest and also the over-the-counter pain relievers.
Other more severe injuries may require surgery and extensive rehabilitation. Usually the pulled hamstring is graded similarly to the other types of muscle strain.
According to the severity of the stain, the hamstring is categorized into three grades. Here are the grades of a hamstring strain.
1. Grade 1:
Grade 1 is a mild hamstring strain which is also called a pulled hamstring. It will happen that the hamstring muscles overstretch but they won’t tear.
But if the hamstring stretches to the point where it will rip, this injury is also considered a tear, usually minimal limitations inactivity.
2. Grade 2:
A grade 2 hamstring injury is a partial muscle tear. This means the muscle hasn’t fully ripped. As compared to the grade 1 hamstring pull, the grade 2 tear hamstring is more painful.
Grade 2 will limit an athlete’s ability to perform activities such as jumping and running. It may have moderate bruising and swelling.
3. Grade 3:
It is the most severe hamstring injury. It will occur when the hamstring muscle rips completely or tears off the bone. A tear that will pull the muscle off the bone is known as an avulsion.
If you have a grade 3 tear, then you must have likely heard a popping sound or sensation when you got the injury. The back of the thigh will also be extremely swollen and painful because grade 3 tears are so severe and you may not be able to put weight on the injured leg. It will cause a severe injury that can cause pain with walking.
If the muscle fibers are significantly or completely torn, then they will potentially require surgical intervention. Often patients complain of muscle spasm, significant bruising, and swelling.
What Are The Pulled Hamstring Symptoms?
Hamstring injuries usually occur with sudden jumping, running, or lunging that can result in muscle injury.
In fact, the tear of the muscle is commonly referred to as a pulled hamstring. An acute hamstring injury will typically cause sudden and sharp pain in the thigh that can stop you mid-stride.
In some cases, you may also hear an audible pop or might feel your leg is giving up. A chronic hamstring injury can occur and an untreated tear or strain worsens over time.
After the injury, you will often be unable to extend the knee for more than 30 to 40 degrees without pain. Acute injury almost always accompanies spasm, tenderness, tightness, either developing immediately or after several hours.
In the case of a rupture, you can often feel or you can see an indentation where the tear will occur. Severe bruising and swelling will typically occur in the pulled hamstring.
The symptoms of hamstring strain depend upon the severity and cause of the hamstring injury. The strain will also be described by how much the damage will occur on the muscle and the tendon fibers.
The symptoms of pulled hamstring according to the grade.
- Grade 1 hamstring strain may be felt as a slight pull or the ache in the back of the thigh. The exact grade 1 hamstring injury may not be recognized, and also the onset of the pain may be gradual. There may be also minimal swelling and nonspecific pain in the muscle of the leg when the knee is extended. .In some cases, the limp may not be present but the pain usually gets worsen with aggressive activities like running and walking up or downstairs.
- Grade 2 pulled hamstring often occurs with an acute event. The symptom of the grade 2 hamstring is an immediate sharp pain that will be felt in the back of the thigh or the higher up toward the buttock. It may cause difficulty in walking because extending the knee causes injuries to the muscles of the legs. Swelling and tenderness will occur in the area of the injury.
- The pulled hamstring symptoms of a grade 3 area progression of a grade 2 strain with the symptoms of swelling and pain more pronounced. Many times in athletic injuries, the muscles can be so aggressively stretched that they will tear with a loud pop. So the tear of the muscle can be heard by the other players on the field. If there is any significant tear, a divot can sometimes be felt in the belly of the muscle at the site of the injury.
Common Pulled Hamstring Symptoms
The pain in the back muscle of the leg is almost always present with a pulled hamstring. The pain is sudden and usually causes when you stop the activity.
Well, the symptoms will depend on the severity of the hamstring injury. Some other common symptoms include:-
The small tear in the muscle causes bleeding and subsequent bruising. The bruise will begin in the back of the thigh muscle.
As the time will pass then the bruise will pass down below the knee and also often in the foot of the injured leg.
The accumulation of the blood from the hamstring injury will cause swelling on the thigh.
The swelling in the thigh can make further muscle contraction difficult and it is very painful.
Wearing a compressive bandage will help to control the swelling of the pulled hamstring.
3. Difficulty With The Muscle Contraction
Bending the knee is often very painful after a pulled hamstring. This will prevent the patient from walking normally.
If anybody is unable to contract the hamstring, then the muscle of the leg is completely rupturing.
4. Muscle Spasm
Muscle spasm is one of the common and painful symptoms of a hamstring strain.
Because of the trauma to the muscle, the signal of the contraction can confuse the muscles that may be stimulated.
The severe muscle relaxant will help with the spasms.
5. Sharp Pain
When the hamstring injury occurs, the person might feel an abrupt and sharp pain at the back of the thigh or on the buttocks.
6. Pain And Discomfort While Sitting
In avulsion type and the proximal hamstring strain can tendon the breaks from the pelvic bone. So the patient will commonly face the pain and discomfort while sitting.
Pulled Hamstring Symptoms That May Indicate The Serious Condition
In some cases, the hamstring injury can be serious. If you have any of the symptoms that are given below then immediately seek medical care.
The serious condition symptoms include:
- Feeling sensation of tearing or popping during the hamstring injury
- Severe and debilitating pain
- Complete loss of the muscle function
- Severe swelling
What Causes A Hamstring Strain?
A pulled hamstring generally occurs when the muscle overloads. These muscles include the biceps femoris, semimembranosus, and semitendinosus.
Usually, muscle overload occurs when a muscle either stretches beyond the limits, or it will challenge with a sudden and excessive weight load.
For example, when you are running and suddenly your leg is fully stretched out just before your foot strikes the ground. When the foot strikes the ground and all the weight is on it, the muscles will get stretched too far and they may start to tear.
Most of the strains occur when the hamstring muscles contract and lengthen at the same time which is known as an eccentric contraction, one of the best examples of this pain is sprinting
This occurs when the back leg is straightened when properly bent on the toes.
The other injuries occur when the hamstring overexerts while lifting the weight with a sudden thrust of energy such as powerlifting.
Hamstring injury is commonly seen in the people who participate in the following activities.
- Running and sprinting, it also occurs in some other events.
The old athletes who walk in their primary form of the exercise are also at a high risk of the hamstring strain. So, adolescents whose bodies are still growing.
Then the muscles and bones do not necessarily grow at the same rate. This means that any of the force or the stress to the muscles such as a jump or impact may leave that vulnerable to tearing.
Hamstring strains usually occur in two different ways. They are either is sprinting related or the stretch related for example in the martial arts, dancing, or gymnastics.
Sprint Related Hamstring Strain
During sprinting, the hamstring muscles work extremely hard. In particular, at a point just before the foot strikes on the ground, this may decelerate the trivia very quickly.
It is at this moment, the hamstring is most likely to tear. The sprint that relates to the hamstring injuries usually occurs lower down the biceps femoris muscles.
More specifically, where the muscle joints are tendons, they often feel worse initially but they recover more quickly.
Stretch Related Hamstring strains
The stretch is related that injuries usually occur higher up at the back of the thigh. It mostly occurs at the tendon of the semimembranosus muscle.
This injury takes longer to heal because the blood supply to the tendon is not as good.
The referred pain is caused by the problems at the lower back and the hip but is felt at the back of the leg.
This may increase the likelihood of suffering a hamstring strain, particularly if you suffer from the recurrence of the hamstring strains.
(Also read: When Do Babies Start Walking)
What Are The Risk Factors Of The Pulled Hamstring?
Certain athletes also have a higher risk of straining a hamstring. This includes sprinters, runners, dancers, and those participating in sports that require bursts of speed such as Basketball.
Some old people who only walk for exercise tend to have a higher risk of pulled hamstring compared to teens who are still growing.
The long thigh makes the muscles tight and more prone to strain. The factors which increase the risk of developing a pulled hamstring are:-
1. Muscle Fatigue
If the muscles are weak and fatigue, they can alter the person’s biomechanics and it might also increase the risk of injury.
2. Muscle Imbalance
When the one muscle group is much stronger than its opposing group of muscle, this can lead to strain.
This will frequently happen with the hamstring muscles. The quadricep muscle of the thigh is usually more powerful than others.
During the high-speed activities, the hamstring may become more fatigue than the quadriceps. This muscle imbalance or fatigue can lead to a pulled hamstring.
3. Exercising With The Tight Muscles
Tight muscles are vulnerable for the pulled hamstring. Athletes who have tight muscles may be more likely to experience hamstring injury.
That’s why athletes should follow the program of daily stretching exercises.
4. Poor Condition
If your muscles are weak, then they are less able to cope with the stress of exercise, that’s why it can lead to being a stain.
5. Previous Hamstring Injuries
The people who have one hamstring injury are more likely to have another hamstring that is one pulled hamstring.
Especially if he is trying to resume all the activities at pre- injure levels of the intensity before the muscles have time to heal and rebuild the strength.
6. Poor Flexibility
If anyone has poor flexibility, then their muscle is not able to bear the full force of the action that will be required during a certain type of activity.
When anyone dehydrates, then their muscles are more prone to carping and therefore the muscles are more prone to injury.
8. Inadequate Warm-up
As I mentioned above tight muscles cause muscle strain. That’s why warming up muscles properly can make them flexible and they are less likely to get injured.
9. Existing Lower Limb Injury
If anyone is suffering from a lower limb injury, it can increase the chances of another injury somewhere else in the same or the opposite limb.
10. Overdoing It
Weak muscles are less able to handle the stress of exercise and also the muscles that get tired lose some of their ability to absorb the energy, this will make them more likely to get injured.
11. Returning To Activities Too Quickly After An Injury
Hamstring strain needs plenty of time and rest to heal completely.
So, resuming activities immediately after the strain will more likely to injure the hamstring strain.
12. Sports Participation
Sports such as dancing, sprinting, running, etc. Which require high muscle pulls and tensions are more likely to cause hamstring injury.
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How To Reduce The Risk Of Pulled Hamstring?
You may be able to lower the risk of pulling, tearing, or straining of hamstring by following these tips:
- Avoid strenuous activities when the muscle is already weak or fatigued
- Do cross-training with a variety of activities
- Maintaining good physical conditioning such as strength, flexibility, and healthy body weight.
- Strengthening the hamstring muscles to promote muscle balance with the quads.
- Gently warm up the body before doing any physical activity
If you are at the risk of pulling a hamstring, then talk with your doctors about the ways to protect yourself.
Also, the athletic trainer is required for you to achieve proper muscle flexibility and balance
How Long Does It Take To Recover From A Hamstring Injury?
It generally depends upon how severe the hamstring injury is.
A minor pulled muscle or strain may take a few days to heal, whereas it could take weeks or the months to recover from a muscle tear. But keep in mind that people heal from the injury at different rates.
When you get better, then you should work on the hamstring with a new activity that won’t aggravate the strain. For instance, runners will try to do laps in a pool.
Whatever you do, just don’t rush things. Also don’t try to return to your old level of physical activity until:
- wait until you can easily move your injured leg as freely as the other leg.
- Until you feel strong on an injured leg.
- When you feel no pain in the leg while walking, jogging, or jumping
If you start pushing yourself before the hamstring strain heals then it will reinjure the hamstring and also develop the permanent muscle dysfunction.
How To Diagnose Pulled Hamstring
Pulled hamstring will get diagnosed depending on the history and physical examination of the patient. The status of the injury will give you the clue as to what type of injury it is.
The healthcare professional may ask some questions about the circumstances of the injury to analyze the mechanism of it and also can guide you on what home treatments you can take.
The past medical history is also important for the diagnosis. Because the previous injury or the arthritis of the back, knee, or hip can decrease the range of motion and flexibility of the muscles, that will cause the hamstring to become more prone to injury.
The physical examination often consists of touching the muscle to assess the tenderness and swelling. The grade 2 or 3 tear may have a defect or division that can be felt along the course of the muscle, confirming the diagnosis.
A range of motion of the back, knee, and hip can also be tested with and without resistance. So, try to unmask pain that will not necessarily be appreciated by the palpation.
Often the doctor lays the patient flat on his stomach and also bends his knee to go degrees. This will relax the hamstring muscles and also may minimize the spasm muscle.
The hamstring muscles can then be felt and a potential defect will be appreciated.
Here are some ways to determine if you have hamstring which includes:-
1. Physical Exam For Pulled Hamstring
Here the doctor checks the thigh swelling, bruising, and tenderness because this helps to decide whether the injury is severe or mild.
Other potential sources of pain will consider and the physical examination will also help to differentiate a pulled hamstring from the bone or the joint pain.
The pain originates in the nerves as it leaves the spinal canal in the lower back and it also mimics the hamstring injury. In most cases, patients do not need further testing.
There is also concern that the pain is due to an avulsion fracture or the other injuries in the pelvis, knee, or the femur.
Occasionally, the sciatic nerves at the back of the thigh may become irritated or get entrapped in healing scar tissue. It can cause sciatic as the symptoms might go down the leg.
In this case, the physician will conduct a thorough neurologic and musculoskeletal examination.
This is why it is important to have a physician or qualified clinician perform a complete neurologic and musculoskeletal examination in the setting of a hamstring strain.
2. MRI For Pulled Hamstring
If your healthcare provider thinks that you have a severe injury, then he will ask you for the MRI. This imaging test will show the tear in the muscle tissues.
3. X-ray For Pulled Hamstring
If your bone gets fractured during the injury, then your doctor may recommend you for the X-ray.
(Also read: Pincer Grasp – What Is Pincer Grasp Definition)
4. Ultrasound For Pulled Hamstring
Ultrasound is another test that can produce a detailed image of the muscles because it can help to show the size and location of the hamstring tear.
What Is The Complication Of A Pulled Hamstring?
Most of the pulled hamstring can heal successfully without causing any complication. However, this will rely on dedication towards the treatment and also the recovery plans.
Without adequate pulled hamstring recovery, re-injury of muscle can occur. Doing too much activity too soon after the pulled hamstring can also lead to permanent damage and chronic problems.
That’s when seeking early medical care and also carefully following the doctor’s treatment plan is one of the best ways to prevent these complications.
Do physical activities or participate in sports only on the recommendation of your healthcare provider.
How To Prevent Hamstring Pull?
Not all hamstring pulls can be prevented. A pulled hamstring will often occur due to muscle pull or poor flexibility.
That’s why, you may be at a higher risk like an older adult or an adolescent, and you may experience a sudden impact that will cause the injury.
Doing regular stretching can promote flexibility and that should be a daily consideration to minimize muscle injury.
Whether it is a home fitness program,yoga classes or pilates at the gym, it can help you increase your balance, flexibility, and tone up the muscle.
Doing these activities can help to prevent any strained hamstring and also joint, bone & muscle injuries.
Doing eccentric muscle strengthening exercises may help in decreasing the risk of a hamstring pull because these exercises allow the muscles to strengthen as they include running slowly towards the downhill and also in the downward motion of squatting.
Muscles that stretch and warm are less inclined to tear. Before doing any exercise or manual labor like shoveling snow, gardening, or other household chores, it becomes imperative that muscles of the legs and back remain flexible and stretched because flexibility in the muscles helps to prevent the pulled hamstring.
The best way to keep the muscle in shape is to prevent pulled hamstring.
Here are some ways that can help you to protect yourself against the pulled hamstring:-
1. Warm-up Your Body Before Doing Any Physical Activities
Gently warm up your body before playing any sport or working out. Jog in one place for a minute or two and do jumping jacks to warm up your muscles.
After playing also do some static stretches where you can gently stretch your muscles, by building each stretch at least for 30 seconds.
2. Keep Your Muscles Strong & Flexible
Do regular exercise and also adopt a good stretching program so your muscles don’t get a shock when you do an intense workout.
So stretch after and before the workout. It is also important to remember that, with the strength training, the muscles will tend to retract.
So, if you avoid the stretching then these muscles can eventually become fixed in the semi-fixed position.
3. Increase The Duration And Also Intensity Of Exercise
One of the thumb rule is to make sure that you don’t do more than 10% of exercise each week. This can lead to overexertion.
So just follow the 10% rule in which you can increase the distance, intensity, or the duration of the workout. By no more than 10% week on week to avoid overexertion also.
4. Stop Doing Activity Immediately If You Feel Pain In Thigh
If you are worried that you have a strained hamstring, then give yourself some time to rest. Also, don’t return to any activity until your leg feels strong. If there is no pain in your injured leg, you can move it freely.
You can also do the squats & other exercises that can engage the glutes and the hip flexor muscles with caution, starting them slowly and also gradually increasing in depth because doing exercise regularly
Because doing exercise regularly can maintain cardiovascular and muscular fitness. So it will help you to prevent the injuries that will relate to the fatigue.
Pulled Hamstring Treatment
The treatment of strained hamstring depends on the severity of the injury. Because of the swelling and bleeding, the athletes should stop their activities and also should rest.
Applying an ice pack and a compressive bandage on the affected area can help to control the swelling. Crutches may be necessary if walking is more painful or if the spasm is severe.
If the pain is significant, the symptoms of the hamstring do not steadily resolve. At this stage, medical evaluation is needed.
One of the good news is that with proper treatment, these injuries can be easily prevented and the athletes can return to the pre-injury level of sports activities.
Most of the pulled hamstring can be easily managed effectively with simple treatments. Here is the RICE method of pulled hamstring:-
Avoid doing all the activities that can aggravate the injury. This means keep your leg as still as you possibly can.
You might also need to use crutches or a knee splint to avoid leg movement.
Ice On Pulled Hamstring
To ease the swelling and pain from a pulled hamstring, use an ice pack for 15-20 minutes throughout the day at the affected area.
You may also even use frozen peas that can be wrapped in a light towel. But don’t apply ice directly on the skin.
Compression For Pulled Hamstring
Compress or apply a bandage to the thigh to limit any swelling and also a movement that can cause further damage.
You can also use a simple elastic bandage or an elasticated tubular bandage that will be available in the pharmacy.
Elevation For Pulled Hamstring
Keep the leg raised up on a pillow as much as possible because it can help you reduce the swelling.
OTC pain medications can help to ease your discomfort with a hamstring injury.
Oral nonsteroidal anti-inflammatory drugs (NSAIDs) like the ibuprofen or some other OTC pain medication like acetaminophen are good for short term relief.
Topical NSAID creams and gels are also helpful to ease the pain. But if you feel, you have injured yourself severely then it is a good idea to see your doctor before self-medicating.
Another best option to relieve the pain is to use a foam roller which is also known as myofascial release to the hamstring.
Place the roller just above the back of the knee and roll upward in the direction of the blood flow to massage the muscles gently. The professional sports massage may also help you to get rid of the pain.
Physiotherapy Treatment For Strained Hamstring
Physiotherapy is one of the most important treatments of a pulled hamstring. Initially, your physiotherapist can advise you on the exact tissue damage and the extent of the damage.
Follow all the assessments that your physiotherapist can provide you. He will also advise you how long your injury takes to heal and also the appropriate treatment that can be developed.
The treatment plan of pulled hamstring involves several treatment techniques such as electrotherapy and manipulations to reduce the swelling and pain and it can also enhance the healing of the injured structures.
Pulled Hamstring Surgery
If the above treatment doesn’t heal a partial or complete tear, then your doctor might recommend surgery to repair the hamstring.
So the hamstring surgeon will fix the tear with stitches. Most of the hamstring surgery is done to treat avulsions.
During the hamstring injury, surgery surgeon will move into his correct position and also staple or stitch it to the bone.
Pulled Hamstring Rehab Exercises
Both strengthening and stretching exercises are important for hamstring rehab.
After the initial acute stage, gentle static stretching exercise is required and you can try it as long as it is pain-free.
After the initial acute stage, gentle static stretching exercise is required and you can try it as long as it is pain-free. Perform some gentle exercises such as cycling and walking.
Short Note On Pulled Hamstring
Most hamstring tears are caused by athletic injuries. Typically, partial tears hamstring heal in 4 to 8 weeks, while complete tears hamstring takes about 3 months.
You should start to feel better by doing some regular physical therapy and a lot of rest. For avoiding re-injury follow the doctor’s guidance.