Hamstrings

We often use taping during rehabilitation

There must be something in the air, maybe it’s the coming of Spring, people are out and about; but the dreaded hamstrings injury is rearing it’s ugly head this month. We’ve been seeing a variety of mechanisms as well in the clinic all from “I slipped and did the splits” to “I was playing hockey and I felt something in the back of my thigh”. Generally these injuries occur when there is a quick contraction of the hamstrings muscle in a lengthened position, and running sports fall into the higher risk sports especially soccer. Hamstring injuries come in different grades and are not exclusively a sports related injury, and don’t discriminate based on gender or age. Their recurrence rate is also very high, which is one of the reasons there are so many studies and return to sport programs out there. The worst I have ever seen was a complete avulsion of the proximal hamstrings tendon off the bone it attaches to, the ischial tuberosity (the bottom bone) and the whole of the back thigh was blue and black. Needless to say, this patient took quite a while to improve.

Risk factors for injury are variable but include being of older age, a previous history of injury, ethnicity, strength imbalances at the hamstrings and quadriceps, flexibility of the hamstrings, hip and back, and of course fatigue.

So lets grade hamstrings injuries and what’s worse, the muscle, belly, proximal or distal attachment?

Grade 1 (mild): a handful of the muscle fibres have been damaged but your performance doesn’t change and you can walk fine. It’ll be sore and a bit sensitive the next 24hrs after injury with some tightness in the hamstring and some mild swelling if any.

Grade 2 (moderate): around half of the muscle fibres are torn and it’ll be very painful, swollen and you’re walk will be affected.

Grade 3 (severe): >50% of the muscle fibres are torn and the muscle belly + the tendon attachment are affected; loads of swelling and pain and likely some bruising but this varies from patient to patient. You’ll find that you can’t walk much at all and there is lots of muscle weakness.

As physios we’re trained to accurately assess and diagnose a hamstrings injury via clinical testing, however, if we suspect a high grade tear more often than not a scan is a useful tool to further add to the diagnosis and inform your recovery.

What would I rather tear? the hamstrings muscle belly, with good blood supply, the belly will heal, while the tendon which is not so well supplied with blood is unlikely to heal much at all. But as you can see, the more severe hamstrings injuries will include the tendon and healing is variable depending on factors such as age and general health.

Proximal hamstrings tears are by far worse than distal to heal and rehabilitation. Timeframe wise you’re looking at up to 12+ weeks of guided rehabilitation for severe tears. In some cases, you’ll require surgical intervention especially if the tendon attachment has ruptured off the bone. The only way it can be reattached is via sewing it back on via surgery, strength work won’t do it.

When we see hamstrings injuries in the clinic we put together rehabilitation programs for all our patients that must be staged in terms of load and manual therapy, this is what you get when you see a trained professional. A physio can help you achieve the best outcomes for your injury, and make sure to give us specifics, that way you’re on your way to getting back to doing the things you love most.

Reach out to us via or social media platforms if you have any questions.

Sam and Andy