What is Hamstring Strain

Hamstring strain happens when the muscles in the back of the thighs (hamstring muscles) are overstretched or torn. The hamstring muscles are used in straightening the hips, bending the knees, and pulling back the legs.

This injury is often called a pulled hamstring muscle. The tissue that connects the muscle to a bone (tendon) may also be affected.

The severity of a hamstring strain may be rated in degrees or grades. First-degree (or grade 1) strains have the least amount of muscle tearing and pain. Second-degree and third-degree (grade 2 and 3) strains have increasingly more tearing and pain.

What are the causes?

This condition is caused by a sudden, violent force being placed on the hamstring muscles, stretching them too far. This often happens during activities that involve running, jumping, kicking, or weight lifting.

What increases the risk?

Hamstring strains are especially common in athletes. The following factors may also make you more likely to develop this condition:

• Having low strength, endurance, or flexibility of the hamstring muscles.
• Doing high-impact physical activity or sports.
• Having poor physical fitness.
• Having a previous leg injury.
• Having tired (fatigued) muscles.

What are the signs or symptoms?

Symptoms of this condition include:

• Pain in the back of the thigh.
• Swelling.
• Bruising.
• Muscle spasms.
• Trouble moving the affected muscle because of pain.

For severe strains, you may feel popping or snapping in the back of your thigh when the injury occurs.

How is this diagnosed?

This condition is diagnosed based on your symptoms, your medical history, and a physical exam.

How is this treated?

Treatment for this condition usually involves:

• Protecting, resting, icing, applying compression, and elevating the injured area (PRICE therapy).
• Medicines. Your health care provider may recommend medicines to help reduce pain or inflammation.
• Doing exercises to regain strength and flexibility in the muscles. Your health care provider will tell you when it is okay to begin exercising.

Follow these instructions at home:

PRICE therapy

Use PRICE therapy to promote muscle healing during the first 2–3 days after your injury, or as told by your health care provider.

• Protect the muscle from being injured again.
• Rest your injury. This usually involves limiting your normal activities and not using the injured hamstring muscle. Talk with your health care provider about how you should limit your activities.
• Apply ice to the injured area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day. After the third day, switch to applying heat as told.
• Put pressure (compression) on your injured hamstring by wrapping it with an elastic bandage. Be careful not to wrap it too tightly. That may interfere with blood circulation or may increase swelling.
• Raise (elevate) your injured hamstring above the level of your heart as often as possible. When you are lying down, you can do this by putting a pillow under your thigh.

Activity

• Begin exercising or stretching only as told by your health care provider.
• Do not return to full activity level until your health care provider approves.
• To help prevent muscle strains in the future, always warm up before exercising and stretch afterward.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If directed, apply heat to the affected area as often as told by your health care provider. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
  • Place a towel between your skin and the heat source.
  • Leave the heat on for 20–30 minutes.
  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

• Increasing pain or swelling in the injured area.
• Numbness, tingling, or a significant loss of strength in the injured area.

Get help right away if:

• Your foot or your toes become cold or turn blue.

Summary

• A hamstring strain happens when the muscles in the back of the thighs (hamstring muscles) are overstretched or torn.
• This injury can be caused by a sudden, violent force being placed on the hamstring muscles, causing them to stretch too far.
• Symptoms include pain, swelling, and muscle spasms in the injured area.
• Treatment includes what is called PRICE therapy: protecting, resting, icing, applying compression, and elevating the injured area.

Hamstring Strain Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Strengthening exercises

These exercises build strength and endurance in your thighs. Endurance is the ability to use your muscles for a long time, even after your muscles get tired.

Exercise A: Straight leg raises (hip extensors)

1. Lie on your belly on a firm surface.
2. Tense the muscles in your buttocks to lift your left / right leg about 4 inches (10 cm). Keep your knee straight.
3. If you cannot lift your leg this high without arching your back, place a pillow under your hips.
4. Hold the position for __________ seconds.
5. Slowly lower your leg to the starting position and allow it to relax completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Bridge (hip extensors)

1. Lie on your back on a firm surface with your knees bent and your feet flat on the floor.
2. Tighten your buttocks muscles and lift your bottom off the floor until your trunk is level with your thighs.
   1. You should feel the muscles working in your buttocks and the back of your thighs.
   1. Do not arch your back.
3. Hold this position for __________ seconds.
4. Slowly lower your hips to the starting position.
5. Let your buttocks muscles relax completely between repetitions.

Repeat __________ times. Complete this exercise __________ times a day.

If told by your health care provider, keep your bottom lifted off the floor while you slowly walk your feet away from you as far as you can control. Hold for __________ seconds, then slowly walk your feet back toward you.

Exercise C: Lateral walking with band (hip abductors)

1. Stand in a long hallway.
2. Wrap a loop of exercise band around your legs, just above your knees.
3. Bend your knees gently and drop your hips down and back so your weight is over your heels.
4. Step to the side to move down the length of the hallway, keeping your toes pointed ahead of you and keeping tension in the band.
5. Repeat, leading with your other leg.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Single leg stand with reaching (eccentric hamstring)

1. Stand on your left / right foot. Keep your big toe down on the floor and try to keep your arch lifted.
2. Slowly reach down toward the floor as far as you can while keeping your balance.
3. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Prone plank (abdominals and core)

1. Lie on your belly on the floor and prop yourself up on your elbows. Your hands should be straight out in front of you, and your elbows should be below your shoulders. Position your feet so the balls of your feet touch the ground. The ball of your foot is on the walking surface, right under your toes.
2. Tighten your abdominal muscles and lift your body off the floor.
   1. Do not arch your back.
   1. Do not hold your breath.
3. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.