The Hamstrings: Common Injuries, Assessment, and Treatment

Treating Hamstring Injuries

Ah, the hamstrings. If you’ve ever dealt with a hamstring injury, you know just how frustrating they can be. As an athletic trainer who’s been working with athletes for decades, I’ve seen my fair share of hamstring problems—from minor tweaks to full-blown tears. Whether you’re a weekend warrior, a professional athlete, or someone who just likes to stay active, understanding the common hamstring injuries, how to assess them, and what treatment options are available can make a world of difference in getting you back on your feet.

In this blog, we’re going to dive into the world of hamstring injuries. We’ll look at the most common types, go over how to assess the damage, and then discuss effective treatment strategies. By the time we’re done, you’ll have a good grasp of how to manage hamstring injuries and, hopefully, avoid them in the first place.

What Are the Hamstrings, Anyway?

Let’s start with a bit of anatomy. The hamstrings are a group of three muscles located at the back of your thigh: the biceps femoris, semitendinosus, and semimembranosus. These muscles run from the ischial tuberosity (that bony part of your pelvis you feel when you sit) down to the tibia and fibula bones in your lower leg.

The hamstrings play a key role in knee flexion (bending the knee) and hip extension (moving the leg backward), which are essential for activities like running, jumping, and kicking. Given their involvement in so many movements, it’s no wonder they’re prone to injury. And boy, when they get injured, they can cause a real pain—literally and figuratively.

Common Hamstring Injuries

There are a few different types of injuries that can affect the hamstrings. Let’s break down the most common ones.

1. Hamstring Strain

This is probably the injury you’ve heard about the most. A hamstring strain occurs when the muscle fibers are overstretched, leading to a tear. The severity of a strain can range from a mild pull (Grade I) to a complete tear (Grade III).

• Grade I Strain: This involves a mild stretch or pull, with only a few muscle fibers affected. You might feel some tightness or mild discomfort but can still walk and move around.
• Grade II Strain: This is a partial tear of the muscle fibers, leading to more significant pain and swelling. You’ll likely have trouble walking without limping, and activities like running will be painful.
• Grade III Strain: A complete rupture of the muscle. This is serious business—you’ll likely feel a sudden, sharp pain and may even hear a "pop." Walking will be difficult, if not impossible, without assistance.

2. Hamstring Tendinopathy

When people talk about hamstring tendonitis, they’re usually referring to hamstring tendinopathy. This condition involves degeneration of the tendon rather than acute inflammation. It often develops gradually and can be the result of overuse, poor running technique, or muscle imbalances.

There are two main areas where hamstring tendinopathy occurs:

• Proximal hamstring tendinopathy: This affects the tendons at the upper part of the hamstring, near the gluteal fold (where your butt meets the back of your thigh).
• Distal hamstring tendinopathy: This occurs near the lower part of the hamstrings, closer to the knee.

3. Avulsion Injuries

An avulsion injury is when the hamstring tendon pulls away from the bone, sometimes taking a piece of bone with it. This type of injury usually happens during high-speed activities or sudden deceleration, like sprinting or hurdling. It’s most common in adolescents, whose bones are still developing, but it can happen to adults too.

4. Hamstring Contusions

These are bruises that result from a direct impact to the back of the thigh. They’re less common than strains or tendinopathy but still worth mentioning. Contusions are typically seen in contact sports like football or rugby.

Assessing Hamstring Injuries

Now that we know the common types of hamstring injuries, let’s talk about how to assess them. As an athletic trainer, I always start with a thorough history and physical exam. Here’s what I’m looking for:

1. History of the Injury

I’ll ask questions like:

• How did the injury happen? Was it sudden, or did the pain come on gradually?
• Where is the pain located? Is it high up near the buttock, down by the knee, or somewhere in the middle?
• What were you doing when you felt the pain? Sprinting, kicking, or just walking?

These questions help narrow down whether we’re dealing with a strain, tendinopathy, or something else.

2. Physical Examination

During the physical exam, I’m checking for swelling, bruising, and tenderness along the hamstring. I’ll also do some range of motion tests to see how much flexibility you have and whether certain movements cause pain.

3. Strength Testing

I’ll assess the strength of the hamstrings by asking you to resist while I apply force. Weakness, especially compared to the uninjured leg, is a sign of muscle strain or more severe injury.

4. Special Tests

There are a few special tests that can help pinpoint the injury:

• Active knee extension test: Lying on your back, we raise the leg and extend the knee to see if there’s pain or limitation.
• Bent-knee stretch test: I’ll bend your knee and then extend your leg while you lie on your back to see how the hamstrings respond.

If the symptoms are severe or don’t improve with time, I may recommend imaging studies like an MRI or ultrasound to get a clearer picture.

Treatment Options for Hamstring Injuries

When it comes to treating hamstring injuries, there’s no one-size-fits-all approach. Treatment depends on the type and severity of the injury. Here’s how I typically tackle them:

1. Rest and Recovery

No surprise here. Rest is crucial, especially in the early stages of a strain. For Grade I strains, you might only need a few days of rest, while Grade II or III strains could require several weeks. During this time, gentle stretching and range-of-motion exercises can help prevent stiffness.

2. Ice and Heat Therapy

In the initial 48 hours after an injury, ice can help reduce swelling and numb pain. After the acute phase, heat therapy can increase blood flow to the area, promoting healing.

3. Compression and Elevation

Compression wraps can help reduce swelling, while elevating the leg helps to decrease inflammation.

4. Physical Therapy

Once the acute pain has subsided, physical therapy becomes the main focus. A physical therapist will work with you to:

• Restore flexibility: Stretching exercises targeting the hamstrings and surrounding muscles.
• Strengthen the muscles: Exercises like bridges, hamstring curls, and eccentric strengthening.
• Correct muscle imbalances: Working on the quadriceps, glutes, and core muscles to improve overall leg stability.

5. Massage Therapy

Sports massage can help relieve tension in the hamstrings and reduce scar tissue formation. Techniques like myofascial release and deep tissue massage can be particularly helpful for chronic cases of hamstring tendinopathy.

6. Trigger Point Therapy

When dealing with hamstring strains or tendinopathy, I often find trigger points in the muscle that contribute to the pain. Trigger point therapy involves applying direct pressure to these spots, which helps release the muscle and reduce discomfort.

7. Massage Cupping

For certain cases of hamstring injuries, massage cupping can be a useful addition to the treatment plan. The suction created by the cups helps increase circulation, reduce muscle tightness, and promote healing by drawing blood to the injured area. Cupping is particularly effective in addressing chronic tension and muscle adhesions that can develop after a hamstring injury.

8. Eccentric Strengthening

There’s a lot of research supporting eccentric strengthening exercises for treating hamstring tendinopathy. This involves lengthening the muscle under load (think of slowly lowering a weight after curling it). Studies have shown that this approach helps remodel the tendon, making it stronger and more resilient .

9. PRP Injections and Other Advanced Treatments

In more stubborn cases, treatments like Platelet-Rich Plasma (PRP) injections may be considered. These injections involve taking a sample of your blood, concentrating the platelets, and injecting them back into the injured tendon to promote healing. Although more research is needed, some athletes swear by it for tendinopathy and chronic strains .

10. Surgery

Surgery is usually a last resort, reserved for severe Grade III strains or avulsion injuries where the tendon has detached from the bone. Thankfully, most hamstring injuries don’t require going under the knife.

The Importance of a Comprehensive Approach

When it comes to hamstring injuries, recovery isn’t always quick and straightforward. It requires a comprehensive approach that combines rest, rehabilitation, and targeted therapies. Throughout my career, I’ve found that patience and consistency are key. If you’re experiencing recurrent hamstring injuries, it’s worth investigating the underlying causes—whether it’s muscle imbalances, poor flexibility, or running technique.

It’s also important to gradually reintroduce activities. Jumping back into high-intensity exercises too soon can lead to a relapse or a more severe injury. Always follow a structured return-to-play program tailored to your specific injury.

References

1. Orchard, J. W. (2005). Hamstrings are most susceptible to injury during sprinting: A prospective study of 249 professional cricketers. Journal of Science and Medicine in Sport, 8(4), 381-387.
2. Askling, C., Tengvar, M., Saartok, T., & Thorstensson, A. (2008). Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. The American Journal of Sports Medicine, 36(9), 1799-1804.
3. Sherry, M. A., & Best, T. M. (2004). A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. Journal of Orthopaedic & Sports Physical Therapy, 34(3), 116-125.

Disclaimer

This blog is intended for informational purposes and should not replace professional medical advice. Always consult a qualified healthcare professional before starting any new treatment or rehabilitation program for hamstring injuries.

Keywords: hamstring injuries, assessment, hamstring strain, tendinopathy, treatment, physical therapy, eccentric strengthening, massage therapy, athletic training, rehabilitation.