December 14, 2011
The following piece was prepared for SC1 Sports by Michael Hegarty MCSP MISCP BSc – Chartered Physiotherapist.
You can contact Michael at:
The Physiotherapy Room,Old Library Trust, Creggan.
What is a pulled hamstring or hamstring strain?
A hamstring strain or a pulled hamstring as it is sometimes called is a tear in one or more of the hamstring muscles. Strictly speaking there are three hamstring muscles (Semitendinosus, Semimembranosus and Biceps femoris) which are known as the hamstring muscle group. The role of the hamstring muscles is to bend (flex) the knee and to move the thigh backwards at the hip (extend the hip). Understanding how the hamstrings work gives vital clues as to their modes of injury. Mild to severe hamstring strains are extremely common in sprinters and hurdlers and in all sports that involve sprinting activities, such as football and rugby.
Symptoms of a Pulled Hamstring:
A sudden sharp pain at the back of the leg during exercise-most probably during sprinting or high velocity movements.
Pain on stretching the muscle (straightening the knee whilst bending forwards).
Pain on contracting the muscle against resistance.
Swelling and bruising.
If the rupture is severe a gap in the muscle may be felt
STRAINS ARE CLASSIFIED IN TERMS OF SEVERITY:
Strains are graded 1, 2 or 3 depending on severity. Grade 1 consists of minor tears within the muscle. A grade 2 is a partial tear in the muscle and grade 3 is a severe or complete rupture of the muscle.
May have tightness in the posterior thigh.
Probably able to walk normally however will be aware of some discomfort
Lying on front and trying to bend the knee against resistance probably won’t produce much pain.
Gait will be affected-limp may be present .
May be associated with occasional sudden twinges of pain during activity.
May notice swelling.
Pressure increases pain.
Flexing the knee against resistance causes pain.
Might be unable to fully straighten the knee.
Walking severely affected- may need walking aids such as crutches
Severe pain- particularly during activity such as knee flexion.
Noticeable swelling visible immediately.
1st THING TO DO IF YOU SUFFER INJURY:
PRICE – The protocol for immediate treatment of injury
The PRICE protocol should be applied immediately after an injury occurs, before being treated by Emergency Professionals.
P is for Protection
- Protect any injury from further damage. Stop playing, use padding and protection; splints; or use crutches to take the weight off a knee or ankle injury.
R is for Rest
- Allow an injury time to heal. Being brave and playing on is not always wise. Ensure rehabilitation time to allow even a small injury to heal.
I is for Ice
- By applying Ice either from a freezer, an ice pack or even a pack of peas onto the injury you will reduce the pain and inflammation. Very cold products can induce hypothermia or cold burn so wrapping the ice in a cloth is advisable.
C is for Compression
- Compression of the swollen area will help to reduce the swelling. Cohesive, Tear Tape, crepe or any stretchy bandage will suffice. Do not get these bandages mixed up with EAB (Elastic Adhesive Bandage) which is a product for support and compression that needs training to use.
E is for Elevation
- Elevating the injury to above the heart prevents the flow of blood to the area and reduces the swelling.
- Depending on severity, can begin early Range of movement exercises
No stretching until 4-5 days post injury, to allow for scar tissue to be laid down
- Avoid aggravating activities
- No running in early phase
- Don’t get any soft tissue work / massage for 5-7 days post injury
GRADE 1: 1-2 WEEKS
GRADE 2: 2-4 WEEKS
GRADE 3: 6-8 WEEKS
Aims of rehabilitation
Reduce pain and swelling.
Improve flexibility and muscle condition.
Restore muscle strength.
Return to full fitness.
Static hamstring stretches provided they are pain free. Hold for 30 seconds and repeat at least 5 times a day.
Standing hamstring curls progressing to hamstring curls on a weights machine or using a resistance band (3 sets of 20 very light every other day then increase the weight and gradually decrease the repetitions to 4 sets of 10 reps three times a week)
As soon as you can do so without pain, begin gentle jogging. Over a period of two weeks gradually increase the duration and speed of the runs.
When you can run for 40 minutes with no problems begin speed work. An example session would be 10 x 60m striding at 50% effort. Two or three days later, 10 x 60m at 70% effort.
Remember to increase slowly and continue stretching, strengthening and sports massage throughout and beyond the rehabilitation process.
Swimming or cycling every other day.
Introduce dynamic stretching exercises
Introduce eccentric hamstring strengthening. Kneeling on the knees, the therapist or trainer stabilises the lower legs as the patient leans forwards as if going to lay on the front. It is important in this position to avoid any movement of the lower back or hips (sets of 10 reps initially once a week, progressing to twice).
Preventing Muscle Strains
Several factors can predispose you to muscle strains, including:
Tight muscles are vulnerable to strain. Athletes should follow a year-round program of daily stretching exercises.
Because the quadriceps and hamstring muscles work together, if one is stronger than the other, the weaker muscle can become strained.
If your muscles are weak, they are less able to cope with the stress of exercise and are more likely to be injured.
Fatigue reduces the energy-absorbing capabilities of muscle, making them more susceptible to injury.
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