What is hamstring strain ?
When an excessive load is applied to a muscle as it is contracting, or if a muscle over stretches as it is lengthening some of the fibres which make up the muscle may tear. If only a few fibres are torn this will usually be called a hamstring strain or grade 1 muscle tear. There are 3 recognised grade of Hamstring strain
Grade 1 Hamstring Strain
When there is damage to a small number of muscle fibres – usually less than 5% of fibres this is a considered to be a mild hamstring strain.
In this case the pain may be sudden onset pain or just tightness in the hamstring, the player might be able to play on, the area will become painful and tender later on, there will probably be no visible bruising or swelling, and the player will be able to walk around without limping.
This could take 2 to 3 weeks rest, however sometimes this is more like a micro-tear with minimal damage, and with good early management the player may return to sport after a week.
Grade 2 Hamstring Strain
When there is more extensive damage, with a large number of muscle fibres involved, but the muscle is still in tact it is known as a grade 2 hamstring strain or hamstring tear.
In this case there will be a sudden onset of pain while the player is in full stride, decelerating or sometimes twisting. The player will be unable to play on, there will be a tender mass at the site of injury, there may be bruising which may not appear until the following day, and may be lower than the area of pain. There will be weakness in the muscle and the player may be limping.
The rest period required is usually between 3 and 6 weeks. Good physiotherapy treatment and early management will reduce the recovery period.
Grade 3 Hamstring Strain
When there is a complete rupture of a muscle it is referred to as a grade 3 hamstring tear. There will be a sudden severe onset of pain, and the player may not be able to walk off the pitch.
There will be severe pain in the muscle and severe pain and weakness on resistance. There may be a visible deformity in the muscle where the fibres have recoiled back into a lump. There will be swelling in the area and bruising will be extensive when it appears the following day.
In a sports person this may require surgery to repair the muscle if the fibres have severely recoiled. Even with good physiotherapy and management it may take 3 months to fully recover.
All muscle strains should be rested and allowed to heal. If the patient continues to play, the condition will worsen. If ignored, a grade one strain has the potential to become a grade two strain or even a complete rupture.
How to treat a hamstring strain?
As with any acute injury the early management of a hamstring is extremely important to aid recovery and prevent further trauma to the area.
PRICE for Hamstring Injury treatment
- Protect the area
- Rest – relative rest is advocated, no running, but move within normal painfree limits
- Ice is extremely important. 20 minutes at a time every 2 hours, protect the skin to avoid ice burns
- Compression – use an elastic bandage or support to apply firm light pressure to the area to limit swelling
- Elevation – keeping the injured area higher than the hip aids swelling reabsorption
In our clinic we will use Laser therapy within the first 48 hours in conjunction with PRICE to accelerate the Inflammatory phase of healing. Then we will offer you manual therapy, electrotherapy, deep dry needling, strengthening, stretching and rehabilitation for return to sport.
Also we will address any underlying issues which may have been causative factors for your hamstring strain.
Why does it take so long for hamstring strain to heal?
There are four main stages of the healing process for hamstring tear
- INFLAMATORY REACTION
The body has a natural healing process which must occur when a muscle is strained or torn.This begins with an inflammatory response which occurs over the first 48 hours. This is a really important time where the inflammatory reaction the body produces chemicals and cells which remove dead muscle fibres and start the repair process. This must be allowed to happen, and that is why you should not take anti-inflamatory medication in the first 48 hours after an injury. It is also why protection of the area, rest, ice, compression and elevation is important
- REGENERATION OF MUSCLE FIBRES
The damaged tissue must be replaced, so new muscle fibres grow from special cells within the muscle.
- FORMATION OF SCAR TISSUE
When an injury occurs there will be bleeding in the gap between the torn muscle ends, and this eventually lays down fibres called collagen which form a scar linking the 2 muscle fibre ends to help them heal.
- MATURATION OF THE SCAR TISSUE
As the scar develops the collagen fibres take on a permanent structure and physiotherapy is useful in this stage to help the new collagen fibres to be laid down inline with the original muscle fibres so improving the long term tensile strength and flexibility of the injured muscle enabling it to withstand more force.
When Hamstring Pain is not Hamstring Strain
Not all pain in the back of the thigh is a hamstring strain or tear. If a hamstring feels ready to pull, tight, or is recurrently pulling throughout the season it may be due to a number of factors:
- A genuine hamstring strain
- Overuse of hamstring due to poor use of gluteal muscles because of poor core stability
- Inflexible hamstring due to ineffective or harmful stretching techniques
- Referral of pain in to the back of the thigh due to disc, joint or muscle injury in the back
- Referral of pain into the hamstring from the Sacro-iliac joint
- Referral of pain from Myofascial trigger points in overworked muscles in the pelvic region or back area.
To determine what the true cause of hamstring pain is, it is essential to have a thorough assessment by a qualified and experienced practitioner who can get to the base of your problems, treat accordingly, advise appropriately and prescribe the correct exercise routine for you.