Pulled Hamstring Injury: Symptoms, Causes, Risks, Treatment

Pulled Hamstring Injury

Ever had a pulled hamstring muscle injury and wondered why it happened then and what can you do to help treat the hamstrings. Well that is what todays chiropractic health post is about.

South Africa has just finished hosting  a successful football World Cup 2010 and it is common to see professional football players not being able to play due to a pulled hamstring injury. But, it is not only soccer players, but also other sports like rugby, cricket and athletics running who suffer a hamstring pull.

So a hamstring muscle injury can be very costly both in money and time off, particularly for professional sportsmen like the soccer stars in the Fifa World Cup.

Hamstring injuries are a very common in sport injury and they can re-occur time and time again.

You may think you have a hamstring injury, but it could also be a pinched nerve like, sciatica, or a hip or low back pain problem. So today I would like to look at what can cause a hamstring injury (both sport and non-sport), how to treat a pulled hamstring injury (by yourself and with professional help, like a chiropractor), and how to try prevent a pulled hamstring injury.

Hamstring Muscle Anatomy

The first thing to you need to know is “what is the hamstring muscle“. Well the hamstring is not just one muscle in the back of the thigh, but a group of muscles.

The hamstrings are made up of the following muscles:

  1. Semitendinosus,
  2. Semimembranosus and
  3. Long & short head of biceps femoris.

So the hamstrings are a strong group of muscles at the back of your thigh that insert at the pelvis and hip and attach as strong tendons behind the knee. The hamstring helps to bend the knee and straighten the leg from the hip.

All the hamstrings are innervated by the tibial division of the sciatic nerve. Except the short head of biceps femoris, which is supplied by the common peroneal division of the sciatic nerve.

Most Common Hamstring Injury

The hamstring muscles are the most common fast running sports injury. The short head of the biceps femoris muscle is the most commonly injured hamstring muscle in sports. The way the hamstring muscles are typically injured is by an eccentric mechanism of muscle contraction.

Eccentric muscle contraction means when the hamstring muscles are stretched, but they are contracting to control the rate of stretch. In running this is when your leg is at the end of swinging through and is out in front of you before it hits the ground.

Eccentric Hamstring Injury Video

In the following hamstring injury video you can watch American athlete, LoLo Jones, hurdling and pulling her right hamstring whilst trying to control her right leg going over the hurdles. This is an example of eccentric muscle contraction.

Point of Hamstring Injury Matters

Where in the hamstring muscles the injury occurs is important from a recovery point of view. The higher up in the back of thigh (i.e. closer to your bum) the longer the recovery. This is because it is easier for the hamstring muscle to heal when the strain is in the belly of the muscle compared to closer to the tendon section by the ischial tuberosity.

So a higher hamstring injury should be treated like a hamstring tendonitis, whilst lower down is more of a hamstring strain.

Worst Sport for a Hamstring Injury

As mentioned earlier, hamstring muscle injuries are common in all sports requiring rapid acceleration and maximum speed running. When research has been done on the rate of hamstring injuries in different sports it was found that hamstrings are the most common injury in:

  • Athletics (especially in sprinters),
  • Football (soccer),
  • Australian Rules Football,
  • Cricket,
  • Touch rugby
  • Hurling
  • Rugby League
  • Rugby Union

So a pulled hamstring muscle seems a very common sport injury in running sports.

Risks of Hamstring Injury

The greatest risk for a pulled hamstring is within the first 2 weeks of returning to sport after a hamstring injury.

In Australian Rules Football on average, 30% of Australian Rules Football players will re-injure their hamstring on return to competition.

Some other risk factors for developing a pulled hamstring muscle are:

1. Older elite athletes are more likely to suffer hamstring strains.

Muscles supplied by the L4-5-S1 spinal nerves (mainly L5 & S1) are more likely to be injured compared to L2-4 ones. The L4-5 and L5-S1 areas of the low back lumbar spine are more prone to degenerative changes so there is more risk of nerve irritation at these levels. This could also explain the hamstring muscle injury risk in older sportsmen.

2. Muscle Imbalance

The hamstring and quadricep muscles affect the way each other works. The quadriceps muscle is the one on the front of your thigh. It is possible that if the hamstrings are not strong enough in eccentric muscle contraction they could be strained. So a very strong quadriceps muscle could cause the hamstring strain.

3. Lack of Warm-Up

Cold muscles are more at risk of muscle strain. An inadequate warm-up routine could contribute to the pulled hamstring injury.
Did You Know that the positive effects of a muscle warm-up could be lost by 20min of sitting. So watch out if your on the bench as a substitute.

4. Fatigue

Tired muscles are at greater risk of straining. Fatigue in muscle can be both local in the muscle and nerve control of the muscle.
Did You Know that fatigue is also responsible for one type of muscle cramp.

5. Flexibility

The amount of flexibility needed is sport specific. A dancer would need more hamstring flexibility than a front row rugby player. The jury is still out if more flexible hamstrings lower the risk of injury. Having tight hip flexors and quadriceps muscles can increase the risk of hamstring strain.
Did You Know that stretching is not considered effective in lowering the risk of sport injury.

6. Body Mechanics

Your posture could be a risk factor for a pulled hamstring muscle. The hamstring muscles are linked to the fascial train of the thoraco-lumbar fascia (TFL) and the erector spinae up to the splenius cervicas and capitus. This means potentially that a rounded shoulder posture, a tight lower back and forward tilted pelvis could increase the strain on the hamstring muscles.
Did You Know you could try some beginner pilates exercises to help your posture.

7. Sport Specific Activities

It has been thought that kicking would increase the risk of a hamstring strain, but it doesn’t seem to be. Fast bowling in cricket is linked to hamstring strains.
Did You Know that teenage fast bowlers in cricket are at risk of lumbar spine spondylolisthesis, with one of the symptoms being tight hamstrings.

8. Running Technique

We have already talked about bad posture as a risk and this bad posture can also affect your running technique. Leaning forward whilst running is seen as a risk factor for getting pulled hamstring muscles. Forward lean is counter-productive to sprinting performance. So trying to push your head forward to run faster won’t help you run faster. Trying to increase your stride length, whilst running could also put you at more risk.
Did You Know that barefoot running may be better for runners injury prevention than wearing running shoes (takkies).

9. Psychological

This is an interesting risk factor for a pulled hamstring. People under psychological stress, like professional athletes, before a big game are creating a physical change in their bodies. It is like thinking of food when your hungry causing your mouth to salivate. A mental thought created a physical change.
Stress and anxiety will make you in a more pro-inflammatory state, meaning it is easier for inflammation to occur. Mental pressure also leads to an increase in muscular tension and negatively effects physical performance, including diminished fine motor control and muscle fatigue.
Did You Know chiropractic treatment can have a positive change on the nervous system which controls stress.

Types of Hamstring Injury

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A muscle strain is considered a tear in the muscle fibers. Hamstring tears can be classified into three groups:

  1. Grade 1 Strain
  2. Grade 2 Strain
  3. Grade 3 Strain

The symptoms of a hamstring strain are:

Grade 1 Hamstring Strain – Mild muscle tear with no bruising visible, mild discomfort on using and moving the muscle.

Grade 2 Hamstring Strain – Moderate tear in the muscle fibres. Altered walking style to avoid pain and pain when contracting or moving the hamstring or leg.

Grade 3 Hamstring Strain – Severe tear of the hamstring muscle. Very painful or sometimes no pain if the tear is completely through the muscle. Visible bruising and weakness in the muscle. Protective limp when walking. Here you can see some pictures of the hamstring bruising behind the knee into the calf.

The most common out of the three is a Grade 1 or 2 hamstring strain. So the healing time for a hamstring strain can range from a few days to weeks/months depending on the severity.

Hamstring Injury Treatment

If you are reading this because you have a pulled hamstring then this is what you can try do to help yourself.

1. Use “RICE”

“RICE” stands for rest, ice, compress, elevate. It is the first thing to do to help a muscle strain. So get the frozen peas out the freezer or a blue soft gel sports ice pack and put it on the area of pain. You should only need to rest a grade 1 or 2 strain for a day or two with a maximum of 1 week for a severe hamstring strain. After that start slow moving or just contracting the muscle without moving the leg (isometric muscle contraction). Keep the leg above heart height to help control swelling and use an elastic bandage to minimise the amount of inflammatory swelling.

2. Vitamin C

Did you know that taking 500mg to 1g of Vitamin C could help collagen formation and repair. So to help the hamstring muscle strain heal maybe try a short course of Vitamin C.

3. Omega 3 Oils

Your Omega-3 oils (essential fatty acids) help from an inflammatory point of view. Inflammation is needed by the body to create healing and scar formation. Omega-3 oils have also been tried for controlling nerve pain (neuropathic pain). Be careful though if your allergic to fish, on warfarin treatment or another blood thinning drug.

4. NSAID’s

NSAID’s stands for non-steroidal anti-inflammatories. You’re in pain and all you want is some pain medication or drugs to help get some pain relief. Most people ask me about taking an anti-inflammatory medication. Anti-inflammatory drugs do not help with the speed of healing, only the control of pain. So it has been suggested that it may be a better option to try other cheaper, less risky pain relieving drugs such as paracetamol or aspirin. Always speak with your GP or pharmacist before taking and pain relief medication.

5. Rehabilitation Exercises

It is usually recommended to start hamstring muscle strain rehabilitation in the following order with isometrics, then isotonic muscle contraction movements. Isometric means contracting the muscle without moving the leg (i.e. squeezing the muscle only). Isotonic is first shortening (concentric) the muscle with contraction (i.e. bringing the heel to your bum movement). Then the isotonic eccentric contraction (i.e. contracting the muscle whilst stretching it out). I would recommend you see a biokinetist or physiotherapist to help you with understanding of how to do this hamstring exercise rehabilitation programme properly.

6. Hamstring Stretches

A lot of people want to know how to stretch their hamstring muscle. As mentioned earlier stretchable, flexible hamstrings do not help prevent a strain injury. However hamstring stretches can help change scar tissue that has formed from a strain injury. A simple hamstring stretch exercise is to do the Slump Test move.

The Slump Test move is to bend forward whilst sitting, then to slowly lift one leg up to straighten your knee and kick your leg out. You should feel a stretch feeling either in the back of the tight or behind the knee. Do this slowly and repeat as much as you want during the day. Do it on both sides. You can also do hamstring stretches whilst sitting on the floor or standing. If standing I would recommend rather doing the Hip Hinge Exercise.

7. Manual Therapy (Chiropractic, Osteopathy, Physiotherapy)

It has been suggested that spinal manipulative therapy could help treat and prevent hamstring injuries by helping body mechanics. Using MRI to confirm a hamstring strain diagnosis, 14–19% of all hamstring injuries are without muscle damage, suggesting no local muscle strain. A recent study found this figure to be as high as 45%.

So hamstring injuries can have non-local cause of pain. Poor body mechanics and posture again could be a problem that needs treating. You could see your local chiropractor for an assessment on your hamstring injury and your bio-mechanics (i.e. posture and movements).

I hope this has been helpful in understanding why you get hamstring injuries, how you pulled the muscle, the risks involved in hamstring strains and what stretches and exercises you could do to treat it yourself. To see one of the chiropractors about your hamstring you can call the chiropractic clinic on 074 159 4040 or use our online contact form for any related questions.