One of the most common injuries in sports, the hamstring strain can sideline an athlete for months. Hamstrings are often torn during quick acceleration movements and are a common injury seen in athletes in which sprinting is a requirement.
It is fairly common to watch an athlete pull up from a sprint and grab the back of his/her leg when watching a sporting event. It is a common injury in athletes involved in track and field, baseball/softball, soccer, and football.
Mechanism of Injury
Athletes get into trouble when they focus too much of their training on building the quadriceps muscle group and not enough on developing the hamstring muscle group. The two muscle groups work together to accelerate and decelerate the knee. If the quadriceps muscle group is significantly stronger than the hamstring muscle group, the athlete will be at risk for a hamstring injury.
The quadriceps muscle group is responsible for extension (straightening) of the knee whereas the hamstring muscle group is responsible to control the deceleration of the extension. If the quick acceleration of the quadriceps muscle group is stronger than the hamstring muscle group can withstand, the muscle is injured.
Another significant factor in placing an athlete at risk for hamstring strain injuries is tightness in the hamstring muscle group. Muscle is a contractile tissue made up of collagen and elastin. The collagen contributes strength to the muscle tissue whereas the elastin allows for the tissue to extend and return to its original position. Muscle tissue can stretch up to a point. If a force exceeds the strength of the muscle tissue, the tissue will continue to stretch to a threshold point and then tear.
The tighter the muscle tissue, the less stretch will occur before the muscle tears. Combine a strong quadriceps muscle with a weak and tight hamstring muscle group, and there will be a high risk of hamstring muscle strain.
Immediate Treatment of Hamstring Strain
Once the muscle has been injured, the athlete needs to stop the activity and apply an ice pack directly to the injured area for 20 minutes. Depending on the severity of the strain, bleeding can continue into the area for several days. The ice will slow down the circulation to the injured area reducing the amount of swelling. An ace bandage can also be applied to provide a mechanical barrier to physically prevent swelling.
Continued activity will only increase circulation into the damaged area increasing the amount of swelling. It is also contraindicated to stretch the muscle immediate post-injury. Rest, ice, and compression are the treatments of choice in the first phase of rehabilitation.
Rehabilitation Plan for a Hamstring Strain
After a couple days of icing, heat can be applied for 10 – 15 minutes utilizing either moist or dry heat. At this point, the goal is to help the body’s own healing mechanisms debride the injured area. The heat accomplishes this by bringing increased blood flow to the area. The increased blood flow will provide oxygen and nutrition to the injured area while removing injury by-product. Heating muscle tissue also helps the muscle tissue to stretch.
Once the tissue has been heated, a gentle soft tissue massage can be given to keep the tissue mobile and prevent adhesions from scarring down the healing tissue. Care must be taken not to apply too much pressure at this point. Aggressive tissue work can disrupt newly laid down collagen tissue causing the healing process to start all over again.
Progressive, slow stretching can then be undertaken to begin to stretch and align the new fibers. This stretch should be a pain-free static stretch held for 30 seconds and repeated three times.
Gradual strengthening of the hamstring muscle group is the next step in the rehabilitation plan. Because the hamstring muscle group is a two joint muscle (extends the hip, flexes the knee), exercises that perform hip extension and/or knee flexion will strengthen these muscles.
Once the muscle has been strengthened, power exercises can be added to retrain the muscle in sport-specific types of activity. Power exercises combine strength and speed. They may or may not be plyometric.
The last phase of any rehabilitation program is the completion of progressive functional activities (activities that mirror what is done in the athlete’s sport). The key to functional exercises is to make them progressive by starting at a lower intensity (50% of maximum intensity) and gradually increasing the intensity level to full speed. These should be performed without pain.
This process can take several weeks to several months to complete. Each phase should be pain-free. Pain is the guide for the athlete to determine when to move forward in the rehabilitation process and when to slow down. Increased pain means the body needs more time to heal. Trying to push through the pain of a hamstring strain will only slow-down the overall healing process.
Terry Zeigler - Educating through writing with over twenty-five years of experience as a Kinesiology Professor and Certified Athletic Trainer.
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