A pulled hamstring is one of the most common injury affecting sports people at all levels.
Depending on the sport played, between 10 and 30 per cent of athletes will suffer a hamstring injury at some point in their careers. Most pulls come from sprinting.
These injuries often lead to the athlete taking significant time off from training and competition that varies from a few weeks to a whole season!
And it is an injury that should be treated with a lot of caution. One in three individuals suffer a re-injury on their return to play in the first couple of weeks.
The hamstrings are the powerful muscles at the back of the thigh that extend from the pelvis to below the knee.
The muscles cross both the hip joint and the knee joint.
The hamstring complex is made of three muscles -- the biceps femoris, the semimembranosus and the semitendinosus).
Acute hamstring injuries may be graded as described below:
Grade 1: A mild muscle strain (sudden onset pain, no loss of strength).
Grade 2: A partial muscle tear (more painful and tender with bruising, swelling and may have loss of strength).
Grade 3: A complete tear (very painful, tender, swollen and bruised. May be accompanied by a “popping” sound. There is loss of strength and inability to use affected leg).
Hamstring injuries most commonly occur in the central part of the muscle or close to the junction with the tendon.
The tears typically occur in the leading leg when the athlete is sprinting.
In rare circumstances the hamstring may pull off the bone at the pelvis. These are more severe injuries and may also be a result of a sudden explosive stretch.
The pain is felt in the buttock and is normally accompanied by significant bruising and swelling in the back of the thigh.
The other form of hamstring injury tends to be the more chronic type where the athlete cannot describe the exact point at which it happened.
There is normally a history of consistent hard training and this type of injury is more commonly seen in runners.
The pain is typically in the buttock and may make even sitting uncomfortable.
How do you treat hamstring injuries?
In the acute stage the management is Rest, Ice, Compression and Elevation (RICE) if practical.
For the tears in the body of the muscle the recovery tends to be shorter lasting a few weeks. In a simple grade I injury, the athlete may be back playing in two to four weeks.
Grade II and III injuries require longer rehabilitation and may take up to 6 months.
The treatment follows a gradual and controlled increase in activity. In the initial phase, focus is on gentle walking and then jogging without putting any strain on the hamstring.
Once one is able to walk and jog lightly without pain they then move to the next phase of recovery which involves gradually increasing the hamstring stretch and gentle strength work.
The final stage of recovery involves full movement and sport specific strength work which is best supervised by a physiotherapist.
In this recovery phase, it is critical to avoid the formation of scar tissue in the hamstring which happens if the recovery is performed too slowly and cautiously.
Scar tissue leads to reduced performance and increased risk of delayed repeat injuries.
It is also important to avoid attempting too aggressive a recovery risking over-stretching the healing hamstring and suffering acute re-injury.
Very rarely some hamstring injuries require surgery particularly if the muscle tendon pulls off the bone at the pelvis.
These are the injuries usually associated with a popping sound.
It is observed, where there is a sudden major force applied to the hamstring, for example, when water skiing or making a tackle at full stretch.
These injuries require the tendon to be surgically re-attached to its origin. The recovery time following this type of injury is typically one year.
The most sensible thing to do then is to work towards preventing incurring a hamstring injury.
There is suggestion hamstring injuries are more common in athletes who are stiff and have weak gluteal muscles or poor core strength.
Prevention focuses on increasing and maintaining good mobility of the hip and the knees, good flexibility and core strength.
Structured warm up before activity has also been suggested to have positive effect in avoiding hamstring injuries.
Prevention remains the mainstay in managing hamstring problems and avoiding the disruption and potential complications of the injuries.
Stretching and core strengthening is a key component to this and should be part of every athletes training program.
Given a hamstring injury, physiotherapy is key in the rehabilitation and pursuit of return to sports at the pre-injury level.
Rarely surgery may be required in the treatment of these injuries.
Mordicai is an orthopaedic surgeon specialising in sports injuries. [email protected] Research assistant Rachel Bridges contributed to this article