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Hamstring Strains

Tis the season for hamstring strains!...It's amazing how injuries seem to come in waves. I've had runners, football players and cross fitters recently with acute hamstring strains recently and this particular group of muscles don't discriminate! Here's why...

The hamstrings are actually a group of muscles on the back of the thigh that are responsible for bending the knee in isolation but during running also helps control your leg speed forward (decelerates your leg) and assists to pull the leg back during running. But it's a muscle we also use daily, so someone who has a hurt hamstring might even feel pain when simply standing or walking up stairs.

The definition of an acute hamstring strain is a "pulled" muscle that occurs suddenly with some lengthening or power type of activity. Lets say you tried to sprint the last 1/2 mile of a 5K (and weren't really ready for it) and now the back of the thigh feels tender due to some micro tearing of that muscle. When you strain a hamstring what it mostly feels like is a "tight" muscle, so it might be tempting to want to stretch BUT this can actually prevent healing. A large strain can be painful and lead to loss of function because of massive tearing. The recommendation is to avoid stretching for at least 3 weeks, maybe 4-6 weeks depending on the severity of the strain.

Think of a hamstring strain as a frayed rope...You wouldn't tug on the rope from both ends to try and fasten it together. There needs to be some healing time but most important, strength time, but timing is important.

Recommendations for acute hamstring strains

  1. Avoid overstretching as this can makes things worse
  2. Patience is the key to treating hamstring strains. It can take as long as 6 months-9 months (depending on the severity and location)
  3. Hard effort, especially higher running speeds like sprinting, utilizes greater muscle activation and can lead to high loads on the hamstring, so high speed or high lengthening activities need to be worked back into slowly.
  4. Rest alone will not make a hamstring strain better. Initial Isometric and eccentric strengthening at the right time is vital to give those hamstrings the ability to handle high forces again.
  5. If tolerable, think of other things besides static stretching, to give it some movement while also maintaining your aerobic endurance (dynamic stretching, high knees, walking, biking) as long as there is no pain.
  6. If your physical therapist has returned you to a good state where you can functionally do all things without pain, you will most likely be discharged (yup, using insurance in a traditional health care setting sucks!) BUT if you want to return to running and sprinting with no pain, you must find a return-to-sport therapist who can guide you on power strengthening and fast-twitch training.
  7. If you have a chronic or long-term pain in the hamstrings find a physical therapist who can properly rule out the low back as a problem! Yes, the low back can refer to the hamstring and cause pain.