01 Jan Hamstring Strain Got You Hamstrung??? Stop Stretching, Start Strengthening, Get Back to Performing
Hamstring strains are the most common injury of the lower extremity, and they’re certainly something that we see a lot of. The story we typically hear is that someone was sprinting or changing direction, and then it happens. They feel a sudden, sharp pain or pull in the back of their leg as they limp off the field.
If you have ever had a hamstring strain then you know how much of a pain in the butt they can be (get it?). Not only will it put you on the sidelines, but it’s not uncommon for someone to have a recurring hamstring injury after they strained it the first time.
In fact, one of the biggest risk factors for a hamstring strain is previously suffering from one. Furthermore, studies show that the highest risk for re-injury is within the first two weeks of returning to sport.
Knowing that this is such a common injury, coupled with a high risk of re-injury, that raises a few questions.
What do you do when you strained your hamstring?
How do you avoid re-injury?
Let’s dive into it…
Hamstring Anatomy 101
The hamstrings are two joint muscles that cross over both the hip and knee joints. Meaning, they have influence over both joints.
To be more specific:
- They act to extend the hip (bringing the leg back as to kick a ball)
- They flex the knee (bringing the heel up to the backside)
- They’re responsible for controlling or slowing down the knee when walking or running (terminal swing phase).
The 3rd action is important because this is where most hamstring strains tend to take place.
Terminal Swing Phase
How It Happens
Most hamstring injuries occur during the last 25% of the swing phase, just before heel strike. It’s at this point where the muscle is changing its role from slowing down the forward swinging leg with an eccentric contraction, to creating a propelling force with a concentric contraction. This high demand takes place while the hamstrings are in a lengthened (stretched) position and under force.
In other words, the muscle has to rapidly change how its working while in a vulnerable position.
So How Bad Are We Talking?
There’s no mistaking the moment that you strained your hamstring, or almost any other muscle for that matter. The question is, how bad is it?
Grade I: a few muscle/tendon fibers are torn, minimal strength loss, pain with sprinting or explosive movement (walking is likely ok)
Grade 2: a partial tear, significant loss of strength, pain with walking
Grade 3: the muscle/tendon is completely ruptured, major loss of strength and function, unable to walk, bruising around the site of injury.
Now What? – The Do’s and Don’ts
Do Get Looked At
If you think that you may be dealing with a grade 2 or 3 type of strain, it’s a good idea to get looked at by a medical professional that can assess and help you through the rehab process.
If there is severe strength and loss of function, an MRI may be necessary to rule out a complete tear regardless of if there was bruising present or not.
No matter the severity, we want to start the rehab process before things start to scar down and heal on their own. The goal of a good rehab program is to gradually introduce load as the muscle progresses through the healing process.
Rest is good for the first 24-48 hours. After that, the goal is to get moving in some way, shape or form. However, it’s definitely recommended to hold off from any painful activity (running, jumping, heavy lifting). All of the phase I exercises I’ll get into should be pain free.
Don’t Start Stretching
Whenever something is painful, we have this tendency to try and “stretch it out”. However, this is rarely, if ever the solution to a problem. Besides, a muscle strain is just a fancy way to say that there is a tear within the muscle or tendon. The last thing we want to do is to stretch something that’s already torn or compromised, especially within the first week of injury.
Do Get Moving
We want to keep movement pain free, one of the best ways to do that is to activate the hamstrings without lengthening or shortening them (isometric contraction).
Later, as things start to heal and progress, we can challenge the muscle differently in order to build strength and resilience.
Below is a format for the basic principles of what the rehab process will look like from the time of injury, up to the moment where we step back onto the field.
Early on in the rehab process the goal is activate the hamstrings without too much tension, avoid stretching, focus on core exercises and light agility work.
By getting into an athletic stance and going through some side steps, we get the hamstrings to turn on without going through any significant movement. We can even progress this slightly by adding a Hip Circle, giving the hips more of a challenge.
Single Leg Stand
Working in some balance is another way we can sneak in some pain free hamstring activation. This allows us to work into a bit of a hip hinge, fire up the muscles that surround and stabilize the hip, and were not putting any excess tension on the injured hamstrings. Feeling ok? Step onto a Slack Block for an added challenge
Using the first two exercises as sort of a warm up, we can start to lighty load the hamstrings and glutes. A bridge is a good way to get things started as long as this does not increase symptoms.
Even if some of the more exciting activities are off limits at this time, we can and should still perform exercises for our hips and core. Planks and side planks are always a solid go to.
Once we have the ability to walk pain free, and fire up with hamstrings with 50% effort with no pain we can head into phase 2. The goal here is to get full pain free range of motion, introduce some eccentric hamstring exercises, and progress our agility/sports specific training.
Glute Bridge Walk Outs
Progressing our bridges to be a bit more eccentric focused helps to lengthen the hamstrings without actually stretching. More importantly, building strength and resilience where it’s needed most. If you recall, most strains occur during the rapid change from eccentric to concentric contractions.
Eccentric Bridges With Slider
Another modification to the bridge that focuses on the eccentric control of the hamstrings.
Single Leg RDL
As we progress through the rehab process, it’s important to get into postures and shapes that are similar to your sport activity. As great as the glute bridge is, I can’t name too many sports that require someone to lift their hips into the air off their back. However, the RDL from the side view looks a lot like a sprinting position.
Forward Lunge on Box
By elevating the front foot we get a bit more stretch on the hamstrings while performing a dynamic exercise.
Agility/Jog at 50%
Progressing our agility and introducing jogging to a 50-60% intensity, preparing for some more sport specific performance.
At this point we are looking to be back to nearly full strength. The focus from here on out shifts to advancing our eccentric exercises, introducing plyometrics, and getting ready to return to full activity.
RDL with Weight
Nordic Hamstring Curl
Split Squat Jump
So, Are You Ready?
Knowing when to return to sport for most injuries isn’t an exact science, the hamstrings are certainly no different. Instead have to base it off of performance.
Generally speaking we want to see no pain with a max effort contraction, full range of motion and flexibility restored, and a solid progression through an eccentric focused program. The end stage of hamstring rehab should not look much different from a strength and conditioning session. Returning to full activity without completing this process puts us at serious risk for re-injury.
Dealing with something similar or you just want to know more? Let’s talk about it. To set up a free 15-minute consult, call us at (817) 438-6583 or you can email me directly at [email protected]
- Prior M, Guerin M, Grimmer K. An evidence-based approach to hamstring strain injury: a systematic review of the literature. Sports Health. 2009;1(2):154-164. doi:10.1177/1941738108324962
- Sherry MA, Beset TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther. 2004;34(3):116-125
- Cressey E. “5 reasons you have tight hamstrings.” Web blog post. Ericcressey.com. 12 Jun 2012. Web. 22 Nov 2021.