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Hamstring strain | Strain at the back of the thigh

A hamstring strain is the most common acute sports injury that does not involve body contact. Even if you have not yourself felt a “snap” at the back of the thigh during a sprint, you have certainly seen someone on the football pitch or athletics track suddenly grab the back of their thigh with their face contorted in pain.

Hamstring strain | Strain at the back of the thigh

But what exactly is a hamstring strain, what do you do when it happens, and should all strains be treated the same way?

What are the hamstrings?

The hamstrings are a “collective term” for three large muscles at the back of the thigh: semimembranosus, semitendinosus and biceps femoris. These muscles cross two joints, as they run all the way from the sitting bone (pelvis) to the lower leg bone. Their main job is to bend the knee and extend the hip.

What is a hamstring strain?

A hamstring strain can vary greatly in severity depending on where the injury occurs and how extensive it is. Severity is often graded from 1 to 3, where grade 1 is mild, grade 2 is moderate and grade 3 is severe.

The most common form of hamstring strain is a sprint injury. The hamstring can be exposed to forces of up to 10 times body weight when we sprint, and if this is more than the tissue can tolerate, an injury can occur. It is then usually in the middle part of the thigh, at the muscle-tendon junction, that the injury is located.

Another form of hamstring strain that can occur is when the muscle is lengthened more than it can actually cope with. This is typically in a fall with the knee straight and the hip flexed. The injury can then often occur higher up at the back of the thigh, that is, right up towards the sitting bone where the tendon attaches to the bone. This type of injury is often the most serious, as in some cases a complete tendon rupture can occur, which is categorised as grade 3. If a complete rupture is suspected, referral for imaging is made. If a complete rupture is confirmed, further referral to an orthopaedic surgeon to assess surgery may be appropriate.

In adolescents who are still growing, not all parts of the skeleton have fused yet. They then have apophyses (growth zones) in the bone, and these are typically areas that are attachment points for ligaments and tendons. The sitting bone is one such area. Before this growth zone has “closed” (most often at 16 years for girls and 18 years for boys), it is somewhat more prone to injury. If you suffer such an “overstretch trauma” of the hamstring as described above, it is possible to get an avulsion fracture. This means that the hamstring tendon pulls off a small piece of the sitting bone. In these cases the injured area should be offloaded, and in some cases surgery may be appropriate.

Pain towards the sitting bone can also be a more load-related injury that has developed over time, called proximal hamstring tendinopathy. This is not the same as a strain and may require a different treatment approach. That is why a correct diagnosis is important.

What should you do after a hamstring strain?

Immediately after a hamstring strain you should start with the principles of first aid for acute injury, summarised by the acronym PEACE. Compression is applied with a slight bend in the knee, starting from below and working upwards. If it is a less serious injury, it is important to start using the hamstring again after a few days to restore function. Read more about the principles of PEACE & LOVE here.

If, on the other hand, it is a more serious injury, such as a complete rupture or an avulsion fracture, there can be a big difference in both treatment approach and timeframe. That is why it is important to have the injury examined, in order to make the rehabilitation phase as optimal as possible. An ultrasound examination may also be appropriate to assess the extent of the injury. If needed, it can be supplemented with other types of imaging.

Our practitioners have good experience with both diagnosing and rehabilitating hamstring injuries.

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