Hamstring strains, or injury to the hamstring tendon, can be a challenge to both the athlete and clinician when attempting to rehabilitate, recover, and return to prior activity level. This is due in part to a number of factors including the high incidence rate of this type of injury, slow healing process, and persistent symptoms. It has been found that nearly 1/3 of hamstring strains recur within the first year following return to sport without a proper and comprehensive rehabilitation program.
Hamstring injuries can occur in a variety of sports. Hamstring injuries that result from high-speed running as in track and football generally occur during the end swing phase of the gait cycle. In this type of injury the lateral hamstring tendon, or biceps femoris is generally the most often injured. Hamstring strains can also occur during activities such as dancing, kicking, and water skiing. These injuries result from simultaneous hip flexion and knee extension, which places the hamstring in an extreme stretch position. This type of injury typically presents in the semimembranosus, or most medial tendon.
The primary goal of hamstring rehabilitation is to return the athlete to his/her prior level of performance with minimal risk of injury recurrence. Factors that must be considered during rehabilitation include hamstring weakness, fatigue, lack of flexibility, and muscle imbalances between the hamstring and quadriceps muscles. In addition, limited quadriceps flexibility and strength and pelvic, core and trunk strength deficits may contribute to hamstring injury risk and should be addressed.
Hamstring injuries are generally classified according to the amount of pain, weakness, and loss of motion present. They are categorized by the extent of muscle fiber or tendon damaged, resulting in grades of I (mild with minimal damage), II (moderate with minimal disruption of fibers without a tear), and III (severe with complete tear or rupture). Your physical therapist will perform a thorough evaluation during your initial visit. The evaluation will include a battery of tests that measure range of motion, strength, and pain. This will help to provide a reasonable estimate of rehabilitation duration and a basis for beginning treatment.
The physical therapist will develop an appropriate treatment regime for your return to prior level of function and sport participation. Initial exercises may include hamstring stretching and strengthening (with specific focus on eccentric hamstring strengthening and neuromuscular control), quadriceps flexibility and strength, and lumbopelvic control. The treatment program is specific to each individual and each injury, and should be tailored to promote the goals of the patient. Progression criteria is based on factors such as pain response, strength and flexibility improvements, and activity progression. Agility activities, plyometric exercises, and return to sport-related activities will be incorporated when deemed appropriate and based on progression criteria.
Proper rehabilitation is necessary following hamstring strains in order to return to prior activity level. Physical therapy can provide you with the proper treatment aspects to assist you in your return and prevent reinjury once return-to-sport is accomplished.
Heiderscheit B, Sherry M, Silder A, Chumavno E, Thelen D. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. Journal of Orthopaedic &Sports Physical Therapy. 2010; 40:67-81.