Dealing with a Sprained Hamstring

author : AMSSM

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How to avoid reinjuring a hamstring muscle during training

Member Question

"I strained a hamstring last week. it's not that bad and it looked like it was getting better pretty quickly, but I aggravated it again the other day and I feel like I am back to square one again. I know these types of things can linger for a long time so my question is what is the best way to deal with this? Do I just need to rest it or is there something I should be doing to speed recovery up? I don't feel like I need to see a Dr. or anything. It's not that bad. I definitely don't want it to get worse though."

Answer from Deanne Eccles-Rotar, M.D.
Member AMSSM

Hamstring injuries are very difficult to recover from. The main reason for this is that it is easy to re-injure the hamstring when attempting to return to participation. The hamstring is a muscle that crosses two joints - the hip and the knee - and it is a major part of the movement of walking and running. It is active the early phase of foot strike to stabilize the knee and the late phase of push off for propulsion. During mid-swing it controls momentum of the leg. It is among the most common injuries in sports medicine and is typically seen in sprinters or when a runner is going to accelerate or if the runner is becoming fatigued and tries to maintain a fast pace. The injury typically occurs at the muscle tendon junction of one of the following muscles: biceps femoris, semimembranosus and semitendinosus. The hamstring has a common origin at the ischial tuberosity and inserts on the tibia (semimembranosus/tendinosus) or fibula (biceps femoris). The typical mechanism of injury is an eccentric contraction of the muscle - when the muscle is contracting and stretching at the same time.

The injuries are usually graded 1 to 3 with grade 1 being a mild strain, grade 2 being a partial tear and grade 3 being a significant tear to the muscle. The injury is rarely treated surgically unless there is a complete rupture of the tendon from the insertion into the bone. The initial treatment for the injury is the RICE protocol - rest, ice, compression and elevation. Early mobilization is recommended - within a week after the injury - to facilitate proper alignment and regeneration of the muscle fibers and limit scar tissue formation/muscle adhesions. The key to proper rehabilitation involves progressive eccentric strengthening of the muscle. Athletes can start with gentle stretching to regain range of motion/flexibility equal to the contralateral leg. Once flexibility is restored eccentric strengthening can begin. Theraband stretch tubing or band is very effective for eccentric strengthening. It is also advisable to evaluate for asymmetry in core strength with a focus on lumbar paraspinals, hip flexors and hip abductors. A physical therapist can help evaluate for imbalances and also evaluate firing pattern of the lumbar paraspinals, gluteals (hip abductors) and hamstring. It is not uncommon to find a weakness in the hip abductor/gluteal musculature and this should be evaluated in addition to the focus on the hamstring.

Once the strength and flexibility imbalances have been corrected you can start working back into running. The best way to do this is to start back to steady easy pace running on flat terrain. If the hamstring starts to feel tight stop running and walk then stretch and continue efforts at strengthening until you are able to run at a steady pace for 3-4 weeks without feeling tightness. Once you are running easily at steady pace you can gradually work on increasing distance or adding some pace work.

There is research on using growth factors such as autologous blood or PRP injections - platelet rich plasma injections into the injured area of the hamstring to facilitate healing. This would probably be reserved for hamstrings that are more severely injured or that have been consistently re-injured. These studies are limited but do show promise.

So my recommendation to you would be to:

1. Look for any muscle strength and flexibility imbalances and correct these
2. Make sure to add hip abductor strengthening into your rehab program
3. Focus on eccentric strengthening of the hamstrings
4. Slowly return to running with steady pace work for 4 weeks prior to adding speed/interval or long distance training.

Good luck with your return to running!

- Deanne Eccles-Rotar M.D., Dean Clinic Sports Medicine, Janesville, WI

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date: December 17, 2015