Member Case Study: Pulled Hamstring

author : AMSSM

comments : 0

This injury commonly occurs during what is called the recovery phase and/or the take-off phase of running. Hamstring strains range from mild, grade I, to a more severe, grade III.

Question from bestbets:
I have been dealing with a sore hamstring while running for the past month or so. I started to notice it a few weeks before my first HIM. It seemed that about after mile 4, the top of my right hamstring, almost to the point of my glute, would ache. Usually I would finish up my run just fine and it wouldn't hurt again until I went out for another run. It doesn't hurt while swimming or cycling either.

During my HIM, my right calf and right hamstring were really tight. Naturally being in a race I just ran through the pain. It was OK the next few days. I got a massage. Had a few hot tub sessions. Haven't been icing or taking anti-inflammatories though.

My race was about three weeks ago now and pretty much every time since the race my hamstring has flared up again on the run. It seems now that the pain is really in the actual belly of the muscle. And it pretty much hurts all the time. I'm tight from not working out and stretching as much as I usually do, but I always stretch after a run. I haven’t been cycling or swimming since the race.

Any thoughts on what this is and what I should do about it? How long do I need to rest to make sure it is fully healed? I have a marathon (possibly a half if I'm not fully healed) in 8 weeks.

Answer:
Based on the history, it appears as though you have strained one of your hamstring muscles. This injury commonly occurs during what is called the recovery phase and/or the take-off phase of running. This is more easily understood as the time just before and as your heel strikes and then as the toe is pushing off for your next stride, respectively. This is usually why no pain is experienced with non-impact exercise such as swimming or biking. Pain is very commonly of sudden onset, like as you described “at mile 4.” The majority of the hamstring muscles attach to the ishcial tuberosity, which is located at the base of the pelvis or in the area of gluteus muscles. Symptoms are commonly exacerbated by extension of the knee with the hip flexed at 90 degrees.

Hamstring strains range from mild, grade I, to a more severe, grade III, which include tendon/muscle rupture or tear. It seems as though yours is still mild as it is limited to pain and does not involve loss of function or bruising, which are common with more severe injuries. Treatment involves rest, ice, and anti-inflammitories initially. Initial rest should be at least 3-5 days without activity or strain on the muscles. Icing the area 3 times per day for 15 minutes and taking regular doses of anti-inflammatories is recommended.

Heat is not recommended in the first 3-4 days, since though it improves pain initially, its use will lead to increased pain and swelling later. Following the acute treatment period you should initiate a GRADUAL progressive exercise program. This should involve stretching initially, and slowly working back to running. Cross-training with swimming followed with biking can be very beneficial while working back to full running. Care should be taken not to push it too quickly, even though there is a desire to return to full activity, as it can complicate rehab and even cause a more severe strain/tear. 

Mild strains will resolve between a few days and two weeks with the above treatment. If pain continues, I would recommend being seen by your local sports medicine doctor to rule out other more serious injuries. If the pain remains localized at the ischial tuberosity, or near the “glute,” you may need an x-ray to make sure there is not an avulsion fracture present. Other vascular or nerve impingement syndromes may also be a cause of pain in this area.

A recent article on hamstrings can be found on the Beginner Triathlete website HERE.

Christian Millward MD
Member- AMSSM
Provo, Utah

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date: October 1, 2006