Physiotherapy in Winnipeg for Hamstring Injuries
Welcome to River East Physiotherapy's patient resource about Hamstring Injuries.
The big group of muscles and tendons in the back of the thigh are commonly called the hamstrings. Injuries in this powerful muscle group are common, especially in athletes. Hamstring injuries happen to all types of athletes, from Olympic sprinters to slow-pitch softball players. Though these injuries can be very painful, they will usually heal on their own. But for an injured hamstring to return to full function, it needs special attention and a specially designed rehabilitation program.
This guide will help you understand:
- How the hamstrings work
- Why hamstring injuries cause problems
- How physiotherapists and doctors work with you to treat injured hamstrings
Where are the hamstrings, and what do they do?
The hamstrings make up the bulk in back of the thigh. They are formed by three muscles and their tendons. The hamstrings connect to the ischial tuberosity, the small bony projection on the bottom of the pelvis, just below the buttocks. (There is one ischial tuberosity on the left and one on the right.) The ischial tuberosities are often called the "sit bones" in yoga classes and in plain language.
The hamstring muscles run down the back of the thigh. Their tendons cross the knee joint and connect on each side of the shinbone (tibia).
The hamstrings do two movements. First, they pulling the leg backward and by propelling the body forward while walking or running. This is called hip extension. Second, the hamstrings bend the knees, a motion called knee flexion.
Most hamstring injuries occur in the musculotendinous complex. This is the area where the muscles and tendons join. (Tendons are bands of tissue that connect muscles to bones.) The hamstring has a large musculotendinous complex, which partly explains why hamstring injuries are so common.
When the hamstring is injured, the fibers of the muscles or tendon are actually torn. The body responds to the damage by producing enzymes and other body chemicals at the site of the injury. These chemicals produce the symptoms of swelling and pain.
In a severe injury, the small blood vessels in the muscle can be torn as well. This results in bleeding into the muscle tissue. Until these small blood vessels can repair themselves, less blood can flow to the area. With this reduced blood flow, the muscles heal more slowly.
The chemicals that are produced and the blood clotting are your body's way of healing itself. Your body heals the muscle by rebuilding the muscle tissue and by forming scar tissue. Carefully stretching and exercising your injured muscle helps maximize the building of muscle tissue as you heal.
In rare cases, an injury can cause the muscle and tendons to tear away from the bone. This happens most often where the hamstring tendons attach to the ischial tuberosity. These tears, called avulsions, sometimes require surgery.
Related Document: A Guide to Knee Anatomy
How do hamstring injuries occur?
Hamstring injuries happen when the muscles are stretched too far. For example, sprinting and other fast or twisting motions with the legs are the major cause of hamstring injuries. Hamstring injuries most often occur in running, jumping, and kicking sports. They may also occur in workplaces requiring heavy lifting or climbing.
Water skiing, dancing, weight lifting, and ice skating also cause frequent hamstring injuries. These sports are also more likely to cause avulsions.
A major risk factor for a hamstring injuries is having a low level of fitness, or starting a new, strenuous activity too quickly. If you start a new activity without giving your legs enough time to adapt, you are at risk for many injuries, including hamstring injuries.
Children very seldom suffer hamstring injuries, probably because they are active and generally more flexible than adults. Muscle fatigue and not warming up properly can also contribute to hamstring injuries.
Imbalances in the strength of different leg muscles can lead to hamstring injuries. The hamstring muscles of one leg may be much stronger than the other leg, or the quadriceps muscles on the front of the thigh may overpower the hamstrings.
What does a hamstring injury feel like?
Hamstring injuries usually occur during heavy exercise. In especially bad cases, an athlete may suddenly hear a pop and fall to the ground. The athlete may be able to walk with only mild pain even in a severe injury. But taking part in strenuous exercise will be impossible, and the pain will continue.
In less severe cases, athletes notice a tight feeling or a pulling in their hamstring that slows them down. This type of hamstring injury often turns into a long-lasting problem.
The hamstring may be pulled, partially torn, or completely torn. The injury can happen at the musculotendinous junction (mentioned earlier), within the muscle, or where the tendon connects on the ischial tuberosity (avulsion). In the rare case of a complete tear, the pain is excruciating. The torn tissues may form a hard bunch in the back of the thigh when the leg is bent. The skin may also bruise, turning purple from bleeding under the skin. This is not necessarily dangerous but can look somewhat alarming.
How do health care providers diagnose the condition?
When you visit River East Physiotherapy, our physiotherapist will take a detailed medical history that includes questions about your exercise schedule, your activities, and the way you warm up. You will also need to describe your symptoms.
Our physiotherapist will examine the back of your thigh. The physical exam will involve flexing and extending your leg. The probing and the movement may hurt, but it is important to identify exactly where and when you feel pain.
Hamstring injuries are grouped into three categories, according to the severity. The following images show each grade of injury:
Grade One - Mild
Grade Two - Moderate
Grade Three - Severe
Grade one injuries are muscle pulls that do not result in much damage to the structure of the tissues. Grade two injuries are partial tears. Grade three injuries are complete tears.
Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the physiotherapists at River East Physiotherapy have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
River East Physiotherapy provides services for physiotherapy in Winnipeg.
It is very important to treat and rehabilitate your hamstring injury correctly. Incomplete or improper healing makes reinjury more likely.
Although every person recovers at a different rate, as a general rule, for minor muscle pulls, you may need two to four weeks to safely get back to your activities. For more severe muscle tears, you may need rehabilitation for two to three months, with complete healing possibly taking four to six months.
When you begin your physiotherapy program at River East Physiotherapy, within the first five days after your injury, the main goal of our treatment is to control the swelling, pain, and hemorrhage (bleeding). Hamstring injuries are initially treated using the RICE method. RICE stands for rest, ice, compression, and elevation.
Active rest is critical. Our physiotherapist may recommend a short period (up to one week) of limiting your hamstring movement. Severe tears may require a longer period of reduced movement. But this doesn't mean you'll spend extra time lying down or immobilized! Moving your whole body will help with healing, because general activity helps with the healing process. This is because your blood and movement bring the immune system cells and nutrient chemicals to the injured site, and it also helps grow the amount of small blood vessels in the area ("vascularization").
Our physiotherapist can help you learn how to properly move about while you're trying to rest your hamstrings - on crutches or otherwise.
We may apply ice to the injured hamstring, but it will depend on you and your condition. Ice is used less frequently these days to treat acute injuries, since the swelling and pain that comes with injury is part of the body's inflammatory response. And the inflammatory response is what helps your muscles heal!
That said, cold does reduce pain by numbing the nerves. And experiencing less pain helps you relax, reducing muscle spasms and allowing you to move easier. So whether ice is right for you really depends on you and your physiotherapist's judgement!
Compression can help reduce the bleeding in your muscle to limit swelling and scarring. To apply compression, your physiotherapist may wrap your hamstring firmly in an elastic bandage. It is unclear exactly how effective compression is in encouraging healing of hamstring injuries, but patients often report having less pain with the wrap.
One of the worst parts of getting injured is not knowing what's happening and what to do next. It's the role of our physiotherapists to provide education on your injury, to help you understand what to do, what not to do, and what will happen next with your body. It can be comforting to have personalized guidance on how to get back to your active lifestyle.
Our physiotherapist may refer you to your doctor or pharmacist for advice on medication. These professionals may recommend a short course of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to relieve the swelling and pain. For muscle injuries, pain relief may be the major benefit of NSAIDs.
Health care providers disagree on when to give NSAIDs. Some think you should start using them right after the injury and stop using them after three to five days. Others think you should not use them for two to four days so you don't interrupt your body's natural healing response. The inflammation is an important part of your body's work to heal your injury. It is important that you follow your health care provider’s advice, as it will be customized to you.
Stretching & Exercise
As your hamstrings begin to heal, it is critical that you follow your River East Physiotherapy exercise program to regain your strength and mobility. Our custom exercise programs encourage your body to rebuild muscle instead of scar tissue. They are also designed to prevent reinjury.
Early in your rehabilitation, our physiotherapist may recommend that you do some of your exercises in a swimming pool or on a stationary bike set to low resistance. These exercises allow you to take your hamstrings through a range of motion without having to hold up your weight. When you can walk without a limp and feel very little tenderness, we will have you start a walking program. Eventually you may be able to work up to jogging, and the movements you need to do to return to sport or work.
Stretching may be part of your River East Physiotherapy rehabilitation program, to help make sure your hamstring doesn't shorten as it heals. Our physiotherapist will show you how to stretch properly. Increasing your flexibility may help you avoid another hamstring injury in the future. It is important that you maintain reasonable knee and hip "range of motion" to keep your hamstrings healthy.
We usually include a strengthening component in each exercise program. We may begin your strengthening exercises with isometric exercises. These exercises involve contracting the muscles without moving your leg joints. As your hamstrings get stronger, we will add movement and light resistance. It is important that you feel little-to-no pain during these exercises.
You should maintain your general level of fitness throughout your rehabilitation. Our physiotherapist can suggest workouts that don't stress your hamstrings, but keep you active.
Most hamstring injuries get better with treatment and rehabilitation. Even world-class athletes with severe hamstring injuries are usually able to return to competition. By keeping the hamstrings flexible and strong, and giving the body time to heal, you should be able to return to the activities you enjoy.
Surgery is rarely needed, and only if there is a complete avulsion or tear. If you do have surgery, you will likely begin your recovery with a period of rest, which may involve using crutches. Our physiotherapist can show you how to properly use your crutches to aviod putting too much weight on your healing leg. After surgery our physiotherapists can start you on a careful and gradual exercise program for your post-surgical rehabilitation.
When your recovery is well under way, regular visits to River East Physiotherapy will be less frequent. Although we will continue to be a resource, we'll make sure you are in charge of doing your exercises as part of an ongoing home program.
River East Physiotherapy provides services for physiotherapy in Winnipeg.
Surgery is rarely needed for hamstring injuries. However, it may be needed for an avulsion to reattach the torn hamstring tendon to the pelvis. If surgery is delayed after an avulsion, the tendon may begin to retract further down the leg, and scar tissue may form around the torn end of the tendon. Both of these factors make it more difficult to do the surgery.
To begin the operation, an incision is made in the skin over the spot where the hamstring tendon normally attaches to the pelvis. The surgeon locates the torn end of the hamstring tendon. Forceps are inserted into the incision to grasp the free end of the torn hamstring tendon. The surgeon pulls on the forceps to get the end of the hamstring back to its normal attachment. The surgeon cuts away scar tissue from the free end of the hamstring tendon.
The original attachment on the pelvis, the ischial tuberosity, is prepared. An instrument called a burr is used to shave off the surface of the tuberosity. Large sutures or staples are used to reattach the end of the hamstring tendon to the pelvis.
When the surgeon is satisfied with the repair, the skin incisions are closed.
Surgery may be needed to repair a complete tear of a hamstring muscle. An incision is made over the back of the thigh where the hamstring muscle is torn. The muscle repair involves reattaching the two torn ends and sewing them together.
Surgical approaches evolve over time, as surgeons learn and review the most recent research. Speak to your surgeon to best understand the benefits and risks of undergoing surgery.