Hamstring Strain

A hamstring strain is a common sports injury and is often graded into three different severities. A Grade 1 is a minor muscle pull or strain. A grade 2 is a partial muscle tear. Grade 3 is considered a complete muscle tear. The length of time that it takes to recover from a hamstring injury will depend on the severity of the injury. While grade 1 hamstring strains may only take a few days to heal, grade 2 and 3 injuries can take several weeks or months.

What causes a hamstring injury?

Most hamstring injuries are caused when the muscles or tendons are stretched too much. This is a common occurrence during sudden movements, such as those required in sports. This includes sprinting, jumping and stretching.

Although hamstrings strains are a very common sports injury, they can often be avoided by strengthening and having the adequate amounts of flexibility. Exercises like the Nordic hamstring curl have been shown to reduce hamstring injury in sport.

The signs of a hamstring injury

Grade 1 hamstrings are often evident when there is a sharp and sudden pain around your thigh. It may also feel painful to move your leg, but the overall function of your leg won’t be impeded. People often describe an overall ‘tightness’ or ‘pull’. There is usually not a ‘pop’ heard or felt and is more of a overstretch.

Grade 2 hamstring strains are more severe than Grade 1. The pain is often more evident and distracting, and your leg may feel really tender to the touch. There will also be some bruising at the back of your thigh (and usually migrates to the knee due to gravity) that presents a couple of days after the incident. Your leg may feel weak and painful to move. Grade 2’s are usually diagnosed after a ‘pop’ is heard or felt. The ‘pop’ is some of the muscle fibers being torn but not total disruption of the muscle tissue.

Grade 3 hamstring strains are complete tears and will cause you a lot of pain. You will feel a ball of tissue at the origin or insertion of the muscle because the tissue is no longer complete from start to finish.

Treatment, rest and recovery

Treatment often involves taking care of your leg and applying cold packs to your hamstring. This can be specially designed ice packs or can simply be a bag of frozen food items wrapped in a towel. Ice should not be applied directly to the skin and this should be done for a minimum of 20 minutes every few hours throughout the day.

Compress the thigh by using an elastic bandage to reduce swelling. Elevation when lying is helpful to allow any swelling to go back to the heart. Lastly, make sure you take plenty of rest an avoid physical activity that causes more pain.

To allow the normal healing process of the body, I do not recommend using an anti-inflammatory medication. Using ice and Tylenol will help with the pain as well as the compression wrap. There’s also the option of using topical analgesics, like Biofreeze, for pain.

I recommend a graduated increase in activity for the hamstring while it is recovering. For the first three days I recommend not stretching so as to minimize tissue damage. Foam rolling has been shown to not disrupt the normal healing process of the tissue so even in the early stage of healing, foam rolling is okay.

Using the guidance of an experienced rehabilitation professional can be helpful to guide you along the recovery process. Manual therapies like active release technique, dry needling, cupping, massage, kinesiology tape, and Instrument Assisted Soft Tissue therapy can help reduce pain and get you back to activities sooner. With all manual therapy techniques, graded exercises should be given to you to do. In addition, home care should include a gradual return to normal activities and increases in progressive resistance exercise. An exercise progression example I use in my office would be:

* Reciprocal Inhibition. Day 1-3

* Light Stretching for 1 minute. Day 4-7

* Isometrics (1 minute, 2/day). Day 7-14

* Concentric Exercise (shortening), 12-15 reps 2 sets, 1/day

* Eccentric Exercise (lengthening), 20 reps, 2 sets, 2/day

* Dynamic Exercise (explosive or quick)

Nutritional Considerations

From the nutritional side, using CBD ointment or tincture can help with inflammation and pain. Vitamin C helps with collagen synthesis (repair) and I recommend taking 5000mg/day up to 10,000mg/day immediately after and injury to give your body the nutrients it needs to heal. Vitamin IV’s or Intramuscular injectables are best or oral supplementation will work as well. Don’t overdo the vitamin C or you will get ‘dirty pants’ (diarrhea). Start with the lower recommendation and build up over the course of a week or two. Protein is important to regenerate muscle tissue. I recommend 1.6g/kg of body weight per day under normal situations and then bump up to 2.0g/kg body weight when healing from an injury. High quality protein like chicken, meat and fish are best but can be supplemented with whey protein. Vegetarians and vegans have to be especially aware of the quality of protein they take in to ensure all the essential amino acids are being consumed.

In conclusion, hamstring injuries are common among active individuals. If you suffer a hamstring injury, seek the help of the medical provider who helps you with these types of injuries. Usually being non-surgical injuries, good options to treat these are chiropractors (trained in sports medicine), physical therapists (trained in sports medicine) and athletic trainers who have special training in soft tissue modalities and injuries.

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