Pulled Hamstring Muscles
The upper leg muscles provide your knees with movement (extension, flexion and rotation) and strength. The hamstring muscles are located on the back of your thigh. They work closely with your quadriceps muscles (front of your thigh), your gluteal muscles, and your calf muscles to ensure proper movement of your leg and hip.
Your hamstring muscles control movement of your body, hip and knee, help turn your leg in and out, and are involved with power activities that include a lot of propulsion, thrust and control (such as jumping, running, and walking). The muscles act as a brake to stop an action, you can feel this when walking or running downhill, landing from jumps or performing squats, and when trying to stop quickly after sprinting.
The hamstrings (posterior thigh muscles) are made up of 3 long muscles that start at the bottom of your pelvis extending down the back of your thigh and along either side of your knee, to your shin bones. The lateral hamstring is the biceps femoris (made up of 2 parts - a short head and long head) and the medial hamstrings are the semitendinosus (joins the sartorius muscle and gracilis muscle at the pes anserinus on the tibia) and the semimembranosus (the largest hamstring muscle). The tendons (tough fibers that connect muscle to bone) for these muscles begin at your the bony bump under each buttock, known as your "sit bone" (ischial tuberosity) and attach on the outer edges of your shinbone (your tibia and fibula) just below the back of your knee. They help to stabilize your knee. Your hamstrings also have a lot of soft connective tissues and are innervated by your sciatic nerve.
A hamstring strain or hamstring sprain is tissue damage that causes pain and inflammation. These injuries can be caused by an acute injury in which the tissue is stretched or twisted beyond the limits or by a chronic injury that occurs with excessive use over time. The type of tissue that is damaged determines if it is a sprained hamstring or a strain. What's the difference? Read more
Causes of a Hamstring Pull
Extra stress placed on the hamstring muscles and tendons can occur during: active sports that require speed, power and agility (soccer, football, baseball, softball, basketball, rugby, tennis) or track & field activities that have a lot of jumping, kicking, running and fast "stop/start" motions with your legs (sprints, hurdles, long jump). During intense activities we often load our hip joint by up to eight times our body weight.
Individual activities can put a lot of continuous pressure on your hamstrings (running, water skiing, skating, cheerleading, dancing, weight lifting, climbing). These athletes are susceptible to chronic pulls as a result of the repetitive nature of their activities. They often suffer from avulsion fractures following a burst of speed.
Muscle exhaustion and fatigue decrease your strength, power and endurance which increase your risk for injury. Over-stretching, overexertion and overuse of your hamstring muscles occurs frequently in sporting activities and/or daily life. When you have not warmed-up and stretched properly before moving, your muscles aren't ready for the stress, therefore your chances for injury are increased. Doing too much, too soon, too fast, or exercising and moving about in cold weather, puts you at even more risk for a pulled hamstring. Sometimes you will get a pulled hamstring doing very simple tasks like landing in a strange way from a jump, aggressively stretching in yoga class, or running after your kids or the bus.
Utilizing a poor technique (over-striding in running or walking), improper equipment (old shoes) or hard and uneven training surfaces during activities will often put your body at a higher risk for injury. These will also make you feel more tired as the inefficient movements require you to use more energy to complete tasks than required.
Repeated hamstring injuries are very common. Why?
During the healing process your body will fill in tears in your hamstring muscles with dense, brittle tissue called "scar tissue". The human body will use scar tissue as a temporary solution and will try to build the scar tissue as fast as possible to heal a tears in the hamstring muscle tissue. Scar tissue can form fast to bring together the edges of a tear, but working fast doesn't mean that the job's done right. When scar tissue forms it doesn't come together as neatly as regular (healthy) muscle tissue would. Scar tissue fibers will lay down over top of your tear in a cluttered, messy and jumbled up way.
Imagine throwing a bunch of drinking straws in the air... When those straws hit the ground they will land in a random, unorganized way. It even seems silly to think that those straws could land perfectly straight and all in the same direction.
This is how scar tissue works. The scar tissue that forms in your hamstring muscle tissue will be unorganized and won't line up properly with the healthy tissue surrounding the tear. This scar tissue will also attach to everything in and around your hamstring injury including the surrounding healthy tissue as well. This can result in a long-term fusing together of your muscle that stiffens your hamstring reducing your mobility in your leg and making your injury even more painful!
Not giving your body and tissue enough time to repair itself is often the biggest reason for re-injury. This is seen most frequently in runners. Past injuries to your lower back, pelvis, knees, calf and/or achilles tendon can also lead to a hamstring injury (especially if they haven't healed properly).
Muscle imbalances or weakness in your muscles (especially in your hamstrings and quadriceps, or your lower back and pelvis muscles) can cause strength differences and poor coordination that result in a hamstring pull. Your quadriceps often overpower your hamstrings (generally if hamstring strength is less than 60% of quad strength).
Tight hamstring muscles often result from not stretching properly before your activities. However, shortened and tightened muscles, spine stiffness and poor flexibility can be hereditary and/or a side-effect of aging; it is seen more frequently in men than women. All of these can cause a lot of pressure on your body (low back stiffness can pressure your sciatic nerve which causes your muscles to tighten) and require a lot of work on your part (daily stretching).
Alignment issues, leg length discrepancies, or the way your foot hits the ground when you walk can put a lot of stress on your hamstring muscles and result in a hamstring pulls.
Other factors that can put extra tension on your hamstring and influence your risk of experiencing a hamstring pulls include:
- Poor fitness levels and lack of exercise
- Poor nutrition and obesity
- Posture irregularities (lumbar lordosis)
- Meniscal injuries
- Neural tension (scar tissue around the nerves)
Progression of a Hamstring Pull
There are three types of pulled hamstring muscles. The most common hamstring injuries are grade 1 or 2 strains that happen where your hamstring tendon and muscle meet (musculotendinous junction). The strain is graded by how severe the damage to the hamstring is.
Mild Hamstring Pull 'Grade I' tear - A mild strain is the overstretching of the fibers of the muscle or tendon. This type of strain causes discomfort in the upper thigh (and possibly lower back)..
Hamstring 'Grade II' tear - Actual tearing of the fibers in the muscle and/or tendon. It would feel like a sharp pain in the back of the leg and you may hear a tearing sound at the time of the injury. There will be a visible hamstring contusion, or bruising, in the torn muscle area in the days following the injury.
Hamstring Rupture 'Grade III' tear - When a muscle ruptures , or tears completely, you will feel a very sharp pain at the point of the tear and you may hear or feel a 'pop'. If you have a multi-muscle tear, it normally occurs at the point where your hamstring tendons and muscles meet near the ischium. You will a great deal of pain when try to move your leg and your range of motion will be limited. There will be a hamstring bruising (noticeable contusion) and swelling. Treatment of a complete tear usually requires surgery to re-join the muscle tissue at the point of the tear.
If you continue to experience the hamstring injury symptoms and have tried the suggested conservative treatments (cold compression and Blood Flow Stimulation Therapy™) for 2-3 weeks, it is recommended that you seek professional medical attention. It is recommended you seek immediate attention if you:
- hear a "loud pop" in your muscle when injured
- have immediate severe pain, swelling or discoloration in your hamstrings
- experience severe weakness in your leg (compared to other leg) and have difficulty walking
- have a temperature over 100.4º F (38º C)
- notice blue toe nails, numbness or coldness below your injury
Diagnosing a Pulled Hamstring
A physical examination will be performed to determine the grade of your hamstring pull. Your doctor will loo and feel the muscles, bones and other soft tissue in and around your hamstring, as well as your entire leg, pelvis and lower back, to evaluate sameness (symmetry), recognize differences and identify pain and tenderness. This will help to discover any abnormalities, fluid, bruising, bone or tissue deformity, and leg length discrepancies. He/she may ask you to complete a series of flexing and extending leg movements to see what motions cause pain, weakness, tightness, or instability. He/she will also evaluate your feet and gait (the way you walk) to determine if you have other alignment issues.
Most common hamstring injury diagnostic tests: Most grade 1 or 2 hamstring strains don't require diagnostic testing, however these tests will help confirm if you have a grade 3 strain and/or will rule out other causes of hamstring pain.
X-rays will provide a two-dimensional image of the overall bone structure of your upper leg (pelvis, femur and knee). They are helpful in identifying instability, brakes, abnormal bone shapes (bone spurs, calcifications or cysts, joint degeneration), and/or other leg problems.
CT scans (computed tomography) and ultrasounds have been also used on occasion.
MRIs (magnetic resonance imaging) will provide more detailed information and will help to evaluate the soft tissues in and around your hamstring (muscles, tendons, ligaments, fascia, and other connective tissues). They can identify ligament or tendon damage, and can help to determine the extent of your injury, the grade of your tear or inflammation, as well as other associated conditions.
How to Treat a Pulled Hamstring
Treating your hamstring strain correctly is essential to getting rid of your pain and restoring function to your upper thigh. Proper treatment will get you back to regular activities sooner, stop your pain, and reduce the risk of future re-injury.
To restore strength and range of motion in your hamstrings, treatment should focus on preventing scar tissue formation and shrinkage and weakening of the muscle (atrophy). This requires rest and therapies at the right time. Almost all types of hamstring pulls and tears (except a complete hamstring rupture) can be properly treated with trusted therapies that are available for use at home. Complete ruptures usually require surgery. However, using these conservative treatments after surgery can help speed recovery, improve function, and increase range of motion in your hamstrings.
Gradually Increase Activity
Once the pain from your pulled hamstring starts to decrease, a physiotherapist or athletic trainer can set up an individualized strengthening, endurance and stretching exercise program for you to rebuild your hamstring and leg muscles. A gradual build-up to your regular activities is essential during your rehabilitation to restore strength, fitness and co-ordination. Generally you will start with passive range of motion and isometric exercises (strength building exercises that involve contractions against resistance without moving your joints). Once you complete these with minimal pain, you will be able to participate in more dynamic movements and strengthening activities (like hamstring curls, squats, lunges, deadlifts, elastic tube exercises, water exercises, stationary cycling, walking, elliptical training and/or weight training). When tenderness is gone and you are able to fully tense the hamstring without any pain, you can gradually return to jogging or higher impact activities for short periods of time. It is important to stop if you feel any twinges of pain.
Avoid aggressive stretching (yoga) too soon, stress your hamstring muscles and cause re-injury. However, gentle stretching will be essential to regain normal tissue flexibility and prevent against scar tissue development (straight leg seated or standing stretching). Daily stretching, a few times a day, in which you hold stretches for 15 - 30 seconds each is recommended once you are ready. Use pain as your guide whether you are ready to move on to the next level or not.
Modifiy any activity that involves repeated bouncing movements or "stops and starts". Starting at 50% of what you would normally do, and increase gradually as you see improvement in your condition. Warm up, with light jogging or a BFST® via a Inferno Wraps® treatment and cool down via Freezie Wraps®, your leg after your activity. Individuals will often exercise or lift weights on their own to try and build up their strength; however in doing so, they can do more damage. A medical or fitness professional will help to ensure your rehabilitation process is effective.
Use Supportive Devices
To increase your comfort and prevent further damage you may want to use an upper thigh support (neoprene sleeve or brace), strapping, tape, or compression short which will help support the area, eliminate pulled muscles, and reduce stress on the injured tissue. Some of these are also designed for heat retention to prevent further strain. They can be used until your injury is gone or during active sports for additional stability. However they should not be worn at all times, as they can limit muscle development, cut off circulation and impede healing of your muscle tissue.
Cold Compression Therapy
For years, doctors, trainers, and other medical professionals have recommended RICE (Rest, Ice, Compression, Elevation) to treat the pain and swelling of fresh injuries, chronic pain, and after any re-injury.
Although RICE can help to treat these symptoms, ice and freezer gel packs reach temperatures so low they can cause cryoburn, an ice burn on your skin. The problem is, up until now there hasn't been another option to treat painful conditions and injuries, so ice and freezer gel packs have been the only choice.
Fortunately, you no longer have to settle for these ice cold methods that are uncomfortably cold against your skin, provide short term relief, cause ice burns, and numb your skin and underlying tissue beyond feeling so you don't even notice the ice burn until it's too late. The Leg/Arm Freezie Wrap® allows you to treat your shoulder in an effective and convenient way. Cold Compression Therapy works by stopping and slowing nerve and cell function in the injured area and reducing swelling that can block blood vessels.
Treating an injury with cold compression therapy as soon as you can is important because it decreases swelling and inflammation. This limits the amount of tissue damage that occurs within the first 72 hours of an acute strain.
When a hamstring pull or tear occurs we think the damage is done at the time of the injury. In reality, the tissue damage continues to occur even after the injury has happened. Yes, at the time of the injury blood vessels are damaged. But after the injury, swelling and inflammation set in and blocked blood vessels causing further damage. When this happens you will notice a hamstring contusion (hamstring bruising).
Blood contains oxygen that is vital to the survival of your tissue cells. Blocked blood vessels can no longer carry blood to your cells and the cells begin to break-down further damaging your injured hamstring. By applying cold compression therapy to a fresh injury or re-injury you reduce tissue damage and reduce the amount of healing that will be required to get your hamstring muscles and tendons back to normal.
Aside from preventing tissue damage, cold compression therapy reduces pain by gently numbing nerves in the injured area and providing comforting support to your hamstring muscles. Cold compression Leg/Arm Freezie Wrap® is the natural way to reduce upper leg pain quickly.
The Leg/Arm Freezie Wrap® cold compression therapy is an effective and innovative way to treat your painful hamstring symptoms.
Once the initial swelling and severe inflammation of your hamstring injury is under control, you can begin the healing process.
Blood Flow Stimulation Therapy™
Once inflammation and swelling have been reduced, nourishing and strengthening muscle and tendon tissue is the goal. Blood Flow Stimulation Therapy™ (BFST®) promotes blood flow to the treatment area bringing the necessary oxygen and nutrients to your muscle fibers. BFST® speeds up the body's natural repair process for faster and more complete healing.
When you rest your leg and stop moving because it hurts, the natural blood flow is reduced. Without proper blood flow, musclar atrophy (shinkage or deterioration of a muscle) can occur and your body's ability to heal itself becomes limited. You need to improve blood flow while giving your hamstring the rest it needs. That's where the Inferno Wrap® comes in.
The Inferno Wrap® is the tool you need to treat your pulled hamstring. Not only does it speed your recovery through BFST®, the gentle warming that is produced with the increase in blood flow relaxes your thigh muscles and reduces soreness. In addition, the improved blood flow whisks away dead cells and toxins that have built up from your hamstring strain, further loosening your muscles and reducing pain.
Keeping your legs as healthy and strong as possible throughout the healing process will allow you to exercise your hamstrings once your pain is gone and your strain is healed. The Leg/Arm Inferno Wrap®, available exclusively from MendMeShop®, provides effective, non-invasive, non-addictive pain relief and healing with no side effects.
The benefits of BFST® do not end once your hamstring stops hurting! Even when your upper thigh muscles have healed, your activities can put them at risk of an overuse injury, tightness, or another strain. An Inferno Wrap® treatment before activity is an easy way to warm up the muscles and prepare them for use. Then, end your day with another treatment to prevent tightness from setting in overnight. This incredible healing tool will be useful for years to come!
With these easy therapies - cold compression with the Freezie Wrap® and BFST® with the Inferno Wrap®, you can treat your hamstring injury properly and completely. You will notice significantly reduced pain and an incredible improvement in your hamstring range of motion.