What are the main causes of hamstring strains. How can runners prevent hamstring injuries. What are effective stretches for hamstring flexibility. Why do hamstring strains have a high recurrence rate. How does muscle imbalance contribute to hamstring injuries.

The Anatomy of Hamstrings: Location and Function

The hamstrings are a group of three muscles located on the back of the thigh, extending from the pelvis to the knee. These muscles play a crucial role in various leg movements and are particularly important for runners and athletes. Understanding the anatomy of hamstrings is essential for preventing and treating strains effectively.

The Three Hamstring Muscles

• Biceps Femoris (BF): Originates at the ischial tuberosity and inserts at the head of the fibula
• Semitendinosus: Originates at the ischial tuberosity and inserts just below the inside of the knee
• Semimembranosus: Originates at the ischial tuberosity and inserts between the other two muscles

The biceps femoris is the most commonly strained hamstring muscle, likely due to its unique positioning and function. These muscles are responsible for extending the thigh, bending the knee, and providing rotational ability when the knee is bent.

Common Causes of Hamstring Strains in Runners

Hamstring strains are prevalent among runners and sprinters, with several contributing factors increasing the risk of injury. Understanding these causes can help athletes take preventive measures and reduce the likelihood of experiencing a hamstring strain.

Muscle Imbalance: A Primary Culprit

One of the most frequent causes of hamstring strains is muscle imbalance, particularly between the hamstrings and the quadriceps. During sprinting, just before heel contact, the hamstrings are fully extended while the quadriceps are shortened. If there is a significant imbalance in strength or tone between these muscle groups, the hamstrings may become hyperextended, making it difficult for them to contract fully and increasing the risk of strain.

Other Contributing Factors

• Excessive neural tension (tonus)
• Lack of flexibility
• Muscle fatigue
• Insufficient warm-up

These factors, combined with the multi-articulate nature of the hamstrings (meaning they affect multiple joints), contribute to their vulnerability to strains.

Recognizing the Signs of a Hamstring Strain

Identifying the symptoms of a hamstring strain is crucial for proper treatment and recovery. While the severity of symptoms may vary depending on the grade of the strain, there are some common signs to watch out for.

Key Symptoms of Hamstring Strains

• A loud “pop” sound at the onset of injury (typically in grade II strains)
• Pain and tenderness in the affected area
• Discomfort while stretching the hamstring
• Possible bruising on the lower leg
• Difficulty walking or running

It’s important to note that not all hamstring strains will present with a loud “pop” sound. Many runners experience milder strains that may not have this dramatic onset but still require attention and proper care.

Effective Stretches for Hamstring Flexibility and Injury Prevention

Incorporating targeted stretches into your routine can help improve hamstring flexibility and reduce the risk of strains. Here are two effective stretches that runners can perform for self-care and injury prevention.

Bent Leg Hamstring Stretch

This stretch targets the distal end of the hamstrings, closer to the knee.

1. Stand on a landing with a set of stairs in front of you
2. Place your target leg a few steps higher, aiming for a 90-degree angle at both hip and knee
3. Gently attempt to straighten the knee joint while keeping the hip position fixed
4. To target the biceps femoris specifically, slightly turn your foot inward before extending the knee

Straight Leg Hamstring Stretch

This stretch targets the full muscle belly of the hamstrings.

1. Stand on a stair landing
2. Place your target leg up a few stairs, fully extending the knee
3. Position your hip at a right angle in front of you
4. Lean forward slightly to increase the stretch

Remember to perform these stretches gently and avoid bouncing. It’s best to incorporate them into your post-run or training routine when muscles are warm and pliable.

The Role of Massage and Bodywork in Hamstring Health

Massage and bodywork can play a significant role in maintaining healthy hamstrings and preventing strains. These techniques offer several benefits that complement stretching and strength training exercises.

Benefits of Massage for Hamstring Health

• Breaks up scar tissue and adhesions between muscle bellies
• Improves blood flow to the muscle tissue
• Reduces muscle tension and promotes relaxation
• Enhances flexibility and range of motion
• Aids in recovery after intense workouts or competitions

Regular massage sessions with a qualified therapist can help runners maintain optimal hamstring function and reduce the risk of strains. Additionally, self-massage techniques using foam rollers or massage balls can be incorporated into daily routines for ongoing maintenance.

Strengthening Exercises to Address Muscle Imbalances

Addressing muscle imbalances between the hamstrings and quadriceps is crucial for preventing hamstring strains. Incorporating targeted strengthening exercises can help achieve a better balance and reduce injury risk.

Effective Hamstring Strengthening Exercises

• Romanian Deadlifts: Focus on proper form and gradual weight progression
• Nordic Hamstring Curls: An advanced exercise that targets eccentric hamstring strength
• Glute-Ham Raises: Builds strength in both the hamstrings and glutes
• Single-Leg Deadlifts: Improves balance and unilateral hamstring strength
• Stability Ball Leg Curls: Engages the hamstrings through a full range of motion

It’s essential to consult with a certified personal trainer or coach to ensure proper form and technique when performing these exercises. They can also help design a balanced strength training program that addresses your specific needs and goals as a runner.

Recovery and Rehabilitation After a Hamstring Strain

If you experience a hamstring strain, proper recovery and rehabilitation are crucial for preventing recurrence and returning to running safely. The recovery process may take several weeks to months, depending on the severity of the strain.

Phases of Hamstring Strain Recovery

1. Acute Phase: Focus on reducing pain and inflammation (RICE – Rest, Ice, Compression, Elevation)
2. Subacute Phase: Gentle stretching and range of motion exercises
3. Strength and Conditioning Phase: Progressive strengthening exercises and functional training
4. Return to Running Phase: Gradual reintroduction of running with careful monitoring

During the recovery process, it’s essential to work closely with a physical therapist or sports medicine professional. They can guide you through appropriate exercises, monitor your progress, and help determine when it’s safe to return to running.

The Importance of Proper Warm-Up for Hamstring Health

A thorough warm-up routine is crucial for preparing the hamstrings and other muscles for the demands of running. Insufficient warm-up is a common factor contributing to hamstring strains, especially in sprinters and high-intensity runners.

Components of an Effective Warm-Up

• Dynamic stretching: Leg swings, walking lunges, high knees
• Light jogging: Gradually increasing pace and intensity
• Activation exercises: Glute bridges, leg curls with resistance bands
• Drills: A-skips, B-skips, carioca
• Strides: Short bursts of acceleration to prepare for higher speeds

A proper warm-up increases blood flow to the muscles, improves flexibility, and prepares the neuromuscular system for the upcoming activity. This can significantly reduce the risk of hamstring strains and other running-related injuries.

Understanding the High Recurrence Rate of Hamstring Strains

Hamstring strains have a notoriously high recurrence rate among runners and athletes. This tendency for reinjury can be frustrating and potentially career-limiting if not addressed properly.

Factors Contributing to Hamstring Strain Recurrence

• Inadequate rehabilitation: Returning to running too soon or without proper strength restoration
• Persistent muscle imbalances: Failing to address the underlying strength discrepancies
• Scar tissue formation: Improper healing can lead to inflexible scar tissue, increasing strain risk
• Biomechanical issues: Unaddressed running form problems that contributed to the initial injury
• Insufficient warm-up: Continuing to neglect proper pre-run preparation

To minimize the risk of recurrence, it’s crucial to fully complete the rehabilitation process, address any underlying biomechanical issues, and maintain a consistent strength and flexibility routine even after returning to running.

The Role of Nutrition in Hamstring Health and Recovery

While often overlooked, nutrition plays a vital role in maintaining healthy hamstrings and supporting recovery from strains. Proper nutrition can help reduce inflammation, support muscle repair, and enhance overall muscle function.

Key Nutrients for Hamstring Health

• Protein: Essential for muscle repair and growth
• Omega-3 fatty acids: Help reduce inflammation
• Vitamin C: Supports collagen production for tendon health
• Magnesium: Aids in muscle relaxation and recovery
• Zinc: Promotes tissue healing and immune function

Incorporating a balanced diet rich in these nutrients can support overall muscle health and may help reduce the risk of hamstring strains. Additionally, proper hydration is crucial for maintaining muscle elasticity and preventing fatigue-related injuries.

Advanced Techniques for Hamstring Injury Prevention

As research in sports medicine advances, new techniques and approaches for hamstring injury prevention continue to emerge. These advanced strategies can be particularly beneficial for competitive runners and those with a history of hamstring issues.

Innovative Approaches to Hamstring Health

• Eccentric training: Focusing on the lengthening phase of muscle contraction
• Plyometric exercises: Incorporating explosive movements to improve muscle reactivity
• Proprioceptive training: Enhancing body awareness and control
• Fascial release techniques: Addressing restrictions in the connective tissue surrounding muscles
• Neuromuscular electrical stimulation: Improving muscle activation patterns

These advanced techniques should be incorporated under the guidance of a sports physiotherapist or strength and conditioning coach to ensure proper implementation and minimize the risk of injury.

The Impact of Running Biomechanics on Hamstring Health

Understanding and optimizing running biomechanics can play a significant role in preventing hamstring strains. Poor running form can place excessive stress on the hamstrings, increasing the risk of injury.

Key Biomechanical Factors Affecting Hamstring Strain Risk

• Overstriding: Landing with the foot too far in front of the body
• Pelvic tilt: Excessive anterior or posterior tilt can alter hamstring function
• Foot strike pattern: Heel striking vs. midfoot or forefoot striking
• Cadence: Step frequency and its impact on stride length
• Core stability: The role of core strength in maintaining proper running posture

Working with a running coach or biomechanist to analyze and improve running form can help reduce the risk of hamstring strains and improve overall running efficiency.

The Psychological Aspect of Hamstring Injury Recovery

Recovering from a hamstring strain isn’t just a physical process; it also involves significant mental and emotional challenges. Understanding and addressing the psychological aspects of injury recovery can greatly impact the success of rehabilitation and return to running.

Mental Challenges in Hamstring Strain Recovery

• Fear of reinjury: Anxiety about returning to full intensity running
• Loss of fitness: Concerns about deconditioning during recovery
• Impatience: Struggling with the often lengthy rehabilitation process
• Identity issues: Coping with temporary loss of runner identity
• Motivation fluctuations: Maintaining consistency in rehabilitation exercises

Incorporating mental strategies such as visualization, goal-setting, and mindfulness practices can help runners navigate the psychological challenges of hamstring strain recovery. Working with a sports psychologist can provide additional support and tools for maintaining a positive mindset throughout the rehabilitation process.

Understanding Hamstring Strains: “POP!” — Phila Massages

Hamstring strains, or tears, are a common occurrence in runners and sprinters.  There are several contributing factors to hamstring strains and there is a high chance of recurring injury.  Strains in the hamstrings are more frequent than in some other muscles for several reasons: muscle imbalance, excessive neural tension (tonus), lack of flexibility, fatigue, and insufficient warm up are just a few of the factors that play a role in this type of injury. Anatomy

Depicted is the back of your right leg

Before I go any further, I’d like to explain the location and function of the hamstrings. They are three muscles on the back of your thigh, between the pelvis and the knee.  All three of these muscles begin, or originate, at the Ischial Tuberosity (your sitting bone).  The first muscle you see in the picture above is the Biceps Femoris (BF).  The BF is logically named because it has two heads; the long head and the short head. The BF terminates, or inserts, at the head of the fibula (outside of your knee), and is the more common location of hamstring tears.  The second muscle depicted above, the Semitendinosus, is located more medial than the others.  This muscle terminates just below the inside of your knee. Finally, the Semimembranosus, is located between the others.  The end of this muscle is also just below the inside of your knee.

You can feel all three of these muscles while sitting down.  Just reach behind your knee and you’ll feel a hard tendon just above the knee, on the outside.  You will feel two other tendons on the inside of your knee.  The BF is on the outside, by itself, and the other two are on the inside.

Usually, strains will occur at the musculotendinous junction, or where you see red changing to white in the picture above.  At the onset of injury, you will feel, or hear, a loud pop (*only for grade II strains  – most runners we see will not have that experience).  This is followed by some possible bruising to the lower leg, pain to the touch, and pain while stretching.

Role of the Hamstrings

The hamstrings are multi-articulate muscles, meaning that they provide movement for several joints. The main action is extending your thigh (kicking straight behind you).  They also bend your knee and provide the rotational ability of your knee (only when it’s bent).  Any multi-articulate muscle will have a higher chance of strain, but the hamstrings are generally more easily strained than others.  As stated above, this is due to several factors.  We will stick with the most frequent cause of hamstring strains: muscular imbalance.

Cause of strains: muscle imbalance

Located opposite the hamstrings are the Quadriceps.  A strength or tonus imbalance between the two groups is often the cause of strains during running or sprinting.  While sprinting, just before heel contact, your hamstrings are in a fully extended position.  They are stretched out fully, while the quadriceps group is shortened.  If there is a hefty imbalance, your hamstrings may be hyperextended.   This hyperextension makes it extremely difficult for your hamstrings to contract fully.   When you hear that “pop”, your hamstrings are generally fully extended.

How to prevent strains

Prevention of this type of injury is paramount, as the chance for recurrence is high, and recovery may take several weeks or months.  Stretching will help decrease the tonus in your hamstrings, also increasing your stride length. Massage and bodywork will break up scar tissue and adhesions between the muscle bellies.  You can also help reduce strength imbalances by seeing a certified personal trainer, or coach.  Some passive stretches you can perform for self-care are explained below.

My personal favorite, a bent leg stretch, can be very effective for stretching the distal end of your hamstrings, closer to the knee.  To perform this stretch, all you need is a set of stairs.  Stand on the landing and place your target leg a few steps higher than the other. You want your hip, as well as your knee, to be at 90 degree angle.   From there, you can gently try to straighten the knee joint, while the hip joint is kept in position. This stretch is depicted below. If you want to target the BF specifically, just turn your foot slightly inward before attempting to extend your knee. This can be helpful because the BF is commonly strained.

An effective stretch for the full muscle belly is the straight leg hamstring stretch.  To perform this one, stand on the landing of your stairs again and place your target leg up a few stairs so that your knee is fully extended and your hip is at a right angle in front of you.  This stretch is depicted below.

As with all passive stretching, be gentle and do not “bounce” into the stretch.  After your run or training, gently hold the positions for ~30 seconds 2-3 times per side. If there is any pain during the stretch, stop.  Pain is not gain in this instance.  if you lack the mobility to perform these stretches, you can always make an appointment at our office where we can assist in increasing your range of motion.

Below, I have embedded a video, made by one of our colleagues, showing you exactly how to perform these stretches in self-care. All you need to get the most out of these mobility exercises is a strong rope, or band. When referring to the “distal” end of the hamstrings, we mean the area closest to the knee.  When referring to the “proximal” end, we are referring to the section nearest the hip.

Hamstring Tear Causes, Symptoms, Treatment, and Recovery

A hamstring tear injury is a rip in the hamstring muscles. It happens when the hamstrings are overstretched or overloaded with too much weight. Depending on the injury, the hamstring can tear partially or completely.

The injury can affect one or more of the muscles in your hamstring muscle group. These muscles include the:

• semitendinosus
• semimembranosus
• biceps femoris

These muscles, which are in the back of your thigh, help bend your knees during activities like jumping and running.

While anyone can tear their hamstring, the injury is most common in athletes. Let’s look at the symptoms, treatment, and typical recovery of hamstring tears.

Typically, a hamstring tear occurs during physical activity. Common causes include:

• Athletic injuries. Most torn hamstrings are caused by extreme stretching or overload during a sport. The injury often happens to people who play sports like soccer, football, and ice hockey.
• Past hamstring injury. If you’ve torn your hamstring in the past, you’re more likely to tear it again. The risk is higher if you do intense activity before you’re fully healed.
• Overtraining. Training too hard can overload your hamstrings and cause tears.
• Poor flexibility. If you have limited flexibility, certain movements may stretch your muscles too far.

In addition to athletes, older people are prone to hamstring tears. That’s because flexibility often declines with age.

Adolescent athletes, who are still growing, are also at risk. Since bone and muscle grow at different rates, the growing bone can tighten the hamstring muscles, making them more susceptible to injury.

The symptoms of a torn hamstring depend on the severity of your injury. You might feel:

• sudden, sharp pain
• a “popping” sensation at the time of injury
• tenderness
• swelling within the first few hours
• bruising within the first few days
• partial or complete weakness in your leg
• inability to place weight on your leg

Depending on their severity, hamstring injuries are categorized into one of three grades.

Grade 1 is mild hamstring strain, which is also called a pulled hamstring. It happens when the hamstring muscles overstretch but don’t tear.

If the hamstring stretches to the point where it rips, the injury is considered a tear. Hamstring tear grades include:

Grade 2 hamstring tear

A grade 2 hamstring tear is a partial muscle tear. This means the muscle hasn’t fully ripped.

Compared to a grade 1 strain, a grade 2 tear is more painful. Your leg will feel somewhat weak and you’ll likely limp.

Grade 3 hamstring tear

The most severe hamstring tear is a grade 3 hamstring tear. It occurs when the hamstring muscle rips completely or tears off the bone. A tear that pulls the muscle off the bone is called an avulsion.

If you have a grade 3 tear, you likely heard a “popping” sound or sensation when you got the injury. The back of your thigh will also be extremely painful and swollen.

Because this tear is so severe, you may not be able to put weight on the injured leg.

While some people use “tears” and “strains” interchangeably, the terms don’t necessarily mean the same thing.

In a hamstring tear, the muscle fibers stretch so much that they rip. A strain, on the other hand, is when the muscle is only overstretched.

Basically, a hamstring tear is a type of strain, but not all strains are tears.

At your appointment, a doctor will do several things to determine if you have a torn hamstring. This might include a:

• Physical exam. The doctor will check your thigh for swelling, tenderness, and bruising. This helps them decide if your injury is mild or severe.
• MRI. If the doctor thinks you have a severe injury, you might get an MRI. This imaging test will show the tear in your muscle tissue.
• Ultrasound. An ultrasound is another test that produces a detailed image of your muscles. It can show the size and location of the hamstring tear.
• X-ray. You’ll need to get an x-ray if the doctor thinks the bone was fractured during your injury,

Torn hamstring treatment depends on the grade of your injury. In general, treatment options include:

RICE method

The RICE method is the first line of treatment for most sports injuries. For grade 2 tears, it’s the main form of treatment.

RICE stands for:

• Rest. Taking a break from physical activity will let your hamstrings heal. You might need to use crutches or a knee splint to avoid moving your leg.
• Ice. To ease swelling and pain, wrap an ice pack in a towel and place it on your hamstring for 20 minutes. Repeat a couple times each day.
• Compression. An elastic compression bandage can help relieve swelling.
• Elevation. Elevating your injured leg will also decrease swelling. Place it higher than your heart by using pillows, cushions, or folded blankets.

Pain medication

Typically, treatment often includes nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. You’ll need to take NSAIDs for about a week after your injury.

A doctor can recommend the appropriate medication and dose for you.

Physical therapy

Once the pain subsides, you’ll go to physical therapy. The physical therapist will plan a regimen that’s designed to improve your flexibility and range of motion.

As you get better, they’ll have you do strengthening hamstring exercises.

Hamstring surgery

If the treatments above don’t heal a partial tear, or if you have a complete tear, you may need surgery to repair it. The surgeon will fix the tear with stitches.

However, most hamstring surgeries are done to treat avulsions. During the procedure, the surgeon will move the muscle into its correct position and staple or stitch it to the bone.

Recovery time can vary greatly. It depends on various factors, including your:

• hamstring tear grade
• history of torn hamstrings
• age
• overall health

Recovery takes at least 4 to 8 weeks if you have a partial tear. During this time, you’ll need regular physical therapy and lots of rest.

If you have a complete tear, recovery can take about 3 months. It might take slightly longer if you get surgery.

Your doctor will let you know when you can go back to work. If you have a physically demanding job, you might need to stay home for most of your recovery time.

It’s important to follow your doctor’s rehabilitation plan during recovery. This will improve your outlook and reduce the risk of re-injury.

Most hamstring tears are caused by athletic injuries. Typically, partial tears heal in 4 to 8 weeks, while complete tears take about 3 months. You should start to feel better with regular physical therapy and lots of rest.

To avoid re-injury, follow your doctor’s guidance. They’ll let you know when it’s safe to return to sports.

Hamstring Stretch and Tight Hamstrings

Tight hamstrings can be a serious hindrance to your workouts. If you’re trying to get back to exercising as quickly as possible, don’t stretch right away. You need to rest your hamstrings and then you can slowly build flexibility with daily stretching exercises.

Index

• 1 Hamstring stretch: exercises to avoid
• 2 Hamstring stretches
  • 2.1 Back hamstring stretch
  • 2. 2 modified barrier stretch
• 3 Other remedies for tight hamstrings

Hamstring strain: exercises to avoid

Hamstring strain can seriously impair your ability to play sports or even walk. Tight or very sore muscles reduce your coordination and range of motion and put extra strain on your ligaments and tendons. To heal hamstrings, the first step should be at least a day or two of rest until most of the pain has dissipated. late muscle soreness is a common symptom of overtraining and a clear sign that you need to take a break.

Once the pain and stiffness begin to ease, your muscles will heal enough to begin regaining flexibility. If the pain doesn’t go away for a few more days, see your doctor for a more serious injury.

Rest for a day or two before you start stretching your hamstrings.

Hamstring stretchers

If your job requires you to sit for long periods of time, your hamstrings spend most of their time in a contracted state. This reduces your flexibility and increases the chance of sprains. Restoring flexibility with hamstring stretching can help repair stretched muscles and prevent future injury.

Incorporating daily stretching exercises is the best remedy for tight hamstrings after the initial pain subsides. Start stretching and training very slowly after stretching the hamstring, with light weight training and low-intensity cardio such as walking.

There are several exercises for hamstring injuries that can increase the flexibility of injured muscles. Do these exercises every day and you will notice an increase in hamstring flexibility within weeks to months.

Back Hamstring Stretch

Start by lying on your back. Bend your left knee and place your foot on the floor, then slowly lift your right leg straight up into the air with your foot toward the ceiling.

Place your vertically raised leg against the corner of a wall or doorframe for stability, then press your heel up until your foot is against the wall. You should feel your hamstrings stretch as your leg pulls up. Hold this position for 15 to 30 seconds and do two to four reps on each leg.

Modified Barrier Stretch

Start by sitting on the floor with your legs extended in front of you and pointing your toes towards the ceiling. Then bend your left knee and place the sole of your left foot on the inside of your right thigh.

As you exhale, slowly slide your hands up your right leg, keeping your head and spine straight.