Imagine you are high school upperclassmen, returning from an offseason of training. Learning new techniques, hoping to return to your high school team much improved. Those dreams of a college scholarship looking all too real now. You are taking part of your team’s warm ups and are required to sprint at the end of it. You decide that you want to show how fast you have become, you then feel a pull on the outside of your right leg towards the back. You note immediately that walking and going up and down stairs is uncomfortable. Later that night, you even notice bruising in the back of your leg. You go to the doctor the next day and he or she diagnoses you with a grade 2 hamstring pull, you are expected to now miss a couple of weeks of practice and team activity.
The hamstrings are made up of three muscles, with one having two heads. This one is the bicep femoris, which is the one that is primarily injured in this scenario, often giving us that pulling sensation towards the outside of the leg. These pulls typically occur during the eccentric phase of running or lengthening phase where the runner is straightening the leg out in front of them. Typically the tear that occurs during a hamstring pull is at the tendon of attachment of the hamstring towards the back of the knee.
These hamstring pulls occur can be related to a number of reasons. However, the more common ones will be outlined, beginning with muscle imbalances such as overdeveloped quadriceps and inhibited gluteus musculature. This leaves the hamstring to be overused and at a high likelihood of injury. Occurrences of hamstring pulls also occur due to poor hamstring flexibility. If poor flexibility is present then when someone goes to extend their leg or eccentrically lengthen, then it would be more likely to pull or tear. Lastly, why hamstring pulls are likely to occur to an athlete is due to the presence of an anterior pelvic tilt/poor posture. Unfortunately, if one’s natural posture is to rotate their pelvis forward they are putting their hamstrings on stretch. This takes the muscle out of its optimal length, it is stretched and then told to work at a high rate leaving it to get injured! Again these are only three occurrences that leave us predisposed to hamstring pulls, but if we work to correct them, then we are better equipped to prevent further injury.
If you do suffer a hamstring pull physical therapy can help you return to your normal function and help prevent future injury. The first phase of therapy involves decreasing the inflammation present in the hamstring musculature and bending the knee on the affected side in order to prevent adhesions. The following phase involves achieving full pain-free ROM and lightly loading the muscle. The last couple of phases involve loading the muscle eccentrically in order to prepare the muscle to withstand the lengthening phase that originally hurt it. Most importantly during physical therapy, the plan of care will involve decreasing the likelihood of reinjury not to just allow the athlete to resume prior level of activities but correct what brought them there in the first place.
An injury to a high school athlete, or to a weekend warrior is never ideal, especially when it occurs during what we think is a straight forward activity, such as running. If one completes their rehab and maintains their patience. Then not only will a return to sporting activity can resume but we can be more informed and possibly perform better.