You've Pulled your hamstring. Now What?

​What are the “hamstrings”? The hamstrings are a bundle of three separate muscles: semimembranosus, semitendinosus, and biceps femoris.  All three of them are located on the back of the thigh.  The main action of these muscles is to bend, or flex, the knee as well as internally rotate and adduct the leg.  Injuries to this muscle group are extremely common unfortunately, and can happen to individuals of all activity levels; however 29% of sports injuries can be classified as hamstring strain injuries. Usually people will feel the onset of pain while running or sprinting and can hear or feel an audible pop.  Bruising is also not uncommon depending on the severity of the strain.  

These injuries are very susceptible to a risk of reinjury, so it’s essential to determine the true cause of the injury. Whether it be due to a muscle imbalance with the quadriceps, or a lack of flexibility and strength.  Little evidence exists to show that over the counter anti-inflammatory medications are beneficial as well. Low level laser therapy, and working on the appropriate rehabilitation plan can provide long-term effects. With rehabilitation the goal is to address the biomechanical dysfunction that led to the initial injury.  Eccentric strengthening has been shown to be the most effective at reducing re-injury.  Eccentric contractions occur when the muscle is being activated while also lengthened at the same time. In addition to eccentric strengthening of the hamstrings, working on core and lumbo-pelvic stability and balance should be a focal point.  

The initial phase of rehabilitation begins immediately after the injury and can last for four weeks. In this phase regular activity should be modified to reduce extraneous stress on the tissue, however movement and mild exercise can prevent full atrophy and decreased neural drive.  In this phase exercises will be geared towards range of motion and include mainly open-kinetic chain movements.  The second phase of rehabilitation aims to restore maximal strength contractions with pain-free repetitions. This second phase can last for several weeks.  The third, and final, phase includes dynamic and advanced exercises to re-establish athletic movements in full capacity.  The overall prognosis of hamstring strain injuries is very good as long as the appropriate rehabilitation is performed.  


 Phase I Exercises 

• Grapevines (side stepping over each leg)
• Single leg stances with the eyes open and closed
• Stationary biking

Phase II Exercises

• Grapevines or lateral walks with resistance
• Single-leg RDLs (standing on one leg and leaning forward like a lever to touch the ground)
• Glute bridges and walking the legs out
• Push-up holds with rotation
• Side-planks
• Wood-Chops with a band
• Eccentric hamstring curls

Phase III Exercises

• Side shuffling
• Backwards running
• Single leg bridges
• On the ground
• With a chair (foot on chair and bridge-up)
• With yoga or exercise ball
• Single Leg RDLs with weights
• Eccentric hamstring curls with a yoga or exercise ball

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-Danirose Billings

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