How to Avoid and Treat Hamstring Strains
A pulled (or strained) hamstring is 1) common among athletes who rely on explosive speed, 2) painful, 3) hard to heal and 4) in many cases, preventable.
The injury is a strain or tear in the muscles and tendons that run along the back part of your upper leg. Those three muscles, working in concert with the quadriceps on the front of your thigh, allow your legs to straighten out at the hip joint and bend at the knees. When the hamstrings contract, the quadriceps relax. And when the quads contract, the hamstrings relax. It’s a not-so-delicate tug-of-war game. When they are out of sync, bad things can happen that extend beyond the muscle groups themselves. One theory for the high incidence of ACL injuries in females is an imbalance of strength between the hamstrings and quadriceps.
How It Happens
Several factors, often in play at the same time, can cause a strained hamstring.
- As mentioned, an imbalance between the relative strength of the hamstrings and the quadriceps—the quads are naturally stronger than the hamstrings—and the amount of work they are able to perform at any moment could cause a strain.
- Not warming up properly may add to the risk factor. “A cold, unstretched muscle that is required to contract at maximum intensity is at highest risk,” warns Ramin Modabber, MD, of the Santa Monica Orthppaedic and Sports Medicine Group.
- If one or both sets of muscles are fatigued from training or the demand of the sport, they are even more vulnerable.
- If you suddenly need an extra burst of speed (like legging out an infield hit in baseball, making an explosive move to the basket in basketball, sprinting to get the ball in soccer, or trying to escape a tackler in football), tremendous force is required of both the hamstrings and the quadriceps.
Put all four factors together at the same time — muscle imbalance, inadequate warm-up, fatigue, and a sudden need for speed—and you’ve created your own perfect storm for a pulled hamstring. Running in cold weather could make it even worse. And poor running technique can also contribute to an overload of the muscle and a strain.
By the Numbers
1, 2, or 3
Number of muscles in the hamstring group that can be strained.
When the injured leg is within 10 percent of the strength of the unaffected leg, an athlete should be able to return to competition, according to the Journal of the American Academy of Orthopaedic Surgeons.
Who’s At Risk
Any athlete who relies on explosive leg action is most at risk. At the top of the list are runners (especially sprinters), jumpers, and skaters, followed closely by football, basketball, baseball and soccer players. Regardless of the sport, older athletes are more susceptible than younger ones.
- Severe pain behind the upper leg and/or buttock at the moment of the injury
- Muscle spasms behind the leg after the injury has occurred
- Bruising, tenderness
- Possible popping or snapping sensation
- With a complete (Grade 3) tear, you may feel a “ball” of muscle on the back of the leg.
- Rest. Don’t put weight on the affected leg. Use crutches, if necessary.
- Apply ice packs for 15-20 minutes, 3-4 times a day, for at least the first 72 hours.
- Elevate your leg (using a pillow) when sitting or lying down.
- Use an elastic wrap around your upper leg for compression (to control swelling).
- Aspirin, ibuprofen, and naproxen may relieve pain and reduce inflammation.
- If the pain is significant or if the symptoms don’t subside within two weeks, see a doctor.
“Hamstring strains can be difficult because the muscles are extremely strong and they contract every time an athlete tries to accelerate,” says Dr. Modabber. “It is not unusual for athletes, especially those who try to return to a sport too quickly, to experience pain with these powerful contractions on recently injured tissues.”
Minor hamstring pulls may heal on their own with time. Give your legs a rest and gradually return to training based on the absence of symptoms, not the number of days or weeks since sustaining the injury. Remember: Athletes recover at different rates. Severe hamstring pulls may take weeks or months to heal.
Keep these guidelines in mind:
- Cross-train in sports that don’t place a heavy demand on the hamstrings (upper body strength training, easy lap swimming, soft tossing a baseball or hitting off a tee).
- Gently massage the surrounding area (not directly on the immediate area) with a foam roll, tennis ball, or trigger point roller. Gentle massage should not cause pain. Often, the areas around the injury, including the hip, side of thigh and quadriceps can benefit from massage while the hamstring is trying to heal.
- Apply ice packs for 15-20 minutes after an exercise session.
- Observe the 10 percent rule: Do not increase exercise intensity, frequency or duration more than 10 percent a week.
Incorporate these injury-prevention moves into your routine to help reduce your risk for a hamstring strain:
- Bent Leg Active Isolated Stretching (gently improve the length of the hamstring by using your quadriceps (the muscle in front of your thigh) to straighten out your knee; this will cause you hamstring to relax, and length can be restored to the muscle)
- Massage Stick - Hamstring: (gently use the massage stick to give yourself a self massage at the hamstring; do not cause pain; only a small amount of pressure should be used to help decrease the knot you may feel in the back of the thigh.
- Romanian Dead Lifts
How to Avoid It
- Do not increase exercise intensity, frequency or duration more than 10 percent a week.
- Stop exercising if you feel tightness in the back of your legs. Tightness may develop before an actual tear occurs.
- Allow extra warm-up time in cold weather.
- Incorporate the prehab exercises above into your training program.
Incorporate these moves into your regular warm-up sessions. Perform 10 reps of the glute bridge and 10 with each leg for the other exercises.
Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.
- M. Ramin Modabber, MD, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California
- Sue Falsone PT, MS, SCS, ATC, CSCS, Director of Performance Physical Therapy, Athletes’ Performance & Core Performance
- American Academy of Orthopaedic Surgeons
- Journal of the American Academy of Orthopaedic Surgeons
- Medicine & Science in Sports & Exercise
- National Athletic Trainers Association