Hamstring Injuries

Structure and Function:

  • Three muscles
  • Crosses two joints; they start above the hip and below the knee.hamstring.png
  • Complex balance of concentric and eccentric actions.
  • Greatest function is eccentric and very demanding; control.
  • Acute hamstring injuries come from sprinting most often. People feel something rip – like carpet tearing.
  • Check the spinal movements e.g. sciatica as hamstring pain can often be neurological rather than something genuinely wrong with the muscle.


  • Tears
    • Grade 1 – microscopic damage; mild muscle pull or strain
    • Grade 2 – majority of tears; partial muscle tears
    • Grade 3 – one bit torn away from the other; complete muscle tear
  • Tendonopathy
    • Proximal
    • Distal
    • How much of the muscle is involved?


  • Clinical
    • Strength; will hurt them, assess strength and pain
    • Stretch; also going to hurt, assess flexibility and pain
  • Investigation
    • Ultrasound
    • MRI; looking for the size of the injury, not the size of the edema


  • Interventional
  • Rehabilitation – a lot more options available
    • Pathology
    • RICE – limit secondary muscle damage
    • Mobilise
    • Strengthen – weights, open and closed chain; look what strength they have within a comfortable range.
    • Return to function
  • Strength
    • Low level of activity: knee flex and extend hip so leg raise. Hamstring and gluteals extend hip so need to strengthen glutes to prevent future hamstring injury.
    • Build up to low resistance flexion with the rubber bands around ankles or hips and a post.
    • Resisted weight machines as these are closed chain activities; it strengthens the muscle but it is not functional.
    • Put the closed chains together, making it open chained, so squats, lunges, and dead lifts.
    • Must be able to walk before they can run.
    • Cycling – mainly concentric, low risk, protects cardiovascular fitness and gets muscle working.
    • Cross trainer is a good progression from walking with reduced loading compared to running, but is a similar action.
    • Walking then uphill or backwards then jogging.
  • Speed
  • Acceleration
    • Acceleration/deceleration are very important in sports but likely to damage hamstring, so this must be put into rehab
    • Can use GPS tracking to get a look at speeds etc
    • The quicker you push an injured athlete and harder, more likely they will break
    • Have to introduce sport specific skills e.g. spring to this cone then kick a ball
  • Endurance
  • If fibres heal shorter than others then they will take all the stress so need to make sure they’re flexing and lengthened

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