Hamstring injuries are common in athletic populations particularly running based sports such as Rugby, Hockey and soccer where there are short and sharp changes of speed and direction.
Ideally, a well-structured strength and mobility program should be used by athletes or patients looking to commence or resume a sport to PREVENT injuries like this occurring.
There are varying degrees of injury to the hamstring. Muscle fibres can be injured near the top of the muscle (proximal) where it inserts onto the pelvis, lower down (distal) at the insertion behind the knee or in the mid-belly musculotendinous junction of the muscle. Varying partial-tears to the hamstrings can result in cease of the activity immediately, or the ability of the player to continue at sub-maximal speed and function.
Distal and partial-thickness tears recover well through 6-8 week strength and conditioning conservative programs progressed and tailored to your specific deficits and sport goals with your Physio.
But what happens to more significant hamstring injuries such as full-thickness tears or tears resulting in avulsion fractures at their attachment points?
Complete proximal Hamstring avulsions often occur with higher energy ballistic exercises such as weightlifting or water skiing where the hip is bent, knee straight and the muscle is contracting under load. Commonly patients will report hearing or feeling a ‘popping’ high at the back of the thigh with extensive bruising. Neural symptoms such as sciatic irritation, buttock pain or numbness with pain shooting down the leg can also be reported.
In these severe injuries the literature suggests early surgical intervention particularly high performing athletes[1], allowing patients to return to greater strengths and functional outcomes when compared to non-operated conservatively managed cohorts that had less significant improvements. Physiotherapy is vital following to return patients to normal gait, hip and knee strength and mobility.
It is important to get your injury assessed early so that the extent or severity of the injury can be appropriately treated, and surgical interventions can be considered. Delayed healing, scar tissue lesions and poor outcomes such as failure to return to sport or previous function if inappropriate treatment or delayed referral to surgery is advised.
Your physio is the best person to assess your presentation and advise you on the next course of action, consultation with your doctor or necessary specialists.
References:
[1] Degen RM. Proximal Hamstring Injuries: Management of Tendinopathy and Avulsion Injuries. Curr Rev Musculoskelet Med. 2019 Jun;12(2):138-146.
