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Introduction

Knee Pain

Hamstring Tear

A hamstring injury involves straining or pulling one of the hamstring muscles — the group of three muscles that run along the back of the thigh.

Hamstring injuries often occur in people who play sports that involves sprinting with sudden stops and starts. Examples include soccer, basketball, football and tennis. Hamstring injuries can occur in runners and in dancers as well.

Self-care measures such as rest, ice and pain medicine are often all that's needed to relieve the pain and swelling of a hamstring injury. Rarely, surgery is done to repair a hamstring muscle or tendon.

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Causes

Muscle Overload

Muscle overload is the main cause of hamstring muscle strain. This can happen when the muscle is stretched beyond its capacity or challenged with a sudden load.

Hamstring muscle strains often occur when the muscle lengthens as it contracts, or shortens. Although it sounds contradictory, this happens when you extend a muscle while it is weighted, or loaded. This is called an "eccentric contraction."

During sprinting, the hamstring muscles contract eccentrically as the back leg is straightened and the toes are used to push off and move forward. The hamstring muscles are not only lengthened at this point in the stride, but they are also loaded — with body weight as well as the force required for forward motion.

Like strains, hamstring tendon avulsions are also caused by large, sudden loads.

Risk Factors

Several factors can make it more likely you will have a muscle strain, including:

Muscle tightness. Tight muscles are vulnerable to strain. Athletes should follow a year-round program of daily stretching exercises.

Muscle imbalance. When one muscle group is much stronger than its opposing muscle group, the imbalance can lead to a strain. This frequently happens with the hamstring muscles. The quadriceps muscles at the front of the thigh are usually more powerful. During high-speed activities, the hamstring may become fatigued faster than the quadriceps. This fatigue can lead to a strain.

Poor conditioning. If your muscles are weak, they are less able to cope with the stress of exercise and are more likely to be injured.

Muscle fatigue. Fatigue reduces the energy-absorbing capabilities of muscle, making them more susceptible to injury.

Choice of activity. Anyone can experience hamstring strain, but those especially at risk are:

  • Athletes who participate in sports like football, soccer, basketball

  • Runners or sprinters

  • Dancers

  • Older athletes whose exercise program is primarily walking

  • Adolescent athletes who are still growing 

Hamstring strains occur more often in adolescents because bones and muscles do not grow at the same rate. During a growth spurt, a child's bones may grow faster than the muscles. The growing bone pulls the muscle tight. A sudden jump, stretch, or impact can tear the muscle away from its connection to the bone.

Symptoms

If you strain your hamstring while sprinting in full stride, you will notice a sudden, sharp pain in the back of your thigh. It will cause you to come to a quick stop, and either hop on your good leg or fall.

Additional symptoms may include:

  • Swelling during the first few hours after injury

  • Bruising or discoloration of the back of your leg below the knee over the first few days

  • Weakness in your hamstring that can persist for weeks

Diagnosis

A hamstring injury is diagnosed in a visit with your primary care or orthopedic provider. The doctor will take a full medical history and physical exam.

During the physical exam, the doctor will evaluate the swelling, tenderness and range of motion in the leg. In moderate tears or strains, the physician may be able to feel a divot in the muscle.

Your provider may also order diagnostic testing, like an MRI or x-ray, if he or she thinks you have sustained other, more serious injuries that need a different treatment regimen.

Non-surgical treatments

Most hamstring strains heal very well with simple, nonsurgical treatment.

RICE. The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation.

  • Rest. Take a break from the activity that caused the strain. Your doctor may recommend that you use crutches to avoid putting weight on your leg.

  • Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.

  • Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.

  • Elevation. To reduce swelling, recline and put your leg up higher than your heart while resting. 

Immobilization. Your doctor may recommend you wear a knee splint for a brief time. This will keep your leg in a neutral position to help it heal.

Physical therapy. Once the initial pain and swelling has settled down, physical therapy can begin. Specific exercises can restore range of motion and strength.

A therapy program focuses first on flexibility. Gentle stretches will improve your range of motion. As healing progresses, strengthening exercises will gradually be added to your program. Your doctor will discuss with you when it is safe to return to sports activity.

Surgery