Hamstring Strain? Physical Therapy Can Help

A man stretching his hamstrings in the Gym
Your physical therapist can help you return to optimal activity after a hamstring strain. Gary Burchell / Getty Images

If you have a hamstring strain or tear (the terms can be used interchangeably), you may benefit from the skilled services of a physical therapist to help you fully recovery. Your PT can treat your pain and prescribe exercises that can help you recover your normal range of motion (ROM), strength, and overall functional mobility.

Symptoms of a Hamstring Strain

Understanding the symptoms of a hamstring strain can help you get the right treatment - at the right time.

Typical symptoms of a hamstring strain may include:

  • pain in the back of your thigh, either behind your knee, in the muscle belly, or near your buttock
  • difficulty fully straightening your knee without pain
  • difficulty taking large steps or walking quickly, or pain with climbing stairs.
  • difficulty and pain with running

The pain you feel can range from mild to severe, and the exact location of symptoms may vary from person to person. If you suspect you have a hamstring strain, you should get to your doctor right away to start on the proper treatment.

Causes of a Torn Hamstring

Symptoms of a hamstring strain may come on suddenly, typically as the result of a quick motion that occurs with running or cutting maneuvers while participating in sports. Occasionally, you can suffer a hamstring strain by simply moving the wrong way while getting up from a chair or while walking and running.

So what is going on with your hamstring muscle when you have a strain?

The muscle or muscle-tendon interface is actually suffering from a tear. The collagen fibers that make up your muscle pull apart, and bleeding into the tissue may occur. Your body then immediately goes into “repair mode” using the inflammatory process. This process involves:

  • bleeding into the injury site to bring in cells to clean up the area and become healthy collagen.
  • formation of scar tissue bridges that will one day become healthy muscle and tendon tissue.
  • remodeling of that collagen tissue to become normal, healthy hamstring muscle tissue.

You can help the repair process along by doing the right things - at the right time - to get your hamstring moving and functioning properly.

First Steps Towards Recovery

If you suspect you have a torn hamstring, you should take some initial steps to get going on the path to recovery. These may include:

  • don't panic. Hamstring strains, although painful, are not typically dangerous.
  • see your doctor to be sure you get an accurate diagnosis.
  • visit your physical therapist to start treating the pain and to start working on restoring your normal mobility.
  • avoid aggravating activities that can cause pain or prevent normal tissue healing of your hamstring.

By starting the right things at the right time, you can safely regain your mobility and get back to your normal activities.

How Severe Is Your Hamstring Tear?

So how do you (and your PT or doctor) know how severe your hamstring strain is?

Are there ways to classify the severity of your hamstring tear? There are.

Hamstring strains and all muscles strains and tears are graded on a three-tiered system. The three grades of muscle strains include:

  • grade I: the muscle fibers are simply overstretched, and microscopic tearing of the tissue may be present. Typically, there are no outward signs of a grade I muscle strain. Pain and limited mobility are present.
  • grade II: partial tearing of the hamstring muscle, with moderate swelling and bruising present.
  • grade III. Full thickness tearing of the muscle tissue, with significant pain and loss of mobility, swelling and bruising in the back of your thigh.

Your doctor may examine your condition and may order special tests, like an MRI, to determine the full severity of your hamstring strain. Sometimes, no diagnostic tests are ordered, as the signs and symptoms of your hamstring strain may be readily apparent to make the diagnosis.

Physical Therapy Evaluation for a Hamstring Strain

When you first visit a PT for treatment of your hamstring strain, he or she will conduct an initial evaluation to gather information about your condition and to determine the best treatment. Components of a PT evaluation for hamstring strain may include:

  • discussion of your injury and health history. Your PT will discuss how your injury occurred and how your symptoms are behaving and changing. Your therapist will discuss your health history to determine if there are any reasons to not provide treatment or if your condition may require a more extensive examination by your doctor or an orthopedist.
  • palpation. Your therapist may palpate, or examine by touch, your hamstring muscle and surrounding tissue.
  • measures of ROM and flexibility. Your physical therapist will measure the ROM of your hip and knee. Hamstring strains typically limit the amount of motion and flexibility around these joints.
  • strength measurements. Your PT will measure the strength of your hamstrings and surrounding muscles.
  • functional mobility measurements and observations. Your physical therapist will check on how your hamstring pain limits your ability to perform normal activities. He or she will watch you walk, run, climb stairs, or jump, depending on the severity of your condition.
  • balance. Your PT may use specific tests to measure your balance and proprioception, both which may be impaired due to your hamstring injury.

Your physical therapist will use the results of the evaluation to form a specific plan of care for your hamstring strain rehab.

PT Treatment for a Hamstring Strain

After your PT works with you to develop a specific treatment plan for your hamstring strain, he or she will start treatment. The main goals of PT for a hamstring strain include restoring normal flexibility and ROM, regaining normal strength, controlling pain and swelling, and helping you get back to optimal function.

There are many different treatments and modalities that your PT may choose to use for your hamstring strain. These may include:

  • ultrasound. Ultrasound is a deep heating treatment that can help improve circulation and extensibility around the injured tissues of your hamstring. Your PT may use this treatment although research indicates that the use of therapeutic ultrasound in musculoskeletal applications may not offer the benefit that was once believed.
  • Massage. Massaging the injured tissue can help improve scar tissue mobility.
  • electrical stimulation. Electrical stimulation may be used to accomplish different goals during your hamstring rehab. Your PT may use e-stim to help control your pain, decrease swelling or improve the way your hamstring muscle contracts.
  • kinesiology taping. Some physical therapists use kinesiology taping techniques to help improve the way your hamstring muscle functions. Kinesiology taping can also be used to decrease swelling and bruising around your hamstring muscles. There is limited research about the use of K-tape, so discuss the use of this modality with your therapist.
  • gait training. After severe hamstring strains, you may be required to walk with crutches while things are healing. Your PT should teach you how to walk properly and how to progress from using an assistive device to walking normally.
  • ice. Ice may be used during the acute phase of injury to control swelling and to decrease pain that you are feeling.
  • heat. Your physical therapist may use moist heat packs to help relax your hamstring muscles and to improve tissue extensibility prior to stretching.

The most important treatment your therapist can offer you is therapeutic exercise. Your PT will prescribe specific exercises for you to do in the clinic, and a home exercise program will likely be prescribed for you to do on a regular basis. This helps you take control of your hamstring strain rehab and puts you in the driver’s seat with your care.

Exercises for a hamstring strain may include:

  • hamstring stretches. Static and dynamic hamstring stretching exercises can help improve the way your hamstring functions. Remember, the injured muscle forms scar tissue as it is healing, and one of the best ways to remodel this tissue is with the movement that occurs with stretching. While stretching, you should feel a strain or pull in the injury site, but it should return to your baseline feeling within minutes of stopping the stretch.
  • lower extremity strengthening exercises. After a hamstring strain, your PT may prescribe strengthening exercises for your hamstrings and the surrounding muscles. Exercises should start slow and be painless. As your injury heals, you can progress to more intense strengthening exercises.
  • hip and core strengthening exercises. Research indicates that keeping your hips and core muscles strong can be an effective way to return to normal activity after a hamstring strain. Advanced hip strengthening and dynamic abdominal strengthening may be prescribed during your hamstring rehab.
  • agility drills including hopping and jumping. As your rehab progresses, your PT may have you engage in more advanced agility drills such as hopping and jumping. Learning to jump and land properly can help protect your hamstrings (and other lower extremity joints and muscles) from injury as you return to active participation in sports.
  • balance and proprioception exercises. Working to maintain appropriate balance and lower extremity awareness may be a part of your hamstring strain rehab. This can help ensure that your muscles are working properly to keep your hips, knees, and ankles in the right position while walking, running, and jumping.

Your PT should explain to you the rationale for each exercise you do, and he or she should make sure you are exercising correctly. If you feel any pain or have questions about your exercises, speak with your physical therapist.

How Long Will it Take to Get Better?

Hamstring strains can be one of those nagging injuries. Research shows that the typical hamstring strain gets better in about 40 days or so. Your specific injury may take longer or shorter depending on the severity of the strain.

One problem with hamstring strains is that they may be re-injured if not rehabbed properly. Recurrence of hamstring strains usually happens within the first year of injury. Working with your PT to learn the right exercises to do can help you minimize your chances of hamstring strain re-injury.

Prevention of Hamstring Strains

Is there a way to prevent or minimize your chances of suffering from a hamstring injury? There may be. Research shows that people who maintain good hamstring strength (especially eccentric strength), may be less likely to strain their hamstring. Eccentric strength is when your muscle contracts while it is lengthening. The Nordic eccentric hamstring exercise, although difficult to do, has been shown to decrease incidence in hamstring strains in elite athletes.

Performing agility drills, like the single leg hop exercise and the drop jump exercise may also help you prevent hamstring strains. Being able to jump, run, and perform high-speed starting and stopping may help train the hamstrings to work properly while participating in sports.

There may be a protective effect of maintaining good mobility, muscular control of the hamstrings and surrounding muscles, and good agility. Again, work with your PT to find out which are the best exercises for you to do to reduce your risk of hamstring injuries.

A hamstring strain or tear can be a painful injury that prevents you from participating in normal work and recreational activities. If you have a hamstring injury or pain, check in with your doctor to see if PT is right for you. Your physical therapist can help manage your pain and improve your mobility and strength so you can get back to your normal activities quickly and safely.

Sources:

Bourne, MN et al. "Eccentric knee flexor strength and risk of hamstring injuries in rugby union." Am J Sports Med. 2015 Nov;43(11): 2663-70.

Goosens, EW et al. "Lower eccentric hamstring strength and single leg hop for distance predict hamstring injury in PETE students." Euro J of Sport Sci. 2015 15(5): 436-42.

Sherry, MA and Best, TM. "A Comaprison of 2 rehabilitation programs for treating acute hamstring strains." JOSPT, 2004; 34(3):116-125.

Continue Reading