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The hamstring muscle is in fact a group of three muscles –  the semimembranosus and semitendinosus medially (more inward) and the biceps femoris laterally (more outward) which is divided into a long and short head. ( see picture)

A substantial force is usually required to develop an acute muscle strain in the hamstrings. This is so much the case that individuals can typically recall precisely when their injury took place. A few risk factors are listed below:

• Age – the older athlete has an increased risk of acute hamstring strains.
• Previous injury – a prior history of acute hamstring strain increases the risk of future injury
• Hamstring:Quadriceps strength ratio – the weakness or strength of the hamstrings and quadriceps n relation to each other are seen as a risk factor.
• Poor lower limb proprioception( knowing where your limb is in space)

There are 2 distinctly different types of acute hamstring strains. The more common of the two, Type 1 hamstring strains usually occur during high speed running when the hamstrings is working eccentrically and involve the long head of biceps femoris most commonly at the upper muscle-tendon junction. These types of strains seem worse in the early stages of the injury with a marked acute decline in function but respond well to treatment and typically require a shorter rehabilitation period than the type 2 hamstring strains.

Type 2 hamstring strains occur during movements leading to extensive lengthening of the hamstrings into hip flexion such as high kicking or sagittal ( front) splits and are typically located close to the ischial tuberosity (high up the leg, in the bum region) and involve the uppermost free tendon of semimembranosus. These types of injuries can have less dramatic acute limitation but their rehabilitation period is often longer than that of type I strains.

The most common cause of posterior thigh pain is hamstring muscle strains but that does not rule out referred pain into this area from other structures such as the lumbar spine, the sacroiliac joint and trigger points in the gluteus minimus and meduis, as well as the piriformis muscles.

Management of the acute hamstring strain starts off in the acute phase by following the RICE (rest, ice, compression, elevation) principles in the first 48 hours as well as commencing with early pain-free muscle contractions. Subsequently recovery moves onto moving onto stretching, neural mobilisation, soft tissue treatments, strengthening and assigning a running program and/or individualised sport-specific training.

Acute hamstring strains are common injuries in most popular sports and have a very high recurrence rate of injury. Therefore having a good prevention program is essential. It has been suggested that a balance/proprioception program, regular soft tissue therapy and eccentric hamstring exercises may help prevent hamstring injuries.

Some of the best eccentric exercises for prevention of hamstring strains are Nordic Drops and Askling’s gliding exercises  and it’s important to see your physiotherapist for assistance in this regard.  But, be aware that in those new to eccentric muscle training, it can result in muscle damage and delayed onset muscle soreness. Therefore, any eccentric strengthening program should factor in adequate time for recovery.

Andrew@PhysioPRO