Hamstring Strain

HAMSTRING STRAINS

Hamstring strains are common with sprinting, kicking, and quick deceleration. Physio treatment focuses on reducing pain early, then rebuilding strength and eccentric control so it doesn’t re-tear.

1. *Acute phase: first 48-72 hours*

Goal is to calm pain and bleeding without overprotecting.

- *Load as tolerated*: Walk normally if you can. Crutches only for severe grade 2-3 tears. Complete rest delays healing.

- *Compression & elevation*: Helps control swelling in the thigh.

- *Gentle movement*: Light knee flexion/extension within pain-free range. Avoid aggressive hamstring stretching - it pulls on the healing fibers.

- *Avoid*: Heat, massage, and stretching in the first 48h. They increase bleeding.

Grade it: Grade 1 = mild pull, Grade 2 = partial tear, Grade 3 = full rupture. Most are grade 1-2 and heal conservatively.

2. *Strength and mobility phase*

Start once walking is pain-free and you can contract the hamstring gently.

- *Isometric holds*: Hamstring bridges, prone holds with knee at 20-30° flexion. Builds strength without lengthening the muscle.

- *Progressive loading*: Slowly add range. Start with double-leg bridges, move to single-leg, then RDLs with light load.

- *Eccentric work*: This is the key for hamstrings. Nordic hamstring curls, slider leg curls, slow lowering in RDLs. Eccentric strength prevents re-tears.

- *Hip and glute strength*: Weak glutes force hamstrings to overwork. Hip thrusts, clamshells, single-leg bridges.

3. *Functional and return-to-sport phase*

Once you can jog pain-free and do single-leg RDLs with light load:

- *Running drills*: Start with walk-jog intervals, build to sprints.

- *Plyometrics*: Hops, bounds, deceleration drills. Land soft, control the hamstring on landing.

- *Sport-specific work*: Cutting, kicking, acceleration drills at increasing intensity.

- *Flexibility*: Only add stretching once strength is back. Dynamic warm-ups > static stretching for prevention.

4. *Why hamstrings re-tear*

Re-injury rates are high because people return to sprinting too early and skip eccentric work. The hamstring needs to handle lengthening under load. If you can’t do 5 controlled Nordic hamstring curls pain-free, you’re not ready for full sprinting.

5. *What to watch for*

- *Proximal hamstring tendinopathy*: Pain high up near sit bone. Needs more hip-hinging, less aggressive stretching.

- *Nerve involvement*: If pain runs down leg with tingling, check for sciatic nerve tension.

- *Bilateral weakness*: Often one side is weak, the other overworks and strains.

Timeline

- Grade 1: 1-3 weeks

- Grade 2: 3-6 weeks  

- Grade 3: 8-12+ weeks, sometimes surgical if tendon avulsed

Return to sport test: Pain-free sprint at 80-90% speed, 10 single-leg bridges, 5 Nordic curls, and no pain with hamstring palpation.

Are you dealing with a fresh pull or a recurring one? Recurrent strains usually mean the eccentric strength and glute activation weren’t fully fixed.

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