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Hamstring Strain

Hamstring strain: does physiotherapy help with hamstring injury?

Hamstring strain causes and treatment explained. Why physiotherapy is vital post injury.

Quick take:

  • Regular physiotherapy can reduce the risk of hamstring injury and re-injury.
  • If not torn, hamstring muscles will heal without surgery.
  • Lack of professional care may lead to long term pain or disability.

Hamstring strain and physiotherapy summary

Often misunderstood and inadequately treated, hamstring strain accounts for between ten to thirty percent of all sports-related injuries. But how does hamstring injury happen?

A violent stretch or contraction while running, walking, or exercising may partially, or completely tear one of the three hamstring muscles. Bicep femoris, semimembranosus, and semitendinosus -located at the back of the thigh- are collectively known as hamstring muscles.

These muscles flex at the knee and extend at the hip.  When strained or damaged, you will experience a sharp pain near your buttocks or in the area that attaches to your knee.

A fall, accident, old age, previous injuries, strength imbalance, poor core stability, and other factors listed below may increase the risk of occurrence.

Hamstring anatomy and why physiotherapy is vital for recovery

While walking or running, hamstrings pull the leg backward (hip extension) and bend the knees (knee flexion). Injury often happens in the area where the muscles join (musculotendinous complex), explaining why hamstring strain is the most common type of injury in sports. Swelling happens because the body produces chemicals and enzymes in the area. If the muscles tear off completely (avulsion), you will need surgery, followed by weeks or months of physiotherapy to aid repair and strengthen the muscle.

In short, Physiotherapy helps patients who have a hamstring tear or strain to; (1) reduce or manage pain. (2) to fully recover from the injury by improving core stability, increasing muscle strength, and promoting healing.

How to self-diagnose hamstring strain

Whenever you feel mild or severe pain, you must seek help from a healthcare provider. Because left untreated, hamstring injury may lead to degeneration of your hamstring tendon, and that may lead to long-term pain and possible disability.

Remember, pain is your body’s way of telling you that something is wrong. You know that you have a strained hamstring if:

  1. You feel pain or have difficulty straightening your knee.
  2. Experience Pain or difficulty walking or running.
  3. Climbing stairs or taking large steps is painful or difficult.
  4. Long-lasting weakness or pain in your leg

What is the typical cause of hamstring strain?

If you experience a sudden sharp pain at the back of your knee or near the buttocks, sometimes accompanied by a tearing or “popping sensation, you may have a strained or torn hamstring muscle. Within a few minutes or hours, swelling and tenderness will develop. Some may experience discoloration or bruising along the back of the leg.

What are the causes of hamstring strain?

Hamstring tears do not result from direct trauma, instead, it is a stretch-induced injury caused by sudden-forced lengthening. The risk factors include:

  • Previous injury
  • Muscle fatigue
  • Stiffness or reduced flexibility
  • Preseason weakness

For athletes, the contributing factors include; being out of shape or overworking muscles, not warming up properly before and exercising, an imbalance in leg muscles, poor technique, or returning to activities too soon after an injury. For non-athletes. Old age, accidents, poor core stability, lack of exercise, are amongst the contributing factors.

We are all at risk of suffering hamstring strain or injury at some point in our lives. So, the important question is what should you do immediately after an injury and the weeks following?

Step 1: hamstring strain first aid (immediately after injury)

Warning: when you strain or tear a hamstring, do not stretch it out. Stretching out the injury may cause further damage and disrupt healing. Physiotherapists recommend that you wait at least five days before you stretch gently. The idea is to Let the symptoms guide you, that is, if the pain is severe or unmanageable, seek medical assistance right away. Whereas, If the pain is not serious, do the following:

Phase 1: first aid

  • Keep the leg comfortable, and apply a cold pack on it every two hours.
  • Use crutches to take the weight off the leg.
  • Get plenty of rest and do not put weight on the leg.

Phase 2: at home physiotherapy

If pain persists for more than 48 hours, seek the assistance of a physiotherapist. However, if you notice some improvement, you may:

  • Have someone perform cross friction massage to increase circulation, decrease collagen cross-linking, and promote optimal collagen healing.
  • Massage the leg with a roller.
  • Gently stretch the muscle.
  • Use an exercise ball to strengthen your leg or core.

Step 2: patient-specific hamstring strain physiotherapy

The first 24 to 48 hours are the most important. This is when you or the patient will experience most of the bleeding and swelling. To control the swelling, apply a cold pack to the affected area every one or two hours.

How will a physiotherapist help me?

Without proper medical training, you may not be able to comprehend the severity of the injury. To you, the damage may not feel serious. But. Internal bleeding -caused by torn arteries or muscles may lead to an embolism or blood clot, which may cause a heart attack.

The purpose of consulting with a physiotherapist is to; identify the extent of the injury, rule out other problems, including bone injury, reduce swelling, stop internal bleeding, and manage pain.

Note: the doctor may recommend imaging tests if unsure of the extent of injuries.

What if the muscle is torn?

If Hamstring strain results in torn muscle, you will need a surgeon to reattach and repair the injury. That is why it is crucial to consult with a physiotherapist immediately after an injury or if the pain or discomfort persists for more than 24 hours without showing any signs of improvement. Without corrective surgery, the result may be long-term pain or in some cases disability.

A complete hamstring tear happens when there is a sudden extension of the knee joint and bending of the hip joint.

You know that there is internal bleeding if:

  • The tissues form a hard bunch in the back of your thigh when bending the affected leg.
  • The skin is bruised or turns purple.
  • There is liquid pooling in the injured area.

Death from a torn or strained hamstring is rare, but it may happen if you do not seek proper care.

When to see a physiotherapist

Note: medical experts grade hamstring muscle injuries as mild, moderate, and severe.

  • Severe injuries result in complete tearing of the muscle-tendon unit. With physiotherapy, it may take weeks or months to fully heal. Without physiotherapy it may take months or years.
  • Moderate hamstring strain results in a significant but incomplete muscle tear. With physiotherapy and rest, it may take three to six weeks to fully recover. Without physiotherapy, the patient is at risk of suffering further injury and will take longer to heal.
  • A mild hamstring strain, as mentioned, is treatable at home with adequate rest and gentle exercise.

You may treat grade 1 or mild hamstring strain following the instructions above. However, if you experience significant pain walking or if the leg cannot bear any weight. You will need physiotherapy to aid recovery, prevent long-term damage, and relieve pain.

Grade 2 and 3 hamstring strain and physiotherapy

Often, the muscle affected in grade 2 hamstring strain is the long head of the biceps femoris. Your physiotherapist will recommend immobilisation for not more than a week. That will be followed by weeks of strengthening and corrective therapy.

How does physiotherapy help with hamstring strain?

Phase two of treatment (after rest and pain management) is delicate and if not done right or too aggressively, may result in further injury. Because of that, we recommend consulting with a physiotherapist. What a physiotherapist will do is design a personalized treatment program suitable to your injury.

Physiotherapy and hamstring strain rehabilitation

Physiotherapy rehabilitation combines multiple components including, joint electrotherapy, taping techniques, and patient-specific exercise prescriptions that help to improve mobility, improve the patient’s quality of life, and shorten the length of hospital stays.

The benefits of physiotherapy after hamstring strain or injury include:

  1. Reduced risk of injury reoccurrence.
  2. Quicker return to sport function
  3. Improved muscle length
  4. Reduced pain

Can you do hamstring physiotherapy on your own?

You may, but the risks involved in self-physiotherapy may worsen the problem. Remember, physiotherapy is patient-specific, so what works for one person, may cause problems for you. The risks include (1) overworking muscles, tissues, or tendons that need to recover (2) pushing past the pain may aggravate an underlying problem (3) aggressive stretching may lead to more tears.

A physiotherapist will check your history, account for past injuries, then craft a suitable program.

How will working with a physiotherapist benefit me?

We encourage physiotherapy at home. But if you have suffered grade 2 or 3 hamstring strain or other injuries that require physiotherapy. It is in your best interest to consult with a physiotherapist for the following reasons.

Pre-rehabilitation and post-surgery rehabilitation

If the hamstring injury (avulsion) suffered requires surgery, physiotherapy will help pre and post-operation. A torn hamstring may cause bleeding or hematoma. Hematoma left untreated, can be serious as explained above. Post-surgery, what physiotherapy will do is reduce swelling, bleeding and may prevent complete loss of hamstring function.

The University of Wisconsin Sports Medicine and Rehabilitation recommends a post-operation four-phased physiotherapy approach to prevent long term damage after a hamstring injury. that is:

Phase 1: range of motion and gait training for at least 6 weeks.

Phase 2: progressive supervised strengthening

Phase 3: speed and amplitude movement, and force distribution

Phase 4: rehabilitation.

Note: physiotherapy may help avoid the need for surgery and reduce hospital stay, that is why you must consult with a physiotherapist within the first forty-eight hours after injury.

Injury prevention and recovery

With years of training, physiotherapists craft a recovery or prevention program suitable for the sport you play. So, if you are an athlete, thinking of becoming one, or are planning to start exercising, it is in your best interest to consult with a physiotherapist.

Improved balance and Age-related issues

The older you get, the higher at risk you are of falling and injuring yourself. A fall risk assessment (see the snippet below), aims to identify risk factors contributing to your risk of falling, obtain a risk score, and formulate a personalized plan. If you have suffered a grade 2 or 3 hamstring strain, we recommend getting one done.

That said, physiotherapy improves core strength, muscle strength, and balance. The result is a lower risk of falling or causing further injury.

Without physiotherapy or specialised treatment, hamstring strain or injury will lead to weakened or tight muscles. Also, as mentioned, lack of treatment may result in disability or long-term pain.

Physiotherapy consisting of adequate rest, leg elevation, and compression in the early stages will help speed up healing and guarantee an optimal outcome. In the latter stages, a physiotherapist will recommend patient-specific exercises to strengthen recovering hamstring muscles, and improve flexibility.

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