Welcome to Hicksville Physical Therapy’s patient resource about leg and hamstring injuries.
The hamstrings consist of a large group of tendons and muscles located in the back of the thigh. Hamstring injuries are quite common, especially in athletes. Virtually any athlete in any sport or skill level could be at risk of hamstring or other leg injuries. Although these injuries can be incredibly painful, they typically heal by themselves. But in order for an injured leg or hamstring to get its full level of functioning back, it requires dedicated attention and a customized rehabilitation program.
This guide will teach you:
Where are the hamstrings, and what do they do?
The hamstrings make up the majority of the back of the thigh. Hamstrings are formed by three muscles and the corresponding tendons. The hamstrings join with the ischial tuberosity, a small bony projection below the buttocks, situated on the bottom of the pelvis. There is an ischial tuberosity both on the left and the right. The muscles of the hamstring extend down the back of the thigh. These tendons cross the joint of the knee and connect on the sides of the tibia (or shinbone).
The hamstring works by pulling the leg back and simultaneously pushing the body forward while running or walking, a motion referred to as hip extension. Additionally, the hamstrings perform knee flexion, in which they help bend the knees.
The majority of hamstring injuries happen in the musculotendinous complex, which is where the muscles join to the tendons. (Tendons are tissue bands that connect bones and muscles.) The hamstring’s musculotendinous complex is quite large, which explains in part why hamstring injuries are commonplace.
In a hamstring injury, the muscles’ or tendon’s fibers are torn, encouraging the body to produce enzymes and other chemicals at the injury site. These chemicals are responsible for the pain and swelling you feel.
In severe injuries, the muscle’s small blood vessels may also be torn, resulting in bleeding within the muscle tissue. Until these blood vessels can repair, the blood flow to the area is reduced, meaning the muscles are unable to heal.
The chemicals and blood clotting allow your body to heal itself. The muscle is healed as the body rebuilds muscle tissue and creates scar tissue. By carefully stretching and gently working out the injured muscle, you can ensure maximum muscle tissue during healing.
Rarely, hamstring or leg injuries can make the tendons and muscles tear away from the bone. This instance is more typical where hamstring tendons attach to the ischial tuberosity. These tears are referred to as avulsions, and in some cases, they require surgery.
How do hamstring injuries occur?
When the leg or hamstring muscles stretch too far, injuries can occur. Most hamstring injuries are caused by spring or other quick, twisting motions performed with the legs. Kicking, jumping, and running sports are major causes of hamstring injuries.
Hamstring injuries can also be caused by sports like ice skating, dancing, weightlifting, and water skiing. These sports are more likely to cause avulsions as well.
Major risk factors of hamstring injuries include poor flexibility and low fitness levels.
Hamstring injuries are rare in children, largely because of their flexibility. Hamstring injuries can also be caused by a lack of proper warmup or muscle fatigue.
Leg muscles at different strength levels may cause hamstring injuries. One leg’s hamstrings may be stronger than those of the other leg, or the muscles of the quadriceps on the thigh’s front may be stronger than the hamstrings.
What does a hamstring injury feel like?
Hamstring injuries are normally sustained during heavy exercise. In particularly bad cases, an athlete may hear a sudden “pop” and fall to the ground. The individual may experience mild pain when walking even if the injury is severe. But continuing to exercise strenuously will be impossible, and the pain will continue.
In less severe cases, athletes will note a pulling or tightness in the hamstring, causing them to slow down. This hamstring injury may result in long-lasting problems.
The hamstring could simply be pulled, or it may be partially or completely torn. The injury may occur at the musculotendinous junction (as previously discussed) within the muscle, or where the tendon attaches on the ischial tuberosity (avulsion). In rare cases of total tears, the pain is intense. The torn tissues may form into a hard bunch in the back of the thigh, particularly when the leg is bent. The skin could turn purple and bruise as a result from bleeding under the skin. This can look dangerous but is not necessarily so.
How do health care providers diagnose the condition?
During your visit to Hicksville Physical Therapy, our Physical Therapists will get your full medical history and will ask about your activities, exercise schedule and regimen, and your warmup routine. You’ll also be asked to describe your symptoms.
Your Physical Therapist will then examine your thigh, flexing and extending your leg, among other movements. The movement and probing may be painful, but it is necessary to identify the exact location and cause of pain.
Hamstring injuries can be categorized in one of three groups, depending on how severe the injury is. These images depict each grade of injury:
Grade One – Mild
Grade Two – Moderate
Grade Three – Severe
Grade One injuries are simple muscle pulls that do not cause much damage to the tissue structure. Grade Two injuries are partial tears, while Grade Three injuries are complete tears.
In some cases, you may be referred to a doctor for further diagnosis. After your diagnostic exam, our Physical Therapists at Hicksville Physical Therapy can offer treatment plans to speed up your recovery, allowing you to get back to your daily lifestyle more quickly.
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It is crucial to properly treat and rehabilitate your leg or hamstring injury. If not treated correctly, you could be at increased risk of reinjury.
Each patient will experience a unique recovery rate, but in general, small muscle pulls will take two to four weeks to heal and allow you to safely return to your daily activities. More severe muscle tears will need to heal for two or three months, and to completely heal, your injury may need four to six months.
When you start your program with Hicksville Physical Therapy, within the first few days after the injury, we will aim to control the pain, swelling, and hemorrhaging (bleeding). Leg and hamstring injuries are first treated with the RICE method: Rest, Ice, Compression, and Elevation.
Your Physical Therapist will likely recommend a few days (up to a week) of immobilization, though severe tears may need longer rest periods. You may need to spend the majority of your time lying down, or you might need to use crutches for a few days. If too much weight is put on the leg or hamstring, the damage may worsen, forming extra scar tissue. Your Physical Therapist will show you how to use your crutches properly.
Ice will be applied to your injured leg to control pain and swelling, but these symptoms won’t stop completely. This is important, as your inflammatory response will help your muscles heal. Cold treatments work to slow blood flow and metabolism in the area, numb the nerves to lessen your pain, and reduce muscle spasms by helping you relax.
The most effective cold treatment involves a plastic bag filled with crushed ice or ice cubes, secured to the leg with an elastic bandage. Keep the ice on the injury for 10-15 minutes. Cold gel packs, cold sprays, and chipped ice can work as well. Cold treatments should be done at least four times daily for the first two to three days. If needed, you can repeat these treatments every two hours. Don’t keep the ice on for too long, or you could run the risk of frostbite.
Compression is used to reduce muscular bleeding to limit scarring and swelling. Your Physical Therapist will use an elastic bandage to firmly wrap the hamstring, applying compression. While it’s unclear how much compression helps hamstring and leg injuries, patients do often report reduced pain.
Elevation keeps your leg still and can reduce swelling. To elevate properly, raise the injured body part above your heart level. For a hamstring injury, you’ll need to lie down and support your leg with pillows.
Your Physical Therapist could also recommend a short course of NSAID (nonsteroidal anti-inflammatory drugs) like ibuprofen to reduce pain and swelling. NSAIDs are used in muscle injuries mainly for pain relief; swelling may not be reduced much in muscle injuries.
Health care providers are still determining when to give NSAIDs. Some providers believe that they should be used immediately following the injury and should be continued for three to five days. Other providers think they shouldn’t be used for two to four days after the injury, allowing your body some time to heal naturally first. Inflammation is an important part of natural healing. Either way, it is critical that you follow the advice of your health care provider.
Stretching & Exercise
As the leg and hamstring start healing, it’s important to follow your Hicksville Physical Therapy exercise program to help you regain mobility and strength. Our exercises are specially designed to help your body rebuild muscle as opposed to scar tissue. They also help prevent reinjury. Rehabilitation may be slow, so it’s important to be patient and not move too fast.
In the early stages of your program, our Physical Therapist may recommend low-resistance exercises in a swimming pool or on a stationary bike. You can then take your hamstrings through various motions without having to support your weight. When you can walk with little tenderness and no longer have a limp, you will begin a walking program and will eventually work up to jogging.
Your rehabilitation program will also involve lots of stretching. Your Physical Therapist will show you the proper technique. You’ll need to continue these stretches after you heal, as you may be at increased risk of reinjury. Stretching regularly and increasing your flexibility could help you avoid future injuries to the same hamstring. Maintaining flexibility can keep your hamstrings healthy.
You may begin with some isometric exercises, which involve contracting your muscles but not moving your leg joints. Your hamstrings will strengthen, and you will eventually add light weights to your routine. It is critical that these exercises bring no pain.
You should maintain a general fitness routine throughout your rehabilitation. Our Physical Therapists will suggest exercises that do not stress your legs or hamstrings.
The majority of hamstring injuries get better with simple treatments and rehab. Many world-class athletes who have suffered severe hamstring injuries can typically return to competition. Keeping the hamstrings and legs flexible and allowing adequate time to heal should allow you to get back to your daily activities.
The need for surgery is rare and is only necessary in cases of complete avulsions or tears. If you do undergo surgery, you’ll begin recovering with a rest period, which could involve crutches. Your Physical Therapist will demonstrate proper use of your crutches and show you how to prevent putting too much weight on your injured leg. Following surgery, our Physical Therapists will begin a gradual exercise program with you.
When your recovery has progressed significantly, you will no longer have regular visits to Hicksville Physical Therapy. We will keep being a resource for you, but you will be in charge of continuing your exercises in your home as part of an ongoing program.
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Our team may recommend a lumbar support belt or corset, although their benefits may not be prevalent in every patient. Lumbosacral corsets have not been proven to provide long-term benefits; however, they have been shown to provide temporary relief of symptoms so long as the piece is being worn. The provided support can limit not only the amount of pressure the spine is receiving but extra movement as well. However, the negative is that a corset can lead to potential weakening of the back and abdominal muscles. Some medical professionals will recommend a rigid spinal brace that will hold the spine in a slightly flexed position. Whatever is chosen, when worn as prescribed, will generally be limited to one to two weeks.
Our team at Hicksville Physical Therapy may also recommend using traction. Traction is often used to treat stenosis as it stretches the lower back, relieving pressure on the spinal nerves. Treatments that are more hands-on, such as massaging and soft-tissue mobilization, may be used in the beginning to help you move with less pain and greater ease.
Hamstring injuries that require surgery are rare. However, surgery is sometimes needed for avulsions in order to reattach the torn hamstring tendon to the pelvis. If surgery is not conducted soon after an avulsion, the tendon could retract further down the leg, and scar tissue could form around the tendon’s torn end. Both consequences can make surgery more difficult.
To start the surgery, the surgeon will make an incision over the area where the hamstring tendon usually attaches to the pelvis. They will locate the hamstring tendon’s torn end, and they will insert forceps into the incision to grasp the tendon’s free end. The surgeon will then pull on the forceps and move the hamstring’s end back to its original position. Then, the surgeon will cut away any scar tissue from the hamstring tendon’s free end.
The ischial tuberosity, or the original attachment on the pelvis, is then prepared. A special instrument known as a burr will be used to shave the surface of the tuberosity. Large staples or sutures will be used to reattach the hamstring tendon to the pelvis.
When the surgeon is happy with the repair, they will close the incisions.
Complete tears of the hamstring muscles may require surgery as well. Your surgeon will make an incision on the back of the thigh above where the torn hamstring muscle is located. Then, the two torn ends of the muscle are reattached and sown together.