Abstract
CLINICAL PRESENTATION & EXAM: A patient with a hamstring strain will present with pain on the posterior thigh, swelling and bruising, and tenderness at the muscle-tendon junction. Stiffness and weakness are present on the upper posterior aspect of the injured leg. The patient may experience a popping sensation at the time of injury, as well as pain when sitting or extending the knee. The exam will begin by palpating the hamstring at three locations; bicep femoris which is lateral of the midline, semimembranosus which is medial to the midline, and semitendinosus which is between the bicep femoris and semimembranosus. A test of the range of motion (ROM) may indicate signs of a hamstring strain along with possible bruising and swelling. ANATOMY & PATHOLOGY: Rapid acceleration and deceleration movement of the thigh can result in an eccentric overload causing a strain of the hamstring muscle fibers. Hamstring strains are classified using three grades of severity. Grade one- minor hamstring strain from overstretching with swelling and pain with 0-4 weeks recovery. Grade two- one or more muscles are partially torn resulting in more pain and swelling resulting in limited use of the affected leg for 2-6 weeks during recovery. Grade 3- the muscle tissue completely tears away from the tendon or bone. This is the most severe grade which takes 4-8+ weeks to recover. The pathology of the hamstring strain may include fiber disruption, inflammation, and scar tissue formation. DIAGNOSTIC TESTING & CONSIDERATION: A hamstring strain is diagnosed by observing, palpation, testing strength with resisted knee flexion, bent knee stretch, and a straight leg raise. A Nordic hamstring test may be used to assess eccentric and concentric strength of the hamstring. Further objective testing will include an ultrasound for muscle tears and hematoma formation and/or magnetic resonance imaging (MRI) to assess the severity of the strain differentiating between partial or complete muscle tears. A hamstring strain could be misdiagnosed as sciatic nerve irritation, ischial tuberosity avulsion, deep vein thrombosis (DVT), and gluteal strain or lumbar radiculopathy which can overlap with hamstring injuries. TREATMENT & RETURN TO ACTIVITY: For an acute hamstring strain (0-7 days) patient should follow the rest, ice, compression and evaluation (RICE) protocol to help relieve swelling and promote healing and flexibility. The patient may take pain/anti-inflammatory medication like ibuprofen and avoid strenuous/aggressive stretching. In weeks 1-4 emphasis is on restoring strength and flexibility. A physician can prescribe light resistance isometric holds, glute bridges and swimming or cycling, if pain free. In weeks 4-8 exercises such as Romanian deadlifts, single-leg bridges, plyometrics, dynamic drills like side shuffle and lateral movements are used. Sport-specific cutting, sprinting, and jumping, may be prescribed as well. Strength, range of motion, swelling, and pain levels should be monitored closely to ensure appropriate healing is occurring. Apply effective warm-ups, eccentric strength training along with hip and core stability, while monitoring workloads to avoid reinjury risks.
Recommended Citation
Lapole, Christopher; Spindler, Lindsay; and Ruot, Chuck
(2025)
"Hamstring Strain,"
International Journal of Exercise Science: Conference Proceedings: Vol. 2:
Iss.
17, Article 171.
Available at:
https://digitalcommons.wku.edu/ijesab/vol2/iss17/171
