I Pulled My Hamstring, Now What?

If you experienced a sudden pop or pull in the back of your thigh, followed by pain with movement, tenderness, and maybe even some discoloration and swelling, you most likely just strained your hamstring. This injury typically occurs when an athlete is sprinting, but it can also occur in other scenarios like when jumping or cutting. If this is you, you’re probably asking yourself “what do I do” or “what happens now”… Let us shed some light on the subject!

A muscle strain in general is the stretching or tearing of muscle fibers when they cannot meet the demands placed on them at the moment of stress. Strains typically occur in two ways. The first is that the muscle is forced to contract too strongly or quickly when trying to do its intended job under increased stress. The second is that the muscle is stretched beyond its normal limits. Some risk factors that can make it more likely you will have a muscle strain are muscle weakness, muscle imbalances, muscle fatigue, and activity/sport of choice. Having a previous muscle strain also puts you at a higher risk for sustaining another injury. Lucky for you, hamstring strains usually respond very well to conservative, nonsurgical treatment with physical therapy tailored to the severity and presentation of your injury. Here at Kinetic Sports Medicine and Performance, we believe treating hamstring strains through early exercise for pain relief and mobility, addressing strength and power deficits, and targeting your sport specific needs to prevent further injury! 

Let’s dive into what your “now what” looks like after sustaining a hamstring strain.

First, having a medical professional evaluate your hamstring injury is key. This is important for figuring out the severity of your strain, including your strength and mobility deficits so that we know where to start and what to address. Here are a few objective measures we take when you come in:

1. Girth measurements: If there is noticeable swelling at the site of injury, we will take circumferential measurements around each thigh at different points to see just how swollen your injured leg is compared to the uninvolved side. This gives us good objective information we can track throughout your rehab process.
2. Movement screen: It’s also important that we figure out what basic movements are affected by your injury. We’ll ask you to walk, squat, and lunge among other things to see how you move and if pain is limiting you. This screen may look different from patient to patient depending on the severity of your injury. Our goal is to find what you can do without pushing into pain.
3. Hamstring extensibility/flexibility ranges: This is basically a test of how flexible your hamstrings are. After an injury to your hamstring, the muscle will typically seize up and become much less flexible because it is trying to protect itself from further damage. We want to know at what range of motion you feel tightness or a pulling sensation versus pain in your hamstring, and we compare these results side to side. This loss of mobility is one of the first things we will address in therapy.
4. Hamstring strength: Yes, you read that right, we are going to look at your hamstring strength! We will not have you perform any maximum strength testing, but it’s important for us to figure out your pain threshold and at what hamstring length you have the most pain. We use the dynamometer to measure your strength with your knee bent to 90 degrees, bent to 135 degrees, and at almost full knee extension at 0 degrees. You will perform all 3 of these tests with your uninvolved side first at full strength. Then, we will cue you to only pull as much as you can WITHOUT pain on your injured side. This gives us good baseline information that we will continue to track throughout your rehabilitation. 

Now that we have a better idea of the extent of your injury, you’re ready to get to work! Here’s a breakdown of the stages of rehab for a strained hamstring. Keep in mind these stages will look very different for each athlete depending on their level of injury and the sport they are returning to!

1. Early Stage Rehab: This stage of rehab is commonly mishandled. Many athletes are advised to just ice and rest, but this is the opposite of what they should be doing! While it is important to not exacerbate the injury and make it worse, it is also important to avoid complete rest.

• Goals:
  • Decrease swelling and pain
  • Restore any lost mobility
  • Initiate low level strengthening

2. Mid Stage Rehab: To progress to this stage, the athlete should have improved active mobility and should be pain free with most daily tasks. Once they have achieved these things, they are ready to begin more advanced strengthening. 

• Goals:
  • Increase strength and extensibility of the hamstring, particularly at longer muscle lengths
  • Increase surrounding muscle strength, resuming nearly full weight room training
  • Progress running speed and distance

3. Late Stage Rehab: This stage tends to look different for every athlete as we begin to work towards specific return to sport movements and target individual strength/power/rate of force deficits. Some general things that we like to see prior to this stage include the ability to work through full lengthening and shortening muscle actions under load, restoration of 80% of strength on each leg, adequate control and tolerance to basic lower extremity strengthening movements, and tolerance for higher speed movements like jumping and running. 

• Goals:
  • Reach 90% of strength of uninvolved limb through full range of motion
  • Tolerance of eccentric muscle action at longer muscle lengths and higher speeds
  • Restoration of rate of force development of muscle
  • Returning to modified sport practice
  • Sprinting!!!

Sprinting is a VERY important part of the rehab process after a hamstring strain. For some reason this is often avoided, but sprinting is the most common way hamstring strains occur! For this reason, a gradual, progressive, and well thought out sprinting program should be incorporated in every rehab program. Sprinting is one of the most demanding activities on the hamstrings and it is the most specific exercise for athletes to return to their sport. 

Is your “now what” question answered? 

Hamstring strains can be daunting, but when treated early with an individualized and progressive rehab program, you could be back on the field sooner than you think! And even when you think your rehab is complete, it’s important to continue strengthening your hamstrings because once you’ve strained a muscle you are at a much higher risk for straining another!

Don’t let a hamstring strain be your downfall! Come see us for a full evaluation today! Book an appointment today with one of our doctors of physical therapy.

Check out our Free Mini Course on Durable Hamstrings for Athletes to keep your hamstrings healthy and keep you playing your sport!