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Posterior (Back) Thigh

Injury Information

Hamstring muscle strain/rupture

The hamstrings form the group of muscles at the back of the thigh. A hamstring strain is caused by an over-stretch, tear or complete rupture of one or more of the three hamstring muscles (e.g. when sprinting from either a jog or a standstill position). Hamstring strains are common in sports that require explosive stop-start running motions (e.g. rugby, netball and athletic sprinting events).

Hamstring strains occur as a result of too much force being placed on the hamstrings muscles during exertion. This occurs often when the hamstrings are tightening to slow the legs forward swing during running. They are common amongst sprinters, jumping sports, footballers and hockey players. Hamstring strains or ruptures may occur due to, muscle weakness and tightness or lumbar spine tightness.

Hamstring strains frequently occur at the beginning of a game/training session due to inadequate warm-up, or near the end of the game/training session when fatigue is a contributing factor.

Symptoms include a sudden, sharp stab during exertion with swelling and bruising increasing in the hours following. Pain will increase with contracting or stretching the injured muscle. Hamstring strains may become recurrent if adequate stretching and strengthening is not achieved before return to sport.

Poor rehabilitation can leave inflexible scar tissue making it prone to re-injury. Hamstring injuries often recur and can become long-term injuries if rehabilitation is inadequate or the progression of rehabilitation is too fast.

Referred pain

Referred pain in this area will tend to be less that of a strain and will be poorly localized. The sacroiliac joint and lumbar spine tend to refer pain to the hamstring area. Tightness in the hamstring as well as lumbar, buttock and calf pain may or may not accompany the hamstring pain. Pain may be shooting or a dull ache and may or may not be constant.

Hamstring tendonitis

This problem is commonly encountered by short distance sprinters or after an inadequately managed hamstring strain. The upper part of the hamstring is most commonly affected and symptoms are subsequently felt in the buttock. Pain will tend to arise slowly after exercise and may feel like a deep burning or sharp pain, low down in the buttock. As the injury progresses untreated, weakness and tightness may be felt in the hamstring area (back of the thigh). Pain may ease in the short term with light hamstring stretching.

Injury Treatment

Exercises

Strengthening programs should only be commenced when:

  • The injury is not painful to touch.
  • The injury is not painful in the morning.
  • The injury is not painful to stretch.
  • The injury is not painful with light to moderate exercise.

Exercises should be 3 sets of 8-12 repetitions.

Early Injury Management

For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.

R - Rest

I – Ice

C - Compression

E – Elevation

Rest from aggravating activity.

Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.

Compression can be achieved with an elastic bandage.

Elevation is used to help swelling to return to the heart through the blood stream.

The injured area should be elevated above the level of the heart.

Stretching

Restoring normal range of motion will allow proper function of the hamstrings and maximise use and strength following a return to sport. Stretching the hamstrings will help to restore the length of the muscles, reducing the risk of further injury and assist performance. Initial stretching should be limited by pain. Longer stretches (10 to 20 seconds) held at positions of greater stretch should be performed as comfort permits. A level of flexibility equal to or greater than the opposite leg is desirable before return to competition. Continued stretching during the season will help to maintain flexibility and minimise the risk of further injury.

Stretches

  • Stretches to be held for three sets of 20 to 30 seconds
  • A light warm-up such as walking or exercise bike for five to ten minutes, should be undergone before stretching
  • Stretches should be held just at the first point of tension.
  • Stretching should be slow and gentle and no excessive tension or discomfort should be felt during stretching.
  • Stretches can be done to help treat an injury but should also be done before and after exercise.

1. Hamstring stretches

2. Gastrocnemius Stretch

3. Gluteal Stretches

Exercises

Strengthening the hamstrings and other lower limb muscles is essential to restore proper function in the lower limb. Pay particular attention to developing a good strength balance between the quadriceps (front thigh muscles) and the hamstrings. Strengthening of the gluteus maximus (buttocks) and gastrocnemius (long calf muscle) is also important. Holding the leg in a fixed position for 10 to 20 seconds (isometric exercise) is safe until the wound is significantly healed and also prevents muscle wasting. As improvements allow, active (self-movement) and functional strength exercises should follow. Some strength exercises also need to be performed as the muscle lengthens (eccentric work) and/or at fast speeds to gain improvements. This kind of strengthening will ensure minimisation of re-injury when kicking a ball or slowing down when running. Strength can be measured by contracting against resistance provided by another person. Ask them to make a comparison of strength between legs.

Strengthening programs should only be commenced when:

  • The injury is not painful to touch.
  • The injury is not painful in the morning.
  • The injury is not painful to stretch.
  • The injury is not painful with light to moderate exercise.

Exercises should be 3 sets of 8-12 repetitions.

1. Hamstring Curl

2. Squat (Quadricept and Gluteal Strength)

3. Calf Raise

1. Exercise Bike

  • The exercise bike provides for effective general knee strengthening, it is low/no impact and provides a consistent resistance for muscle strengthening.
  • The exercise bike can also be an effective exercise for conditions where joint stiffness is an issue.
  • The exercise bike is an effective warm-up prior to other strengthening exercises.

Programs

Running Program for Hamstring Rehabilitation

This program is designed to help condition the hamstring, enabling it to manage the rigors of competitive sport following injury.

  • Speed training is the most important part of sport-specific hamstring rehabilitation as hamstring injuries usually occur during sudden explosive accelerations. Set out two markets starting at 100 meters apart. Sprint between the markers, making sure you stop exactly at the second marker. Do this 10 – 20 times. As you improve shorten the space between markers to 75 metere, then 50 meters, then 25.
  • Try backwards running between jogging and speed training.
  • Gradually increasing straight line (forward) running speed (e.g. from1/2 to 3/4 to full pace) and then introducing curves and bends work will help the scar become accustomed to rapid and multi-directional stresses.
  • Rapid accelerations and decelerations, changes of direction (cutting at 45° and 90°) and jumping will also make the training more specific to sporting activity.

Further Injury Prevention

  • ALWAYS seek the advice of a medical professional before returning to sport. Inadequate rehabilitation and a premature return to sport will increase the risk of re-injury.
  • If hamstring strains continue to occur or if pain is persistent, consult a medical professional for advice on other possible contributing factors.
  • Continue stretching and strengthening exercises as part of a normal training routine
  • If there is pain during activity, stop and apply the principles of acute care (i.e. RICE)
  • A neoprene sleeve can be worn to support the hamstrings and keep them warm during activity
  • Stretching and a sport-specific warm-up should follow a thorough general body warm-up, such as cycling or jogging.
  • Stretching should be performed after exercise
  • Fatigue is a major contributing factor towards hamstring strains. Maintaining high levels of cardiovascular fitness and muscular endurance can help to prevent premature fatigue
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