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I Pulled My Hamstring. Now What?

Woman with pulled hamstring

We’ve all uttered the words “my hamstrings are just tight”. Usually the “just” in front of tight to denote its common occurrence and maybe even to deem it no big deal.

The hamstrings often get a bad reputation. They’re blamed for one’s inability to touch their toes or take the brunt of one’s idea that they have limited flexibility. In actuality, we see more people in clinic with hamstrings that are overstretched or hamstrings that are inhibited (underactive) due to a weak core.

When we are talking core here, we are not talking the six-pack, we are referencing the deep intrinsic core muscles aka transverse abdominus, internal obliques, pelvic floor, and the diaphragm.

The hamstring group is made up of three muscles, the semimembranosus, semitendinosus and the biceps femoris. They work collectively to bend the knee and extend the hip.

What does a hamstring strain feel like?

A hamstring strain feels like a sudden sharp pain at the back of the thigh. It may be accompanied by a “popping” sound. Depending on the severity of the strain or tear, swelling and bruising in the region may occur as well as weakness and inability to bear weight on the affected leg. Hamstring strains are characterized in different grades. A grade 1 strain is a mild muscle pull. A grade 2 is a partial tear usually accompanied by bruising and dull pain. A grade 3 is a complete muscle tear with the person unable to bear weight on that affected leg. The hamstring muscle acts as a true anchor for our pelvis to the earth, keeping us upright and mobile. Without this strong muscle group, movement is nearly impossible.

What causes hamstring strains?

The most common mechanism of injury is when an already overstretched hamstring is then challenged with an added load. Runners, sprinters, dancers, basketball and soccer players are among the athletes most likely to deal with these injuries due to the high impact nature of these activities.  

It could be caused by something else

A hamstring strain doesn’t necessarily denote a problem with the hamstring itself. Patterns in the body come from a composition of life events – injuries, postural compensations, biomechanical imbalances, core instability. All of these things can and do contribute to issues that occur elsewhere in the body.

Posture

An anterior pelvic tilt, or a pelvis that is rotated forward, is an indication that the hamstrings are overstretched. Sitting all day can place extra stretch on the hamstring muscle and lead to weakness.

Muscle Imbalance

Muscles work as synergists (perform the same function together) or antagonists (perform opposite functions) to one another. Underactivity or inhibition of the gluteus maximus, a synergist of the hamstrings, can lead to overactivity of the hamstrings. Overactivity of the quadriceps, antagonists to the hamstrings, can lead to inhibition of the hamstrings. Either scenario can lead to strain.

Old Injuries

Past injuries, especially ankle sprains can lead to a change in body biomechanics and predispose the body to hamstring strains. The body works on a delicate balance of mobility and stability. The hip and ankle function mainly for mobility, while the knee and foot provide stability. A disruption of this balance (limited mobility in the ankle after a sprain, an injury to the knee compromising stability) affects the muscles connected to these joints and can lead to hamstring strain.

For these reasons, it is important to look at the body as a whole, even when sprains and strains are pinpointed towards one joint or muscle. There is a reason that area was injured!

How do you treat a hamstring strain?

Woman stretching her hamstring after a run

Diagnosis of the type of strain is important in progressing with treatment that is right for your case. A protocol of RICE (Rest, Ice, Compression and Elevation) is necessary in the acute stages of healing, but it is important to progress to a rehabilitation stage, as well as to address the biomechanics that may have led to the strain.

We utilize Neurokinetic Therapy as a way to assess which muscles are overworking and need to be released and which muscles are underworking and need to be strengthened. Typically, the core and gluteus maximus require strengthening in cases of hamstring strain. Muscle fibers of the gluteus maximus overlap with the proximal hamstring fibers, so typically if one of these muscles is inhibited the other is too. Sometimes one part of the hamstring will overwork for another part, and the hamstring may require specific muscle massage work.

Active Release Technique is an effective way to treat overactive or true tight muscles. We often implement this soft tissue therapy when addressing hamstring strains. If the hamstring is torn, scar tissue forms at the area of the injured muscle. Active Release Technique is an effective way to break up this scar tissue. Following the idea of balancing mobility and stability, we always follow up any release of muscle (mobility) with strengthening (stability). Rehabilitation exercises that activate the glutes and hamstring are important in recovery and return to activity.

Analysis of gait and foot biomechanics are important aspects of treatment as these are contributing factors to hamstring strains. That old ankle sprain from 12 years ago, may be placing stress up the chain affecting the function of the pelvis and hamstring.

Real Life Case Study

Here’s an example of the kind of case we see daily in clinic.

A 23-year-old male presented to the clinic with pain and limited mobility in the right leg, and pointed just under his sit bone on the back of his thigh.

He noted the tightness in his right hamstring first began a year and a half ago when sprinting on an incline on the treadmill. He heard a “pop” and had immediate pain in the upper portion of the back of his right thigh. He rested, and after four weeks he felt better.

On the day of his visit, he reported some tightness with exercises like deadlifts and leg curls a month ago. And more recently, about a week ago, he started lifting heavier weight with his deadlifts, then noted more severe pain the following day. With any bending or flexing forward he felt like the hamstring was going to snap.

Further history of the patient uncovered a right ankle sprain 3 years ago and he had fractured both ankles 10 years ago. He wears orthotics to correct for flat feet. His job requires him to sit at least eight hours per day.

In checking his posture and gait it was found that he has an anterior pelvic tilt (the pelvis tilts forward overarching the back), overstretched hamstrings and no push off of both big toes!

Our treatment plan began by starting at the core. After two visits of addressing core stability, strength and correcting that pelvic tilt he noticed so much improvement!

By his third visit his hamstring no longer felt that tight “ready to snap” feeling. Neurokinetic therapy found part of the right hamstring to be overworking for the opposite gluteus maximus muscle. Active Release Technique was utilized to release the tighter part of the hamstring. Next steps included mobilizing the big toe, to allow for a better push off of the toes, with an Anatomy in Motion wedge exercise.  Continued strength training and core training with the patient can get closer to his goal of running again.

It is important to look at the body as a whole, and at Urban Wellness Clinic, that is our speciality! Strength from the core out and the feet up leads to the best overall positioning to get out of pain, feel good in your body, and do the things you love to do.

It is important to remember how the body is connected and to have the tools necessary to prevent future re-injury.

If you need our expertise and want a different rehab approach than you are already doing, give us a call at 212-355-0445 or reach out at hello@urbanwellnessclinic.com

In Good Health,

Dr Adriana Lazare