Scientifically proven factors that lead to hamstring tears include age (older athletes are more at risk), race, hamstring weakness, lack of flexibility of hamstrings or hip flexors, and fatigue during sports participation. One of the key risk factors is previous injury. As recurrence is a likely outcome, it is essential that subjects are given an appropriate strength and conditioning program to facilitate return to activity and minimise the chance of re-injury.
Although less common, the tendon within the muscle, or the tendon or bone at either end of the muscle can be damaged. This needs to be assessed and may require medical intervention. It should also be remembered that children and adolescents are less likely to have muscle tears and more likely to have bone growth plate problems that need assessment.
If you have pain in the back of the thigh following a specific incident, you are likely to have a tear. The likelihood is stronger if there is bruising and this may track down to the back of the knee. A professional, such as a physiotherapist, will carry out several tests to confirm the diagnosis. Your physiotherapist will put the muscle on stretch to find where the pain is and how tight the muscle is. You may have already noticed that it is hard to bend over or stretch the knee out straight. Your physiotherapist will ask you to ‘contract’ the muscle using several tests that assess your strength. Again, you may have noticed pain with tasks that require use of the hamstrings, such as bridging up off the floor or wiping mud off your shoes. Finally, the clinician will feel the muscle to locate a sore spot and confirm the diagnosis.
Initially, your physiotherapist will give you a clear diagnosis regarding which muscle is torn and how badly. They will then give you an indication of how long it will take to return to sport or your chosen activity. A plan should then outline the following:
Initial management—this normally includes RICE
- Rest—relative rest and causing no further harm.
- Ice—20 minutes every two hours, during waking hours, for the first two days.
- Compression—use a compression sleeve or bandage.
- Elevation— put the leg above the level of the heart where practical.
Although the muscle is already torn, the first four days are an important time to prevent further damage and compromised healing.
Strengthening—a progressive program of exercises to regain the strength of the hamstrings.
Running—a graduated program to build speed, agility, sport-specific skills and then return to training and finally sport.
Return to sport or physical activity guidelines and expectations.
Physiotherapy can be very effective for the management of hamstring tears. Your physiotherapist will have seen many patients with this presentation and can put your mind to rest regarding diagnosis and planning. Your physiotherapist is best placed to know the evidence supporting the initial management of hamstring tears and the type of exercise prescription that is relevant to allow functional recovery and the prevention of recurrence.
The most important thing you can do as a patient after injury is protect the region from further injury until you seek a professional opinion. Avoid alcohol and anti-inflammatory medication, as local bleeding is increased and healing is slowed. Simple pain medication is adequate if required. It is also important not to stretch in the first 10 days.
Begin the RICE regime.
- Rest—relative rest and causing no further harm.
- Ice—20 minutes every two hours, during waking hours, for the first two days.
- Compression—use a compression sleeve or bandage.
- Elevation— put the leg above the level of the heart where practical.
Traditionally, a hamstring tear will take 2–6 weeks to get better, although variations occur. Initial rest and appropriate treatment is followed by a graduated strength and running program. If the patient is competing in sport, they should train for a period of time, usually a week, before returning to competition.
