|Reef fish near the swim start of Ironman Hawaii|
You're out for a run on a cold early fall day. Not much of a warm up. You sprint to catch up to the group when WHAM! It feels like you got shot in the back of the thigh. Maybe you fall, maybe only limp. But it's a big limp. Maybe you've suffered your first hamstring tear.
The three hamstrings are among the first leg muscles one studies in medical school. They're known as biceps femoris, semi-membranosus, and semi-tendinosus originating at your "sit down" bones extending to just below the knee joint. Functionally they provide for flexion power at the knee as well as extension of the hip.
This muscle group is frequently the source of pain and injury in both the endurance athlete as well as the more explosive sprinters or football players. As can happen in any muscle, the injury pattern can be graded with relation to the degree of severity on a 1 - 3 scale. Grade one injuries are a simple "pulled muscle," grade two comprise those with an actual partial tear of the muscle substance itself, and grade three are the most serious in which the muscle tears completely and surgery to reapir it may be under consideration. These injuries occur when the muscle is stressed to a limit greater than it can handle. Folks who have relatively poor conditioning are at risk for this injury as are those are overly "tight," ones who are fatigued or have a muscle imbalance. As you'd expect, simply the choice of sports can increase ones chances of suffering this injury when considering among basketball and soccer players, dancers, etc. Also a risk group are older adolescents whose growth has yet to be completed.
Grasping the posterior thigh in pain, the hall mark of this injury, can be accompanied by swelling, decreased strength of flexion of the knee, and bruising. Occasionally this bruising can be quite extensive (a little bit of blood goes a long way) as the athlete sees purple hues on the back of the thigh, knee, calf and sometimes all the way to the ankle. There's no doubt that an injury of significance has occurred. When they get to my office with this type of story, we examine the limb for the above bruising, areas of tenderness, and once in a while the examiner can even feel a gap along the course of the muscle. This is especially true when the muscle has pulled off it's bony origin. In some instances further information can be obtained from a plain x-ray. Less frequently, an MRI may be ordered to determine the actual amount of damage.
Treatment options are usually based around both the severity of the injury as well as particulars of the athlete involved. In most cases, a non-surgical regimen will be the order of the day. Short term crutches and cessation of the patients sport put the muscle group to rest and allow it to heal. Application of a straight leg brace furthers these efforts. Traditionally the use of cold therapy icing down the injured location a few times/day can also be beneficial and diminishes the pain to a degree. Many will use a 6" Ace Wrap around the thigh to keep further swelling and bleeding to a minimum, re-wrapping it several times/day, leaving it off at bedtime. We routinely recommend the patient, for the first 48 hours, try to spend time in a recliner elevating the limb, also with the intent of swelling reduction. Surgery is usually reserved for those who've avulsed (pulled off) the attachment of the muscle from the pelvis and those who've suffered a complete tear of the muscle belly itself.
At some point, the services of the local physical therapist may be of benefit to help mobilize the extremity, recover strength and develop a plan which minimizes the potential for re-injury. Depending upon the degree of the tear, the level of swelling, any history or previous hamstring injury, etc., athletes can be back to slow running in a matter of weeks where those who've required surgical repair can take 6 months, or more, to be back to full strength. This is one muscle group where the owner wants to follow instructions. If they don't, and suffer a recurrent hamstring tear, it can lead to a permanently injured muscle which never provides full function again. But, fortunately this is the rare occurrance as most get back to their original sport even it if does take time.
Image 1 Bryce Groark, 2 and 3 Google Images