Straining the friendship
A Pilates perspective on hamstring strains—a treatment protocol and exercises for promoting optimal healing and discounted course details
Our families are often our best teachers when it comes to learning about the intricacies of different injuries and how best to overcome rehabilitation setbacks. One of my husband Michael’s injuries, was a grade 2 hamstring strain from a surfing incident, certainly provided me with an opportunity for growth and learning.
I have written this article with the weekend warrior in mind, but also Christmas and summer holidays in mind, particularly for those with active overstretch hamstring injuries or passive overstretch injuries/tendinopathies (like those commonly seen in dancers and martial artists).
Whenever you deal with an injury, be it a hamstring, shoulder or neck injury, it is important to understand:
the individual muscles and joints involved, and their functional role in whole body movement
your clients’ daily and desired activities, and how they are affected by a specific movement or joint pattern. This information is essential when developing a movement plan.
The hamstring group of muscles are part of the deep longitudinal sling and therefore support the tibialis anterior muscles as part of dorsiflexion, and the erector spinae muscles as part of thoracic extension. Hamstrings are needed for hip extension and knee flexion in various stages of gait. Consequently, the exercises you prescribe must support walking, running and spinal extension.
When rehabbing an injury, it can be challenging to know how best to grade the load and manage a client’s tolerance for movement throughout recovery. How you grade and progress your client’s program depends on the mechanism of injury, the stage of healing, the client’s particular goals and their physical condition before the injury. Mutual and respectful work with a physiotherapist is highly beneficial throughout recovery.
Mechanism of hamstring injury
The mechanism for hamstring injuries are classified as trauma, active overstretch and passive overstretch. Each of these injury types is likely to affect one of the different hamstring muscle groups.
A trauma muscle injury can be caused by contact trauma, or occur after surgery. We frequently see cyclists and skiers who have had an avulsion fracture of the ischial tuberosity, which then results in a hamstring tear. Once a hamstring has been damaged, it is vulnerable to future tears. Direct trauma can also occur as a result of surgeries, e.g. when an anterior cruciate ligament (ACL) is reconstructed and part of a hamstring tendon is removed to recreate the ligament.
An active overstretch injury is also known as a ‘deceleration’ injury because the hamstring actively slows the movement of the leg. Can you think of a situation when the hamstring muscle is working eccentrically, but is suddenly overcome by the stretching force applied to it and forcibly lengthened? I like to think about the movements of a sprinter as they go into a foot strike. This is the stage when the bicep femoris muscle is most vulnerable to this deceleration injury and is why we see these speedy athletes so commonly pulling up on the track. Active overstretch is usually accompanied by a sudden onset of pain and an inability to continue the activity. This is the type of injury my husband experienced while surfing. In another example a client, let’s call her Heather, had been hiking in Scottland for several weeks, walking long distances up and down hills. Heather stopped to do a “bush wee” and when she came out of squat to standing found she had a sharp pain.
A passive overstretch occurs when a stretch force is applied to the hamstring muscle with an injury occurring at the limit of range. This injury is commonly seen among footballers and dancers, but also yogis. It generally involves the free tendon of semimembranosus, but among dancers it can also involve the quadratus femoris. Even if the force is applied slowly (as in a dancer stretching), there may be a pop associated with the injury. Symptoms may not develop for some hours, and individuals may only experience some mild discomfort and dysfunction.
The location of a hamstring strain
The active overstretch or running injury tends to occur at the musculo-tendinous junction of the lengthy intramuscular biceps femoris tendon and adjacent muscle. This type of injury requires about 12 weeks of recovery.
The closer the injury is to the buttock—think close to the ischial tuberosity— the more likely the injury is to involve tendon tissue and the slower the rehabilitation. These cases usually involve a passive overstretch injury and can require a longer recovery program; often around 30–76 weeks. I have worked with a few ballerinas and barre aficionados who have struggled with this recovery process.
