• David Jeremic

Hanging on by a Hamstring!

Updated: Mar 7



In today's blog, we're talking about the mind-boggling hamstring tear!


It can be challenging for healthcare practitioners to determine the best treatment and management approach for these injuries, and what can be done to prevent these injuries from happening in the first place.


In this Blog Post, we discuss what a hamstring tear is, how they occur, the factors that increase their risk of occurring, treatment and management options, and what preventative measures can be taken to best reduce the chance of them happening.


Let's go!



What is a hamstring tear?


So, the hamstrings, or "hammys" , are the muscles that run down the back of your leg inserting behind your knee (and slightly below). This group of muscles commonly get overlooked as a potential injury point in the average athlete. In elite sports these days, the hamstring tear is arguably the most common injury sustained in sports involving high intensity speed, agility, and change of direction, such as football, basketball, soccer, and tennis(1).


The tear commonly occurs at the weakest point of the muscle, the musculotendinous junction. This is the point where the muscle belly becomes the tendon. Depending on how the injury happens, particular hamstring muscles are more susceptible to tearing than others(1).




Hamstring tear grading


There's a fair chance that you've heard of hamstring tear "grades". These grades refer to the severity of the tear and the impact it's having on the person.


The British Athletics Muscle Injury Classification is the most commonly used grading system, as follows (2):


Grade 0

- No tear

- Generalised pain/soreness after exercise

- Pain soreness after unaccustomed exercise.


Grade 1

- Small tear

- Pain during or after activity

- Range of Motion (ROM) normal at 24hrs

- Normal power and initiation

- Pain on contraction.


Grade 2

- Moderate tear

- Pain during activity and restricts participation

- Limitation with ROM

- Pain on contraction

- Reduced power on testing.


Grade 3

- Extensive tear

- Sudden onset of pain

- Significantly reduced ROM

- Pain on walking

- Obvious weakness on testing.


Grade 4

- Compete tear of muscle or tendon

- Sudden onset of pain

- Significant limitation to activity

- Palpable gap on palpation

- Maybe less pain than Grade 3.


**For keen readers, the exact location of each Grade of tear can be classified as per the below graphic (3)**




How does the tear occur?


There are two common ways the tear occurs (4-6).


The first type usually occurs during the landing phase of running or sprinting, especially during the deceleration portions of the movement. How this happens is due, in part, to the anatomy of hip and knee joints, and the relationship they have with the hamstring muscles, whereby the hamstring muscles react to the joints.


Firsty, the landing phase involves the hamstring muscle lengthening to its full muscle length, and the deceleration phase of movement requires the hamstring to contract to slow the leg down. A combination of both of these situations can result in excessive tension of the hamstring. If the hip and knee joints are in compromised positions, then joint proprioception, perception or awareness of the position and movement of the body, will be compromised too, risking poor muscle-joint communication and resulting in the chance of a tear taking place. Usually, the bicep femoris muscle (see diagram below for muscle reference) is most compromised in this position.



The second type of mechanism of injury occurs whilst the hamstring is in a fully extended position, excessively beyond its training limits. Usually these tears occur when there is combined hip flexion and knee extension in the movement or activity, eg high kicking or dead-lifting. In this type of mechanism, the semimembranous muscle is commonly involved In a tear.



Risk factors for hamstring tear


Currently, the greatest risk factor For a hamstring tear is recent injury of the hamstring.


Determining other consistent prospective risk factors for hamstring injuries has been a challenge for researchers, as evidence has not found consistency in risk factors influencing injury. Currently, it appears that risk factors do not operate in isolation, rather they operate in a complex web of determinants, as shown below:






Treatment and management of the tear


As you can see from the diagram above, a multi-modal, person-centered approach (a combination of treatment types/techniques) is best applied in the treatment and management of these injuries(7).


Depending on the severity of the hamstring tear, different treatment management is optimal. Initially, treatment of injury should consist of the RICER protocol (Rest, Ice, Compression, Elevation and Referral).


Chiropractic can help by optimising lumbo-pelvic hip stability, motor patterning, flexbility/posture, advising on player load through a prehab/rehab program, and advising on warm-up preparations.


Referral to a healthcare practitioner is wise even in mild cases, as proper rehab and prehab can begin optimise recovery and potentially reduce the chance of it happening again.


Recently, research was published which provided information about the current average return to play times for grades of hamstring injuries in AFL players(8):


Grade 0 - 14 days (2 weeks)

Grade 1 - 21 days (3 weeks)

Grade 2 - 35 days (5 weeks)

Grade 3 - 88 days (12 weeks)

Grade 4 - Not researched.


At Modern Chiro, we use a person-centred, multi-modal approach to treatment and management. We aim to work with our hamstring tear patients to achieve their full range of motion and potentially their full function in line with these estimated Injury recovery times.



How can a tear be prevented?


Based on the above diagram of the complex web of risk factors, it's certainly wise to keep on top of what you can control. Sticking to Prehab treatment and programs is an excellent starting point.


If you're awaiting surgery for a hamstring tear or are interested in keeping on top of your injury prevention, book online to see how we may be able to help.


David Jeremic,

Chiropractor

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1. Chu SK, Rho ME. Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play. Curr Sports Med Rep. 2016;15(3):184–190. doi:10.1249/JSR.0000000000000264


2.Pollock N, James SLJ, Lee JC, et al. British athletics muscle injury classification: a new grading system. British Journal of Sports Medicine 2014;48:1347-1351. http://dx.doi.org/10.1136/bjsports-2013-093302


3. Macdonald, Ben & McAleer, Stephen & Kelly, Shane & Chakraverty, Rob & Johnston, Michael & Pollock, Noel. (2019). Hamstring rehabilitation in elite track and field athletes: applying the British Athletics Muscle Injury Classification in clinical practice. British Journal of Sports Medicine. 53. bjsports-2017. 10.1136/bjsports-2017-098971


4. Askling CM, Malliaropoulos N, Karlsson J. High-speed running type or stretching-type of hamstring injuries makes a difference to treatment and prognosis. British journal of sports medicine. 2012; 46(2):86–87. doi: 10.1136/bjsports-2011-090534


5. Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. The American journal of sports medicine. 2007; 35(2):197–206. DOI: 10.1177/0363546506294679


6. Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during slow-speed stretching: clinical, magnetic resonance imaging, and recovery characteristics. The American journal of sports medicine. 2007; 35(10):1716–1724. DOI: 10.1177/0363546507303563


7. Buckthorpe M, Wright S, Bruce-Low S, et al. Recommendations for hamstring injury prevention in elite football: translating research into practice. British Journal of Sports Medicine 2019;53:449-456. http://dx.doi.org/10.1136/bjsports-2018-099616


8. Eggleston, L., McMeniman, M. and Engstrom, C. (2020), High‐Grade Intramuscular Tendon Disruption in Acute Hamstring Injury and Return to Play in Australian Football Players. Scand J Med Sci Sports. Accepted Author Manuscript. doi:10.1111/sms.13642


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