Hamstring Pain:  R.I.C.E.

Pulls or strains of the hamstring muscles are one of the most common sports ailments.  They occur often in running sports and are frequently caused by quick starts and stops—as in sprinting, baseball, basketball, tennis, etc.

The hamstring consists of three large muscles in the back of the thigh.  They begin at the pelvis and end just below the knee.  If you straighten and tense your knee, the fleshy part of the muscle can be felt behind the thigh.  If you run your hand behind the knee, you will feel the lower hamstring tendons on each side.  The hamstrings bend the knee.  The opposite muscle in front of the thigh is the powerful quadriceps which straightens the knee.  This muscle is approximately one-and-one-half time stronger than the hamstrings.  People with weak hamstrings are more prone to injury.

Muscles tear as a result of sudden changes in tension.  For example, a sudden start or stop can stress the muscle.  This is why sprinters are more susceptible.

When a hamstring tears, the runner feels a sudden pain in the back of his thigh.  The sensation of a “rip” or “tear” is also common.  Pain will increase over the following hours and swelling and/or a large black and blue spot (ecchymosis) may also occur from the bleeding of the injured muscle.

There are three grades of muscle tears:

Grade I:  (mild strain)  Less than 10% of the muscle is torn.

Grade II:  (moderate tear)  Up to 50% of the width of the muscle is torn.

Grade III:  (severe)  Over half of the width of the muscle is torn.

If you think you have injured the hamstrings, it is best to stop playing or exercising.  Treatment can be summed up with the acronym RICE, which stands for:

1. Rest—crutches may be necessary.
2. Ice—to stop swelling and relieve pain.
3. Compression—apply an Ace bandage to lessen swelling.
4. Elevation—helps decrease the swelling.

Treatment

Several days later, a warm whirlpool is soothing and aids in the healing process by increasing the blood flow to the injured muscle.  Mild strains will heal in a couple of days, while Grade II injuries may take up to two weeks to heal.  Grade III injuries take even longer (three to four weeks).  You can return to sports when it is no longer painful to tense the muscles.  Before you start running, it is best to rehabilitate the knee.

Initially, gentle motion to the knee should be done to regain motion.  Next, when the pain subsides, work out with light weights to re-strengthen the hamstrings.  A simple exercise is to lie face down and bend the knee with an ankle weight attached to the lower leg.  Hold for a few seconds and then relax.  It is best to start with two to three pound weights and gradually increase the amount every week.

Before returning to full activity, you should first do slow, easy running or jogging.  Running speeds can later be increased.

Prevention:

Hamstring pulls can frequently be prevented by proper warm-ups and preliminary stretching exercises.  The warm-ups increase blood supply to the muscles, making them less likely to tear.  The following are good hamstring-stretch exercises.

1. Lie on your back.  Bring one leg up to your chest with the hip and knee bent.  Cup your hands behind the knee and push knee against the hand, straightening the knee.  Hold the stretch for five seconds.  Repeat the exercise five times.  Then do the opposite leg.
2. Kneel down with one knee and straighten the opposite leg in front of you.  Bring your upper torso over the outstretched leg, keeping your arms at your side and your back straight.  Hold the stretch for three to five seconds.  Repeat five times.  Next, stretch the opposite leg.

Please note: these articles are for general information. They are not intended to serve as medical advice or treatment for a specific problem. Diagnosis and treatment of a problem can only be accomplished in person by a qualified physician.