Skip to Main Content

++

  • Pulled hamstring

++

  • 848.9 Unspecified site of sprain and strain

++

  • T14.9 Dislocation, sprain, and strain of unspecified body region

++

Description

++

  • Stretch injury to biceps femoris or semimembranosus resulting in disruption of muscular or musculotendinous units
    • Grade I: mild
    • Grade II: moderate
    • Grader III: severe to complete tear or rupture

++

Essentials of Diagnosis

++

  • Diagnosis made with patient history and clinical findings or with imaging
  • Pain with resistance
  • Location of Lesion May Influence Prognosis

++

General Considerations

++

  • Mechanisms of injury1
    • Deceleration during swing phase while running
      • Typically occurs during high-speed running
      • Involves intramuscular tendon or aponeurosis of biceps femoris (long head), semitendinosus (secondary injury)
    • Excessive stretch while dancing or kicking
      • Typically during extreme hip flexion with full knee extension
      • Injury at proximal tendon of semimembranosus

++

Demographics

++

  • Previous hamstring injury is a strong predictor of recurrence
  • Athletes in high-speed-demand sports (e.g., football, track, rugby, soccer)
  • Athletes in sports/competition involving kicking or extreme hip flexion and knee extension (e.g., dancing, water-skiing)

++

Signs and Symptoms

++

  • Acute-onset pain at proximal hamstring during high-speed running, often with audible pop, typically early or late in athletic event
  • Pain at ischial tuberosity with sitting
  • Decreased range of motion (ROM) in knee and hip
  • Decreased strength with knee flexion and hip extension
  • Tenderness to palpation (possible palpable lesion) at proximal tendon or musculotendinous junction
  • Tenderness may occur along muscle belly proximal to ischial tuberosity

++

Functional Implications

++

  • Inability to run or sprint
  • Inability to sit without limitation from pain
  • Inability to flex hip with knee fully extended

++

Possible Contributing Causes

++

  • Previous history of hamstring injury
  • Explosion activity without proper warm-up
  • Muscle imbalance between quadriceps and hamstring

++

Differential Diagnosis

++

  • Adverse neural tension
  • Adductor muscle strain
  • Avulsion fractures at ischial tuberosity
  • Lumbar radiculopathy
  • Sacroiliac dysfunction
  • Sciatica

++

Imaging

++

  • MRI for soft tissue

++

  • MRI can reveal area of fluid accumulation and location of lesion

++

Medication

++
++

Medical Procedures

++

  • Surgery to repair grade-III strain or avulsion

++

  • To hospital for imaging (MRI)
  • Surgery (if grade-III strain)

++

  • Inability to run or sprint
  • Inability to sit without limitation from pain
  • Inability to flex hip with knee fully extended

++

++

  • Take caution initially not to overstretch and eccentrically load injured muscle
  • Early and continued incorporation of core stability and eccentric hamstring loading progressing to full length
  • Rehabilitation for grade-I and grade-II strains
    • Phase 1, 1 to 5 days post-injury
      • Reduce edema and pain
      • Ice, NSAIDs
      • Protect tissue remodeling
      • Avoid excessive ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.