Hamstring Injury and Treatment

by Dr. Nathan Hinkeldey on September 18, 2012


Pulled HamstringHamstring injuries are extremely common throughout athletics. Some studies show a pulled hamstring to be second only to knee injuries in terms of frequency. Delving further into the statistics, we see that males are 62% more likely to have a hamstring injury than females.

Fortunately, most hamstring injuries aren’t season-ending, however, they often result in significant time off of the field for the injured athlete, with some athletes reporting lingering effects and limitations up to 23 months after the occurrence of the injury. The most alarming aspect of this injury, though, is that re-injury occurs approximately 33% of the time, or in 1 out of 3 athletes. Put another way, athletes with a history of hamstring strains are 50% more likely to re-injure their hamstring. One of the only other predisposing factors is lack of proper quadriceps flexibility. While it may seem counterintuitive that you should stretch your quadriceps in order to protect your hamstrings, that really is the case.

How Hamstring Injuries Occur

Hamstring strains occur most often when the leg is extended. This is why when someone “pulls their hamstring,” they come up limping and cannot extend their leg. The result of this injury is that the muscle and fascia tear, causing inflammation and scar formation. Unfortunately, scar tissue is a lesser tissue which often forms in a disorganized fashion. This ultimately creates a weak spot in the muscle and is part of the reason that re-injury is so common. This tendency for re-injury is why it’s so important to have each occurrence of hamstring strain assessed and treated by a sports medicine doctor.

Prevent Hamstring Injuries

It bears repeating: The key to preventing subsequent hamstring injuries is receiving proper care for the first occurrence of injury. Your hamstring musculature is soft tissue, therefore you should seek out a local sports medicine doctor who is skilled in manual therapy techniques, such as Graston Technique. This type of restorative muscle work is designed to encourage proper fiber alignment and prevent disorganized scar tissue from forming, which in turn, avoids weakness in the muscle or tendon typically caused by scar tissue.

In addition to the manual therapy, you should receive a series of stretches and exercises to progress through in your ongoing healing and treatment plan. For example, triplanar hip flexor stretches, hamstring stretches, adductor stretches, and front and side planks are a great start. (Look for more detail on each of these stretching exercises in upcoming posts.)

Stretching alone, however, is not enough. It’s important that your rehabilitation plan also incorporate controlled movement, even in the early stages of tissue healing. Traditional guidelines suggest rest, ice, compress, and elevate; however, as the research moves forward, more and more rehabilitation experts are suggesting early movement following an injury to prevent irregular scar tissue formation and promote proper mobility.

Core Stability is Crucial

An often overlooked component of hamstring injury prevention is core stability. In 2004, the Journal of Sport Physical Therapy released an article analyzing two different rehabilitation protocols (2). The first group concentrated on hamstring strengthening and stretching, and the second utilized progressive agility and trunk stabilization programming. At the one year follow up, the trunk stability (core stability) group had a re-injury rate of 7% compared with a 70% re-injury rate among the hamstring stretching/strengthening group. Clearly, core stability is a critical factor in effective hamstring strain rehabilitation.

The reason, the study concluded, is that if your core is unstable, your pelvis will be prone to additional, undesirable motion which will place added stress on the hamstring musculature. Proper core stability will help to hold your pelvis stable even when moving your upper and lower extremities, thus placing less stress on the muscles in question and decreasing your chance of injury.

If you have any questions about this or any other type of sports injury, please contact Team Chiropractic & Rehabilitation. Our Johnston Chiropractic Clinic puts an emphasis on sports medicine, including Functional Movement System assessment and treatment. Let us prescribe a routine of stretching and core strengthening exercises to help prevent initial and subsequent hamstring injuries.

Be sure to seek immediate medical attention for any type of physical injury.


(1) Sherry M, Best T, Silder A, et al. Hamstring strains: basic science and clinical research applications for preventing the recurrent injury. National Strength and Conditioning Journal 2011 June 3:(33)

(2) Sherry MA and best TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Ortho Sports Phys Ther 34: 116-125, 2004.


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