How to heal a hamstring strain fast?
The first step in healing a hamstring is to know the diagnosis. The location and grading of the injury will guide how long it will take to heal, but equally importantly will dictate the appropriate rehab. Strengthening will be a key part of the rehabilitation process but it needs to be introduce at an appropriate time. Whitelely et al. (2017) advised that tenderness over the site of the injury, flexibility, and strength measurements should be regularly taken over the rehabilitation period to dictate the progression of treatment. An experienced physiotherapist will be able to guide this. Stretching the hamstring should be avoided in the early stage following injury so as to avoid pulling on the muscle fibres that are trying to heal. High hamstring strains (close to the sitting bone of the buttock) will need to avoid stretching for much longer as stretching the hamstring compresses the tendon against the bone and causes irritation. If you have a significant amount of bleeding/bruising following a hamstring tear, you may have a severe injury and need an MRI to assess the extent of injury. High hamstring tears may need early surgical intervention so should not be missed.
Hamstring strain rehab?
Rehab following a hamstring injury focuses on two key areas – restoring the length of the hamstring, and restoring the strength of the hamstring. Most hamstring strains will gradually restore their flexibility over time. However, people who have recurrent hamstring strains may have an issue with short fascicles (longitudinal sections of the hamstring muscle) that are therefore over stretched more easily with running and sporting activities. There are strengthening exercises that can be prescribed by your physiotherapist that can assist in lengthening these short muscle sections. Nordic hamstrings are one such exercise that have been shown to help with this and also in hamstring injury prevention. Nordics should only be introduced once there is appropriate base strength as they are a highly intense exercise for the hamstring.
Hamstring strength does not return with rest. Your hamstring may feel better and more flexible after a few weeks rest from sport but your strength needs to be restored through specific, progressive strengthening exercises. These exercises can often be introduced quite early in the rehab process which helps to expedite return to sport. Before you return to sport, you should have 90% of your hamstring strength compared to the uninjured side. The best way to test this is using a digital dynamometer which measures force. A physiotherapist that is experienced in hamstrings rehab will have access to a hand-held dynamometer.
Once you have adequate strength you will need to undertake some sport specific exercises to recondition the hamstring appropriately. These exercises vary depending on the sport that you participate in.
Massage and dry needling for hamstring strains?
Massage or dry needling can be helpful in restoring the flexibility of the hamstring following a strain. However, it is important to avoid massage and needling directly over the site of the strain too early as it may cause additional bleeding at the site of the injury and delay recovery.
How to diagnose a hamstring tear?
Hamstring tears usually occur during sudden explosive movements such as sprinting and also in kicking activities They may also occur as a result of overstretching the hamstring suddenly such as when slipping over. Overstretch injuries are often more severe and take longer to rehabilitate. Hamstring injuries have historically been graded on a 1-3 scale, with a grade 3 injury being more severe. A suspected grade 3 injury will likely need an MRI to assess the full extent of the injury and whether surgical intervention may be required. The British Athletics muscle injury classification (Patel et al., 2015) uses MRI findings to grade hamstring injuries from grade 0 (pain in hammy but normal MRI findings) to grade 4 (complete tear of the muscle or tendon on MRI). A grade 1 hamstring will likely return to sport in 2-4 weeks however a higher grade injury will likely take 3 months or may require surgery.
What exercises can I do after a hamstring strain?
It is important to avoid stretching the hamstring into any pain in the early stages following the injury as this will only delay recovery. Early exercises often introduced include cycling, squats, bridges, and isometric heel digs (Aspetar hamstring protocol, 2016). Exercises that maintain function and strength in the surrounding muscles, such as the calf, quadriceps and buttock, may also be prescribed to avoid unnecessary deconditioning. Running is reintroduced at up to 70% speed once hamstring flexibility and strength is >75% compared to the other side (Aspetar hamstring protocol, 2016). Your exercise program should be guided by a physiotherapist experienced in treating hamstring injuries to make sure you are given the right exercises for the stage of your injury rehab.
What is a high hamstring strain?
High hamstring strains refer to an injury to the hamstring tendon near where it attaches to the bone under the buttock called the ischial tuberosity. These injuries are significant as they will generally take longer to rehab. This is because his part of the hamstring tendon is very sensitive to stretching when it is injured and so rehab exercises need to be progressed more slowly to avoid compressing and stretching the tendon over the ischial tuberosity. A suspected high grade high hamstring tear should be sent for an MRI as it may need surgical intervention. Signs of a high grade injury include a large amount of bruising, severe weakness in the hamstring, or being able to feel a defect (gap) in the tendon. A physiotherapist experienced in treating hamstring injuries will be able to advise you on the severity of the injury.
Aspetar hamstring protocol. www.aspetar.com
Patel et al. (2015). British athletics muscle injury classification: a reliability study for a new grading system. Clinical Radiology, 70, 1414-1420
Whiteley et al. (2017). Clinical implication from daily physiotherapy examination of 131 acute hamstring injuries and their association with running speed and rehabilitation progression. BJSM, 0, 1-9