Ministry of Higher education and

Scientific research
Al-Nahrain University
College of Medicine

By:

‫إبراهيم ماهر سلوم حسين‬

1st year student - Group A - (2019-2020)
Supervised by:
Professor Dr. Haider A. Jaafar
PhD Human Anatomy

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Abstract
Hamstring injuries are very common in athletes. Acute hamstring strains can occur
with high-speed running or with excessive hamstring lengthening. Athletes with
proximal hamstring tendinopathy often do not report a specific inciting event;
instead they develop the pathology from chronic overuse. A thorough history and
examination is important to determine the appropriate diagnosis and rule out other

Anatomical aspect
of
Hamstring strains

causes of posterior thigh pain. Conservative management of hamstring strains

involves a rehabilitation protocol that gradually increases intensity, range of
motion and progresses to sport-specific and neuromuscular control exercises.
Eccentric strengthening exercises are used for management of proximal hamstring
tendinopathy. Studies investigating corticosteroid and platelet-rich plasma
injections have mixed results. MRI and ultrasound are effective for identification
of hamstring strains and tendinopathy, but have not demonstrated correlation with
return to play. The article focuses on diagnosis, treatment and return to play
considerations for acute hamstring strains and proximal hamstring tendinopathy in
the athlete
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introduction
Hamstring injuries are one of the most common injuries in AFL, athletics
(sprinting), soccer, cricket and touch football (1). Hamstring strain injuries
typically occur in sports that involve rapid highspeed activity, rapid acceleration
and/or strenuous stretching maneuvers. The evidence suggests that the chance of
re-injury to the hamstring occurs in 34% of cases (2).

Definition
A muscle strain can be defined as excessive stretching or tearing (complete or
partial) of the muscle fibers and is graded according to the severity. Hamstring
strain involves stretching and/or partial tearing of one or more of the 4 hamstring
muscle group. Hamstring strain also known as: Biceps Femoris strain, torn
‘Hammy’ and pulled hamstring.

Etiology
Hamstring strain injuries are graded according to their severity:
Grading Severity
Grade 1 (Mild) Small % of fibers are stretched or torn, mild pain, minimal to no loss of
strength.
Grade 2 (Moderate) Significant% of torn fibers, swelling, pain with active ROM, loss of strength,
palpable deformity.
Grade 3 (Severe) Complete tearing of fibers and/or MT junction, gross impairment, severe
initial pain.

Classification according to the mechanism of injury:

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Two different types of acute hamstring strains have been described with different
mechanisms of injury (3-5):
1) Type I acute hamstring strains occur during high-speed running. The long
head of the biceps femoris is most commonly involved in this type, typically
at the proximal muscle-tendon junction.
2) Type II hamstring strains occur in the setting of excessive lengthening of the
hamstrings. These types of hamstring strains are more common in activities
such as dancing, slide tackling and high kicking that combine hip flexion
with knee extension. Type II hamstring strains commonly involve the
proximal free tendon of the semimembranosus, close to the ischial
tuberosity. Recovery from type II hamstring strains has been shown to be
prolonged compared to type I hamstring strains.

Symptoms:

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Symptoms are pain in the back of the leg during exercise, muscle spasm, swelling,
bruising, and tenderness. With a significant injury, an individual can feel the
muscle "tighten" or "pop" and sometimes feel as if they have been struck in the
back of the leg. Pain can occur when passively extending the knee with the hip
flexed at 90 degrees and with resisted knee flexion. With severe injury, there may
be a palpable defect, bruising can occur, and people may have trouble contracting
the muscle.
Notice the purple color of the skin overlying the strained muscle it’s caused by the rupture of the subcutaneous vessels.

Clinical Diagnosis
Diagnosis involves an evaluation of past history, type of action/activity performed
and physical examination. MRI scans may be conducted to establish deep
intramuscular strains or tearing of the hamstring. These scans are only performed if
a negative response to treatment occurs or the mechanisms of injury are unknown.
The following physical examination techniques are commonly performed when
diagnosing hamstring injuries:
1) Straight Leg Raise: Passive leg raising with straight
knee. Normal ROM is 80 – 90, pain may be
reproduced. Comparisons are made between opposite
limbs.

2) Resisted Knee Flexion: Passive resistance as patient

bends knee. Causes hamstring contraction and pain.
Strength of movement is compared to opposite limb

3) Slump Test: Determines if any neural involvement is

present. Patient straightens out one leg, bends head
downwards and points toes upwards. Stretch is
enhanced by pushing patient forward. Symptoms such
as pain shooting down the leg is a positive indication
of neural involvement.

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4) Palpitation: Physician will touch or palpitate the muscle to detect any
deformity, pain, tension or hole within the muscle belly and associated
structures.

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Treatment:
With adequate rest minor to moderate hamstring pulls will most likely heal in a
few weeks. Initial treatment for a hamstring strain should start immediately post
injury following the doctrine of PRICE (protection, rest, ice, compression and
elevation) and last for 24 to 48 hours.
Rest as much as possible, with the leg elevated. Cold therapy and compression
should be applied and compression bandage can be worn to control swelling. Ice
the affected leg for 15 to 20 minutes every hour for the first couple of days after
the injury and use over the counter medications, like Ibuprofen to help alleviate
pain.

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References:
1. Hoskins, W., & Pollard, H. (2005). The management of hamstring injuries –
part 1: Issues in diagnosis. Manual Therapy, 10(1): 96-107
2. Brockett, C., Morgan, D., & Proske, U. (2004). Predicting hamstring strain
injury in elite athletes. Medicine and Science in Sports and Exercise, 36(3):
379-387.
3. 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.
4. 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.
5. 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.

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