Hamstring - The Good (strain), The Bad (pull), The Ugly (torn)

The Hamstring muscle group has an inferiority complex. You can't blame them. They are long, weak, and skinny when compared to their strong voluptuous counterpart, the Quad. It is an invisible muscle group; you never see them in your mirror. To top it off, you sit on the insert and smash it against the ischial tuberocity. While stabilizing the knee; it keeps you from kicking yourself in the face. The quads pull your lower leg forward with the hamstrings controlling the deceleration phase of the motion. There must be a balance between the two muscle groups. Ideally, the hamstrings should be two thirds the strength of the Quads. If not, you will be a candidate for muscle damage or worse; a damaged knee.

We must first define the difference between a strain, a pull, and a tear. The difference between these three words is all relative to how much tissue is involved. Each one constitutes some degree of torn muscle fibers. Palpatory skills are important in ascertaining the severity of the injured tissue. Muscles are fibrous and being able to isolate the injured muscle or muscles is necessary to assign a word to the injury. Compare the injured leg with the uninjured leg to get a good feel for what you are dealing with. Putting fingertip pressure on the affected area will elicit a pain response. If the muscle is contiguous with only tightness and no knots or swelling, then it is a strain. Point tenderness with swelling or a definitive knot is a pull. A gap or a complete avulsion can be construed as a tear. Obviously, the amount of tissue involved will dictate the length of time to rehab the muscle. Other factors to take into account are the physical shape and age of the player. The better the physical condition and the younger the player enhances the chances for a faster recovery. The only exception is a juvenile going through a growth spurt. The bones grow first and the muscles have to grow to catch up with them. The muscle becomes naturally taut and more prone to injury. Another biomechanical problem to be aware of is an SI joint dysfunction (Sacrum/Illium joint). It is very common in soccer due to kicking the ball predominately with one leg. This can torque the hips and put added stress on one hamstring. If you suspect a ham strain or pull, first check the SI, especially in your younger players whose joints are hyper mobile anyway. Treating SI dysfunction will be another article.

So you have torn some tissue, now what do you do. First, try to determine the amount of tissue damaged. Palpable point tenderness is key to dictating the steps in rehab. The biggest problem in hamstring rehab is this: the point tenderness goes away, the player feels good, he goes out and plays and tears it again only this time more tissue is involved. When the point tenderness is gone, the scar tissue is setting up but is not mature yet. At this point, you can get more aggressive with your rehab. Always exercise in pain free ranges. Cross friction massage helps line up the fibers in the scar tissue. Light stretching after a warm-up period is also added. A warm muscle will stretch twice as a cold one. Scar tissue must be softened and stretched. The exercise bike can be used to keep the player in shape. You have less muscle tissue left now so you must build up the remaining fibers to make up for the deficit. Strength is important but endurance needs to be addressed too before you take the field. Jogging, steppers, or elliptical can be added as benign endurance exercises under pain free conditions. When the muscle is equal to the opposite leg, then a progressive run to sprint program should be added. Practice is an excellent place to test the leg when rehab is over. Game time is not the place to test your hamstring.

A damaged hamstring is more complicated than you think. If you use the rest and play rehab method then you will tear the ham over and over again until there is little muscle tissue left. Go to a qualified sports medicine professional and get it done the right way the first time.