A hamstring strain is a tear where the muscle and tendon attach. It is common in soccer players and sprinters. During sprinting, the hamstring muscles work extremely hard to slow down the lower leg. Once the foot is on the ground the hamstrings are used to straighten the hip backwards; this allows the other leg to move forwards. The hamstrings most often become injured during the time right before the foot strikes the ground. At this stage the muscles are maximally activated and are approaching their maximum length. A strain can also occur when pushing off to sprint; this is an explosive movement that recruits all the power of the hamstring muscles.

Mechanism of Injury

A hamstring strain is graded 1, 2 or 3, depending on severity. Grade 1 consists of minor tears within the muscle. A grade 2 is a partial tear in the muscle and grade 3 is a severe or complete rupture of the muscle.

Grade 1: What does it feel like?

• Your soccer player may have tightness in the back of his thigh.
• He will probably be able to walk normally but will be aware of some discomfort.
• Minimal swelling.
• Lying on his front and trying to bend his knee against resistance will probably not produce much pain.

Grade 2: What does it feel like?

• Walking will be affected (your player may have a limp).
• She may have occasional sudden twinges of pain during soccer activity.
• May notice swelling.
• Pressure increases her pain.
• Flexing her knee against resistance causes pain.
• Might be unable to fully straighten her knee.

Grade 3: What does it feel like?

• Walking is severely affected; your athlete may need walking aids such as crutches.
• Severe pain, especially during soccer activity with knee flexion.
• Noticeable swelling that is visible immediately.

Possible causes of a hamstring strain:

• Age: the older your soccer player is the more he is at risk for a strained hamstring during soccer activities.
• Previous Injury: Previous injuries to his hamstrings or adductor muscles can increase the risk of re-injury in the future.
• Flexibility: The greater the flexibility of his hamstrings the less prone he is to injury while playing soccer.
• Hamstring strength: Lack of hamstring strength is strongly linked to a chance of a pulled (strained) hamstring during soccer play.
• Lumbosacral nerve impingement: Nerve impingement in his L5-S1 lower back bones can lead to related hamstring muscle weakness.
• Tiredness and fitness: When your player is fatigued he loses coordination of muscle groups. The biceps femoris muscle is a hamstring muscle that has two separate nerves to help it work. When your athlete is tired the nerves may not work together, he could pull his hamstring because one section is working while the other is not.

Signs and Symptoms

• Immediate intense pain, “It felt like I was struck in the back of the leg”.

• Hamstring muscles going into spasm (related to pain when your soccer player stretches or uses the muscle).

• Swelling and bruising.

• Decreased strength.

• Sometimes you can feel the torn muscle.

On-Site Management

P.R.I.C.E. PROTECT the area from further injury by avoiding soccer exercises that produce pain. A neoprene sleeve can be worn over the muscle to keep it warm during activity. REST: cutting back on the amount of soccer training can be difficult, but key to recovery. Gradually return to any soccer running activities. Your soccer player should place ICE on her hamstring for 10-20 minutes every 1.5 to 2 hours for the first 2 to 3 days or until the pain goes away. COMPRESS the area by having a trainer or physiotherapist use a compression wrap. This helps decrease swelling and bleeding in the muscle. ELEVATION is important to encourage blood flow to the heart for healing.

Medical Referral. When there is a severe 2^nd or 3^rd degree hamstring strain it is important that you seek medical attention to rule out something more serious. A doctor may prescribe anti-inflammatory medication to help with pain and swelling. You should get a medical referral for a therapist. This individual can perform a proper evaluation of running/jumping biomechanics and footwear. The therapist can also direct you to proper treatment and strengthening activities for return to play.

Rehabilitation. You should find a therapist to assist with your evaluation.

Your therapist may use:

• Sports massage
• Ultrasound and electrical stimulation
• Prescribe a hamstring/soccer specific rehabilitation program
• Advise on hamstring/soccer specific stretches
• Provide walking aids such as crutches

Stretching and strengthening exercises throughout the pain free range will help decrease the swelling in the area and make sure the muscle will heal correctly.

Return to Activity. This is a gradual process and may take some time. In general, the longer you have symptoms before you start treatment, the longer it will take to rehabilitate. The following is a list of guidelines to follow when returning to soccer activity.

• Work towards full range of motion in the affected hamstring compared to the unaffected one.
• Work towards full strength of the affected hamstring compared to the unaffected one.
• Work towards jogging straight ahead without pain or limping.

Your therapist will also use more specific tests to determine when you can return to soccer play.

Prevention

• One of the most important ways to prevent a pulled hamstring is to warm up correctly and completely. Thermal pants are suggested to help with this.
• A specific strengthening program for your soccer player's hamstring muscle group and soccer activities is important to prepare for high speed athletics.
• It is extremely important to continue to strengthen all other muscles in the thighs, pelvis and lower back to make sure your player has correct muscle balance.
• Stretching both before and after soccer exercise.
• Regular deep tissue sports massage can help prevent muscle strains by identifying tight knots and weak points in the muscle.

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