How To Tell Apart A Hamstring Tear From A Hamstring Strain & How is Torn Hamstring Treated?

Hamstrings are tendons of the muscles located at the back of the thigh. The hamstring muscles are responsible for bending the knee, and they help straighten the hip as well. A hamstring tear injury is a rip that occurs in the hamstring muscles. Such type of injury typically happens when the hamstrings get overloaded or overstretched due to too much weight. Depending on the type of injury, the hamstring can either have a partial tear, or it can tear completely. Here’s everything you need to know about hamstring tear injuries.

What are Hamstrings?

Hamstrings are the tendons that are attached to the large muscles located at the back of the thigh. The hamstring muscles are the large muscles that are responsible for pulling on these tendons. Injury to the hamstring muscles can happen when the hamstrings get overloaded or overstretched with too much weight.(1,2,3,4,5) A hamstring tear injury occurs when there is a rip in the hamstring muscles. Depending on the exact type of injury, the hamstring can either have a partial tear or a complete tear. The injury can also affect one or more of the hamstring muscle group. The muscles in the hamstring muscle group include:(6)

This group of muscles, located in the back of the thigh, helps you bend your knee while performing activities like running and jumping.

While it is possible for anyone to tear and injure their hamstring, this type of injury is more commonly observed in athletes. Here’s everything you need to know about hamstring tear injuries.

Causes of a Hamstring Tear

Most commonly, a hamstring tear happens during physical activity. Some of the common causes of this type of injury include:

Athletic injuries: Most cases of torn hamstrings are observed in athletes. This is usually caused by extreme overload or stretching during a sport. The injury is common in people who play sports like ice hockey, football, and soccer.(7)

  • Overtraining: Training too hard can also overstretch or overload your hamstrings, causing tears in this muscle group.(8)
  • Low or limited flexibility: If you have low or limited flexibility, doing certain movements may cause you to overstretch your muscles too far, thus causing a tear in the hamstring.
  • Past hamstring injury: If you have had a tear in the hamstring in the past, you are more likely to experience a tear again. This risk is especially high if you practice intense and strenuous activity before you fully recover from the previous injury.

Additionally, apart from athletes, older adults are also quite prone to experiencing hamstring tears. This is because there is a gradual decline in flexibility as a person ages. Adolescent athletes, whose muscles and bones are still growing, are also at a high risk of hamstring tears. Since muscles and bones grow at different rates, in such athletes, the growing bone can often tighten the hamstring muscles, making them more vulnerable to such injuries.(9)

Symptoms of a Hamstring Tear

The exact symptoms of a torn hamstring depend on the severity of the injury you have suffered. Here are some of the symptoms you may experience if you have a torn hamstring:

  • Tenderness
  • Sudden and sharp pain
  • A ‘popping’ sensation at the time of injury
  • Swelling within the first couple of hours after the injury
  • Bruising within the first couple of days after the injury
  • Inability to put any weight on the affected leg
  • Partial or complete weakness in the affected leg

Categorization of Hamstring Tears

Depending on the severity of the tear, hamstring injuries are typically categorized into three grades.(10)

Grade 1 Hamstring Injury: Grade 1 is defined as mild hamstring strain, also known as a pulled hamstring. This type of injury occurs when the hamstring muscles get overstretched, but there is no tear.

If the hamstring stretches beyond a point and rips, the injury is then classified as a tear. Here are the hamstring tear grades:

Grade 2 Hamstring Tear: A partial muscle tear is referred to as a grade 2 hamstring tear. This means that the muscle has not ripped completely, but there is an injury nevertheless. As compared to a grade 1 hamstring strain, a grade 2 hamstring tear is more painful. You will feel weakness in the leg and are likely to have a limp following the injury.

Grade 3 Hamstring Tear: This is the most severe type of hamstring tear. This happens when the hamstring muscle completely rips or is torn off the bone itself. A tear that pulls any type of muscle off the bone is known as an avulsion.(11,12,13)

How To Tell Apart A Hamstring Tear From A Hamstring Strain?

Most people tend to use the terms hamstring ‘tears’ and ‘strains’ interchangeably, but this does not mean that they are the same thing.(14)

When you have a hamstring tear, the hamstring muscle fibers stretch to such a level that they rip. On the other hand, a hamstring strain is when the hamstring muscle gets only overstretched, but there is no rip.

So while a hamstring tear is a type of strain, but this does not mean that all hamstring strains will result in a rip.

How is a Hamstring tear Diagnosed?

When you go for your appointment, a doctor will carry out various steps to determine whether you have a torn hamstring or a hamstring strain. This may include: (15,16)

Physical Examination: Your doctor will begin by checking your thigh for any swelling, bruising, and tenderness. This will help them in determining if you have a mild or severe injury.

X-Ray: You will need to get an X-ray if your doctor believes that you also suffered a bone fracture during your injury.

MRI: If your doctor believes that you have a severe hamstring injury, they may order an MRI. This imaging test will help your doctor see any tear in your muscle tissue.

Ultrasound: An ultrasound is another diagnostic test that will help your doctor get a detailed image of your hamstring muscles. It will also show them the size and location of the hamstring tear.

How is a Torn Hamstring Treated?

The exact treatment for a torn hamstring depends on the severity and grade of your injury. Available treatment options for a torn hamstring includes:

The RICE Method

This is usually the first method of treatment that is advised for most sports injuries. If you have a grade 2 hamstring tear, this will be the main form of treatment. RICE stands for:(17)

Rest: Take plenty of rest from doing any physical activity to allow your hamstrings to heal. You may need to use a knee splint or crutches to avoid any major movement of your leg.

Ice: To reduce the pain and swelling, wrap some ice in a towel and place it on your hamstring for about 15 to 20 minutes. Repeat this for at least three to four times a day.

Compression: Using an elastic compression bandage will help alleviate the swelling.

Elevation: Keeping the injured leg elevated will also help bring down the swelling. Place the wounded leg higher than your heart level by using cushions, pillows, or folded blankets.

Pain Medication

Typically, treatment for hamstring tear injuries involves taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. You may need to take NSAIDs to relieve the pain for around a week after the injury. Your doctor will recommend the right medication and dosage for you.

Physical Therapy

Once your pain goes down, you will be advised to begin physical therapy. Your physical therapist will come up with a regimen that will help improve your range of motion and flexibility. As you start getting better, your therapist will start you on hamstring strengthening exercises.

Hamstring Surgery

If the above treatments don’t work to heal a partial hamstring tear, or if you have experienced a complete tear, you may require surgery to repair the injury. Your surgeon will fix the hamstring tear with stitches. However, most hamstring surgeries are typically done for treating avulsions.(18,19)

During the surgery, your surgeon will move the hamstring muscle back into its correct position and then stitch or staple it back to the bone.

What is the Recovery Time and Outlook for Hamstring Tear Injury?

Recovery time for a torn hamstring varies greatly. The recovery time also depends on various factors, like:

  • Severity and grade of your hamstring tear
  • Whether you have a history of torn hamstrings
  • Your age
  • And your overall health.

Recovery typically takes around four to eight weeks if you have a partial hamstring tear. During this time, though, make sure to take a lot of rest and also continue your physical therapy.

However, recovery in case of a complete hamstring tear can take around three months to heal. The recovery time will be longer if you have had surgery. Your doctor will advise you on when you can go back to work. However, if you have a physically strenuous job, you will be recommended to stay at home and rest for most of the recovery period.

Remember that it is essential for you to follow your doctor’s advice and rehabilitation plan as you recover. This will not only improve your outlook but also reduce the risk of re-injuring your hamstring.

Conclusion

Usually, most hamstring tear injuries are caused by sports or athletic injuries. A partial hamstring tear tends to heal in four to eight weeks, but the healing of a complete hamstring tear takes around three months. With plenty of rest and regular physical therapy, you will start to feel better in no time. However, to avoid having a re-injury, it is recommended that you follow your doctor’s advice and stick to the treatment regimen. Do not return to your sports or work before your doctor gives you the go-ahead.

References:

  1. Worrell, T.W., 1994. Factors associated with hamstring injuries. Sports Medicine, 17(5), pp.338-345.
  2. Agre, J.C., 1985. Hamstring injuries. Sports Medicine, 2(1), pp.21-33.
  3. Kujala, U.M., Orava, S. and Järvinen, M., 1997. Hamstring injuries. Sports medicine, 23(6), pp.397-404.
  4. Opar, D.A., Williams, M.D. and Shield, A.J., 2012. Hamstring strain injuries. Sports medicine, 42(3), pp.209-226.
  5. BURKETT, L., 1970. Causative factors in hamstring strains. Medicine and science in sports, 2(1), pp.39-42.
  6. Grahovac, N.M. and Žigić, M.M., 2010. Modelling of the hamstring muscle group by use of fractional derivatives. Computers & Mathematics with Applications, 59(5), pp.1695-1700.
  7. Ali, K. and Leland, J.M., 2012. Hamstring strains and tears in the athlete. Clinics in sports medicine, 31(2), pp.263-272.
  8. Roberson, J.H., Pediatric Overuse Injuries and Overtraining.
  9. Brockett, C.L., Morgan, D.L. and Proske, U.W.E., 2004. Predicting hamstring strain injury in elite athletes. Medicine & Science in Sports & Exercise, 36(3), pp.379-387.
  10. Chan, O., Del Buono, A., Best, T.M. and Maffulli, N., 2012. Acute muscle strain injuries: a proposed new classification system. Knee Surgery, Sports Traumatology, Arthroscopy, 20(11), pp.2356-2362.
  11. Koulouris, G. and Connell, D., 2003. Evaluation of the hamstring muscle complex following acute injury. Skeletal radiology, 32(10), pp.582-589.
  12. Gidwani, S. and Bircher, M.D., 2007. Avulsion injuries of the hamstring origin–a series of 12 patients and management algorithm. The Annals of The Royal College of Surgeons of England, 89(4), pp.394-399.
  13. Carmichael, J., Packham, I., Trikha, S.P. and Wood, D.G., 2009. Avulsion of the proximal hamstring origin: surgical technique. JBJS, 91(Supplement_2), pp.249-256.
  14. Liu, H., Garrett, W.E., Moorman, C.T. and Yu, B., 2012. Injury rate, mechanism, and risk factors of hamstring strain injuries in sports: a review of the literature. Journal of sport and health science, 1(2), pp.92-101.
  15. Hoskins, W. and Pollard, H., 2005. The management of hamstring injury—Part 1: Issues in diagnosis. Manual therapy, 10(2), pp.96-107.
  16. Reiman, M.P., Loudon, J.K. and Goode, A.P., 2013. Diagnostic accuracy of clinical tests for assessment of hamstring injury: a systematic review. journal of orthopaedic & sports physical therapy, 43(4), pp.222-231.
  17. Clanton, T.O. and Coupe, K.J., 1998. Hamstring strains in athletes: diagnosis and treatment. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 6(4), pp.237-248.
  18. Blakeney, W.G., Zilko, S.R., Edmonston, S.J., Schupp, N.E. and Annear, P.T., 2017. Proximal hamstring tendon avulsion surgery: evaluation of the Perth Hamstring Assessment Tool. Knee Surgery, Sports Traumatology, Arthroscopy, 25(6), pp.1936-1942.
  19. Subbu, R., Benjamin-Laing, H. and Haddad, F., 2015. Timing of surgery for complete proximal hamstring avulsion injuries: successful clinical outcomes at 6 weeks, 6 months, and after 6 months of injury. The American journal of sports medicine, 43(2), pp.385-391.

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