Hamstring Strain 

  • Author: Jeffrey M Heftler, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Nov 22, 2011
 

Background

Hamstring injuries are common problems that may result in significant loss of on-field time for many athletes because these injuries tend to heal slowly. Once injury occurs, the patient is at high risk for recurrence without proper rest and rehabilitation.

The hamstring muscles are 3 muscles in the posterior thigh: the semitendinosus, semimembranosus, and biceps femoris. The semitendinosus originates at the ischial tuberosity and inserts at the pes anserine; the semimembranosus originates at the ischial tuberosity and inserts at the posterior medial tibia. The biceps femoris has a long head that originates at the ischial tuberosity and a short head at the posterolateral femur and inserts into the head of the fibula. Both muscles serve as knee flexors and hip extensors. See the image below.

Normal sagittal alignment permits the knee to lockNormal sagittal alignment permits the knee to lock in full extension, aided by powerful quadriceps and an intact extensor mechanism. The ground reaction force passes anterior to the "center of rotation" of the knee, while the posterior cruciate ligament, posterior capsule, hamstrings, and gastrocnemius provide a tension band effect.

At heel strike of the gait cycle, the hamstrings actually contribute to knee extension through closed chain kinetics. During the gait cycle, the biceps femoris contracts eccentrically in terminal swing, which is important in the pathology of the injury, as discussed later.[1, 2, 3]

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Epidemiology

Frequency

United States

Hamstring strain is a fairly common injury in physically active individuals.

Mortality/Morbidity

No mortality is associated with hamstring strain; however, morbidity is common, due to pain and reinjury if proper rehabilitation does not occur before the patient returns to preinjury activity levels.

Age

While hamstring injuries can occur in people of any age, incidence increases with age.

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Contributor Information and Disclosures
Author

Jeffrey M Heftler, MD  Interventional Physiatrist, Orthopaedic and Neurosurgical Specialists, Greenwich, CT

Jeffrey M Heftler, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and International Spine Intervention Society

Disclosure: Nothing to disclose.

Coauthor(s)

Michael F Saulino, MD, PhD  Assistant Professor, Department of Physical Medicine and Rehabilitation, MossRehab, Jefferson Medical College of Thomas Jefferson University

Michael F Saulino, MD, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Curtis W Slipman, MD  Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center

Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health, Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References

  1. Schache AG, Wrigley TV, Baker R, et al. Biomechanical response to hamstring muscle strain injury. Gait Posture. Feb 2009;29(2):332-8. [Medline].

  2. Yu B, Queen RM, Abbey AN, et al. Hamstring muscle kinematics and activation during overground sprinting. J Biomech. Nov 14 2008;41(15):3121-6. [Medline].

  3. Silder A, Heiderscheit BC, Thelen DG, et al. MR observations of long-term musculotendon remodeling following a hamstring strain injury. Skeletal Radiol. Dec 2008;37(12):1101-9. [Medline].

  4. Davis KW. Imaging of the hamstrings. Semin Musculoskelet Radiol. Mar 2008;12(1):28-41. [Medline].

  5. Warren P, Gabbe BJ, Schneider-Kolsky M, et al. Clinical predictors of time to return to competition and of recurrence following hamstring strain in elite Australian footballers. Br J Sports Med. Aug 14 2008;[Medline].

  6. Sallay PI, Ballard G, Hamersly S, et al. Subjective and functional outcomes following surgical repair of complete ruptures of the proximal hamstring complex. Orthopedics. Nov 2008;31(11):[Medline].

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  8. Agre JC. Hamstring injuries. Proposed aetiological factors, prevention, and treatment. Sports Med. Jan-Feb 1985;2(1):21-33. [Medline].

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  11. Clanton TO, Coupe KJ. Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg. Jul-Aug 1998;6(4):237-48. [Medline].

  12. Hartig DE, Henderson JM. Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees. Am J Sports Med. Mar-Apr 1999;27(2):173-6. [Medline].

  13. Hennessey L, Watson AW. Flexibility and posture assessment in relation to hamstring injury. Br J Sports Med. Dec 1993;27(4):243-6. [Medline].

  14. Laskowski E. Concepts in sports medicine. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: Saunders; 1996:930-1.

  15. Medical Economics Staff. Physician's Desk Reference. 55th ed. Oradell, NJ: Medical Economics Co; 2000:2631-4.

  16. Pomeranz SJ, Heidt RS Jr. MR imaging in the prognostication of hamstring injury. Work in progress. Radiology. Dec 1993;189(3):897-900. [Medline].

  17. Scoggin JF 3rd. Common sports injuries seen by the primary care physician. Part II: Lower extremity. Hawaii Med J. May 1998;57(5):502-5. [Medline].

  18. Speer KP, Lohnes J, Garrett WE Jr. Radiographic imaging of muscle strain injury. Am J Sports Med. Jan-Feb 1993;21(1):89-95; discussion 96. [Medline].

  19. Worrell TW. Factors associated with hamstring injuries. An approach to treatment and preventative measures. Sports Med. May 1994;17(5):338-45. [Medline].

  20. Yamamoto T. Relationship between hamstring strains and leg muscle strength. A follow-up study of collegiate track and field athletes. J Sports Med Phys Fitness. Jun 1993;33(2):194-9. [Medline].

 
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Normal sagittal alignment permits the knee to lock in full extension, aided by powerful quadriceps and an intact extensor mechanism. The ground reaction force passes anterior to the "center of rotation" of the knee, while the posterior cruciate ligament, posterior capsule, hamstrings, and gastrocnemius provide a tension band effect.
 
 
 
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