Hamstring Injury Clinical Presentation

  • Author: Herman Brad Ruiz, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Nov 10, 2011
 

History

  • The onset of pain and/or weakness is usually sudden and may occur during an explosive movement, such as sprinting.
  • Patients may report hearing an audible pop at the time of injury.
  • Onset of posterior thigh pain is often near the beginning or near the end of the sport activity. This is consistent with the belief that fatigue and lack of warm-up are factors that may lead to muscle injury.
  • Patients may only have a sense of apprehension due to a feeling of inadequate leg control as a result of the injury.
  • Patients may report pain with sitting or while walking uphill or ascending stairs.
  • Swelling and ecchymosis may accompany more severe injuries.
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Physical

  • Physical findings are absent in many hamstring injuries.
  • The patient often has pain with active knee flexion against resistance. The procedure is performed with the hip in a neutral position and the knee in an extended starting position.
    • With the patient in a prone position and the affected extremity's knee flexed at 90 º, palpate from the ischial muscle origins to their insertions. This minimizes patient pain, which can limit detecting muscle defects.
    • Next, with the patient in the supine position and the hips flexed to 90 º, the maximum tolerable active and passive knee extension angle should be noted and compared to the contralateral leg. This allows the physician to assess the severity of the injury and to monitor future rehabilitation progress.
  • In severe cases, swelling and ecchymosis may be present.
  • With a complete hamstring rupture, the muscle may contract into a ball, with an accompanying strength deficit.
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Causes

  • The major predisposing factors are lack of warm-up, poor flexibility, fatigue, and a hamstring-to-quadriceps ratio less than 50%.
  • A previous hamstring injury is the most recognized risk factor for injury. A study of elite track and field athletes with acute, first-time, unilateral hamstring muscle strains found that low-grade hamstring muscle injuries may lead to a higher risk of reinjury than high-grade injuries.[12]
  • Poor running style, especially overstriding, predisposes some runners to hamstring injuries. Overstriding stretches the hamstring and places it in a position of active insufficiency.
  • Dyssynergia secondary to dual innervation of the hamstring muscles may also be a factor that contributes to hamstring injuries.
  • Rapid growth seen during adolescence sometimes leads to tight hip flexors with a resultant anterior hip tilt. This can cause a natural predisposition to hamstring injuries for this age group.
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Contributor Information and Disclosures
Author

Herman Brad Ruiz, MD  Staff Physician, Department of Physical Medicine and Rehabilitation, Division of Orthopedics and Rehabilitation, Loyola University Medical School at Illinois

Herman Brad Ruiz, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of Academic Physiatrists, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph P Garry, MD, FACSM, FAAFP  Associate Professor, Sports Medicine Faculty, Department of Family and Community Medicine, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group

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

Russell D White, MD  Professor of Medicine, Professor of Orthopedic Surgery, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

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

  2. Reid DC. Soft tissue injuries of the thigh. Sports Injury Assessment and Rehabilitation. Philadelphia, Pa: Churchill Livingstone; 1992:551-71.

  3. Sarimo J, Lempainen L, Mattila K, Orava S. Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med. Jun 2008;36(6):1110-5. [Medline].

  4. Sallay PI, Friedman RL, Coogan PG, Garrett WE. Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med. Mar-Apr 1996;24(2):130-6. [Medline].

  5. Askling CM, Tengvar M, Saartok T, Thorstensson A. Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med. Apr 30 2008;epub ahead of print. [Medline].

  6. Croisier JL, Ganteaume S, Binet J, Genty M, Ferret JM. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med. Apr 30 2008;epub ahead of print. [Medline].

  7. Clark RA. Hamstring injuries: risk assessment and injury prevention. Ann Acad Med Singapore. Apr 2008;37(4):341-6. [Medline]. [Full Text].

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

  9. Hoskins W, Pollard H. The management of hamstring injury-- part 1: issues in diagnosis. Man Ther. May 2005;10(2):96-107. [Medline].

  10. Levine WN, Bergfeld JA, Tessendorf W, Moorman CT 3rd. Intramuscular corticosteroid injection for hamstring injuries. A 13-year experience in the National Football League. Am J Sports Med. May-Jun 2000;28(3):297-300. [Medline].

  11. Elliott MC, Zarins B, Powell JW, Kenyon CD. Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med. Apr 2011;39(4):843-50. [Medline].

  12. Malliaropoulos N, Isinkaye T, Tsitas K, Maffulli N. Reinjury after acute posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med. Feb 2011;39(2):304-10. [Medline].

  13. Kujala UM, Orava S, Järvinen M. Hamstring injuries. Current trends in treatment and prevention. Sports Med. Jun 1997;23(6):397-404. [Medline].

  14. Unger CL, Unger DA. Preventing and rehabilitating hamstring injuries. Athl Ther Today. May 1997;44-9.

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

  16. Petersen J, Thorborg K, Nielsen MB, Budtz-Jørgensen E, Hölmich P. Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men's Soccer: A Cluster-Randomized Controlled Trial. Am J Sports Med. Nov 2011;39(11):2296-303. [Medline].

 
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