Diagnosis
A hamstring muscle strain/tear is likely be the result of a ‘moment in time’ when you feel immediate pain in the back of your leg, most likely during running, sprinting or rapid stretching of your hamstring muscle.
You can read more about muscle strains in general here:
And more about the diagnosis of hamstring muscle injuries here:
Prognosis
As mentioned in the above link regarding “Muscle Strains”, every injury will be different, with a myriad of factors combining to determine tissue healing.
A rough estimate would be:
- Grade 1 muscle strain = approximately 0-2 weeks
- Grade 2 muscle strain = approximately 2-8 weeks
- Grade 3 muscle strain = approximately 6 weeks – 6 months
Some clinical prediction rules for hamstring injuries in particular include:
1. Time to painfree walking
- More than 1 day until painfree walking = 4 x more likely to take more than 3 weeks to return to play
2. Time to painfree jogging
- 1-2 days = less than 2 weeks to return to play
- 3-5 days = more than 2 weeks to return to play
- More than 5 days = well over 4 to weeks return to play
3. A previous history of the same injury within 12 months means return to play will take more than 3 weeks.
Treatment
Return to running
There is a big difference in how hard the hamstring muscle works when running slow compared to running fast.
Research has shown that the hamstring muscles experience a peak force of approximately 2 x bodyweight when running slowly compared to up to 9 x body weight when running fast.
(Dorn et al., 2012)
Therefore it is usually safe and appropriate to start running relatively soon after a hamstring injury within comfort.
However, care must be taken when progressing towards higher speed running, which is where a graded return to high speed running program is important.
10 Stage Hamstring Return to High Speed Running Protocol
Here is a 10 stage program designed to safely expose the hamstring to higher speeds and higher rates of acceleration/deceleration.
*** 60m strides ***
Stage 1 = 50%
– Build to 50% over 30m
– Slow down over 30m
Stage 2 = 50%
– Build to 50% over 20m
– Hold 50% for 20m
– Slow down over 20m
Stage 3 = 50%
– Build to 50% over 20m
– Hold 50% for 30m
– Slow down over 10m
Stage 4 = 75%
– Build to 75% over 30m
– Slow down over 30m
Stage 5 = 75%
– Build to 75% over 20m
– Hold 75% for 20m
– Slow down over 20m
Stage 6 – 75%
– Build to 75% over 20m
– Hold 75% for 30m
– Slow down over 10m
Stage 7 = 90%
– Build to 90% over 30m
– Slow down over 30m
Stage 8 = 90%
– Build to 90% over 20m
– Hold 90% for 20m
– Slow down over 20m
Stage 9 = 90%
– Build to 90% over 20m
– Hold 90% for 30m
– Slow down over 10m
Stage 10 = 100%
– Build to 100% over 20m
– Hold 100% for 30m
– Slow down over 10m
NOTES:
- Warm up with a 5 minute jog – increase this by 1 minute per stage
- 10 repetitions of each stage per day
- One stage per day only
- Progress to the next stage only if recovered 100% from previous day
- Consider icing after completing each stage/day
- Walk back after each shuttle and repeat
Return to play
- All criteria met as per Erickson & Sherry 2017 as detailed above
- 10 stage running program completed as detailed above
- At least 1 full week of unrestricted training
- Athlete and physiotherapist both fully confident
References
Dorn, T. W., et al. (2012). Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance. J Exp Biol 215(Pt 11): 1944-1956.
Erickson, L. N., & Sherry, M. A. (2017). Rehabilitation and return to sport after hamstring strain injury. Journal of sport and health science, 6(3), 262–270. https://doi.org/10.1016/j.jshs.2017.04.001