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.
Related reading:
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.
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