Hamstring Injury

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Understanding Your Hamstring Injury & First Steps to Recovery

In this five-part guide, Dr. Kuhlman shares his knowledge of soccer-specific hamstring injuries, going over:

1) Common signs and symptoms of hamstring strains, a grading scale of strain severity,

2) Framework for what to do during the first week post injury

3) When to seek professional help and where to go

4) Common mechanisms of injury (MOIs) in soccer
 5) Basic anatomy of the hamstring muscle group

1) Do I Have a Hamstring Injury?

How can I tell if I have a hamstring injury? What are the symptoms? 

The main symptoms of a hamstring strain are:

• Upon injury, a heard or felt "popping" sensation in the back of the thigh, followed by tenderness, pain, and occasionally bruising
• A tightening or "grabbing" feeling of the muscle
• Recurring pain, especially with movement
• Loss of strength
• In serious cases (especially if the muscle is torn), severe pain and disability

What kind of hamstring strain do I have? 

There are three grades of hamstring strain and differentiating between them can help determine the best course of action on how to treat the injury.

• Grade I strains are characterized by pain/tightness in the hamstring muscle, especially with movements such as walking, bending at the waist, and trying to extend the knee. There is not usually a “pop” heard on initial injury and very little, if any, bruising present.
• Grade II is the next step in severity. Sometimes a “pop” is present and there is usually some level of bruising and weakness associated. Movements will be more difficult, and you may have some pain at rest as well.
• Grade III strains are very often accompanied by a “pop/tear” sensation upon injury, complete loss of strength, elevated pain levels, and will almost always have significant bruising in the area.

The above grading scale refers to traumatic or sudden onset of hamstring pain. However, there are cases of hamstring pain that can come on gradually or seemingly without a known reason. While there are several diagnoses that could explain that pain, they are beyond the scope of this guide. If you are having hamstring pain that has come on gradually, I would recommend reaching out to a local Sports Medicine professional.

If your injury is of traumatic nature, continue onto the next section, which will go what to do in the first week of your injury!

2) Hamstring PROTECT Guide:

Framework for the First Week Post-Injury

The first week is arguably the most important week for tissue healing and getting rehabilitation off on the right foot. But what should you do? There is so much information on the internet, it can be like drinking from a firehose.

Luckily, Dr. Kuhlman has created an injury guide called PROTECT® - Hamstring Strain, designed specifically for soccer players. This step-by-step, easy-to-follow guide has everything you need to start your rehabilitation journey off right and is divided into four pillars of injury care: 

• Pillar 1: Protecting the Damaged Tissue | Rest, Compression, Bracing, Kinesiotaping, Getting Through Your Day Safely
• Pillar 2: Pain Management | To Ice or Not to Ice?, Topical Pain Relievers, NSAID Considerations
• Pillar 3: Tissue Health and Healing | Sleep, Hydration, Nutrition
• Pillar 4: Movement | Massage, Foam Rolling, IASTM
• Putting It All Together: A Sample Day-to-Day Schedule

Dr. Kuhlman developed PROTECT® - Hamstring Strain after countless hours of research and years of clinical, face-to-face rehabilitation - and it's completely free, you just have to enter your email below! 

PROTECT Your Acute Hamstring Injury with Dr. Kuhlman's Free PROTECT Guide!

If you're recently hung up with a soccer injury, the PROTECT Guide is for you! Lay the groundwork for healing and rehab with Four Pillars designed to protect the damaged tissue and ready your acute hamstring injury for rehabilitation. 

3) When to Get Professional Help (and Where to Start)

If you believe you indeed have a hamstring injury, there are a few paths you can take, depending on the severity of your injury. The programs detailed here on The Soccer Assist are designed for Grade I to Grade II injuries to the hamstrings. While elements of this program would be used in more severe (Grade III) cases, it is best to have a medical professional monitor the course of the program at that point. Here are a few signs that you should seek out a local medical professional:

• You are having a hard time moving at all
• You can’t walk without severe pain
• You have significant muscle weakness, a palpable tear, and/or a high level of bruising

I use the saying, “If it feels sketchy, it's probably sketchy” a lot in practice. Basically, that means if you feel like it’s bad, it's probably bad, and you should go get it looked at. But, where should you start? 

“I think I have more than a Grade II hamstring strain, where do I start?” 

If you are like most Sunday League players, you do not have an Athletic Trainer or team doc there to look at your injury. If your team does, go with them! But, if you are a weekend warrior and/or don’t have the luxury of team staff, the gold standard to look for is an Orthopedic office that also functions as an urgent care. They are going to be most prepared to handle orthopedic injuries such as hamstring strains. Depending on the state you live in, a Sports Chiropractor would also be a great place to start; but note that a lot of states restrict what physicians may refer where. If none of those are available, an urgent care/emergency room visit may be warranted. Depending on the severity of the injury, an MRI may be recommended to determine the extent of the muscle injury and will help dictate what the proper course of action is.

“I think I have a Grade I or mild Grade II injury, what should I do?”

That is where The Soccer Assist comes in! We have created programs to guide you from your initial injury (where you most likely are now), to getting back on the pitch, playing the game we all love! The next section details our framework for what to do that first week post injury.

4) Most Common Mechanisms of Injury for Soccer Players

The most common MOI (mechanism of injury) for the hamstrings muscle group is hip flexion (knee to chest motion) combined with a rapid extension of the knee joint (such as a kick). This combination puts the hamstring at maximum stretch and can overwhelm the capacity of the hamstring muscle group to stretch safely.

The hamstrings can be overwhelmed by force (aka too much tension going through the muscle group), or by speed, where the knee is extended at a higher velocity than the hamstring group can tolerate.

In soccer terms, there are two main conditions where hamstring injuries tend to occur.

1. The first is during a sprint, when the player extends their leg forward as they come through their stride.
2. The second is where they are performing a maximal kick, and the hamstring is overwhelmed attempting to control the leg during full knee extension and hip flexion.

5) What Are the Hamstrings and What Do They Do?

(Hamstring Anatomy Lesson)

The hamstrings are a group of three and a half muscles that live in the back of the thigh. The group is made up of the Semimembranosus, Semitendinosus, and Biceps Femoris muscles. The "half" muscle is in there because part of a groin muscle, the Adductor Magnus, functions as a hamstring. They run from the  “Sit” bone called the Ischial Tuberosity on the bottom of the pelvis to the back of the thigh bone (Femur) and leg bone (Tibia).

Their textbook purpose in the body is to flex the knee, but they also play an important part assisting the Gluteus Maximus in extending the hip. In addition, they are responsible for controlling a few other motions: 

• To slow knee extension during a quad contraction (such as during a kick)
• To control hip flexion (such as during the running cycle)

That controlled extension of the hamstring is termed the “eccentric contraction” and it basically means that the muscle is contracting/tensing but lengthening at the same time. This is an important concept, as most of the hamstring injuries discussed previously tend to be during this eccentric contraction process.