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The Painful Facts About Pulled Hamstrings

Written by Joshua Alpert, MD on June 2, 2015

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Chicago Bulls power forward Pau Gasol led the NBA with 54 double-doubles during the regular season, but was plagued by an injured hamstring that kept him off the court for three playoff games against the Cleveland Cavaliers.

He was finally able to play in the Bulls’ season-ending loss to the Cavaliers, but it was evident that his injury was not fully healed.

In order to prevent hamstring injuries, it is important to understand the anatomy of the hamstring tendon, as well as the treatment options when it is injured.

What is the hamstring tendon?
The hamstrings are tendons in the buttocks and back of the thigh. They are formed by three muscles and their tendons. The hamstrings connect to the bottom of the pelvis, just below the buttocks. Their tendons cross the knee joint and connect on each side of the shinbone.

The muscle moves the leg backward, propelling the body forward while walking or running. This is called hip extension. The hamstrings also bend the knees, a motion called knee flexion.

How does a hamstring injury occur?
Hamstring injuries happen when the muscles are stretched too far. Hamstring injuries occur in a variety of sports, but most often occur in running, jumping and kicking sports.

Those with a low levels of fitness and poor flexibility are at an increased risk for injuring their hamstring. Muscle fatigue and not warming up properly can also contribute to hamstring injuries.

When an especially bad pull or tear occurs, people will feel a pull in their hamstring or a sudden pull and severe pain in the back of the thigh and buttocks. In these cases, an athlete may suddenly hear a pop and fall to the ground. The athlete may be able to walk with only mild pain even in a severe injury, but taking part in strenuous exercise will be impossible, and the pain will continue.

In less severe cases, athletes notice a tight feeling or a pulling in their hamstring that slows them down. This type of hamstring injury often turns into a long-lasting problem.

The hamstring may be pulled, partially torn or completely torn. The injury can happen within the muscle or where the tendon connects onto the pelvis. The torn tissues may form a hard bunch in the back of the thigh when the leg is bent. The skin may also bruise, turning purple from bleeding under the skin. This is not necessarily dangerous but can look somewhat alarming.

How are hamstring tears treated?
For minor muscle pulls, two to four weeks is necessary to safely get back to activities. For more severe muscle tears, rehab for two to three months may be indicated, with complete healing occurring by four to six months. Surgery is very rare, and the mainstay of treatment is rehabilitation.

The rehab after a hamstring injury is vital to long-term recovery and success because incomplete or improper healing makes re-injury much more likely.

Hamstring injuries are initially treated using the RICE method – rest, ice, compression and elevation.

Specially designed exercises encourage the body to rebuild muscle instead of scar tissue. Rehabilitation can be slow, but stretching is a vital to any program.

Strengthening exercises usually begin with exercises that involve contracting the muscles, as hamstrings get stronger, light weights are used.

Most hamstring injuries get better with treatment and rehabilitation. Even world-class athletes with severe hamstring injuries are usually able to return to competition.

By keeping the hamstrings flexible and giving the body time to heal, you should be able to return to the activities you enjoy.