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What to do if you've strained your hamstring running

hamstring strain
What to do if you've strained your hamstringGetty Images

Some running injuries develop gradually. Others will make their presence known more rudely, with what physiotherapist and England Athletics Medical Lead Sarah Connors calls an ‘ouch moment’. Depending on the degree of severity, a hamstring strain or tear is usually easily identified. It’s an injury often found in athletes that need bursts of explosive power, such as sprinters and footballers, but can affect endurance runners, too. According to the British Journal of Sports Medicine around 15% of injuries to elite British track and field athletes are hamstring-related.

Where is your hamstring?

The three large muscles at the back of your thigh are known as the hamstrings. They join the hip joint to the knee joint. You’ll use your hamstrings a lot in any activity that requires you to bend your knees, including running of course. The most serious variety of tearing in the hamstring area involves a tear to the tendon, which joins the muscle to the bone.

How do you know if you have strained your hamstring?

A hamstring injury can occur in different areas, which will affect the healing time. You might have a tear in the muscle, in the muscle junction with the tendon, or in the tendon itself. Different levels of pain can indicate what has happened. ‘You might feel a sort of: “Ooh, what was that?” and possibly still be able to jog on with it,’ says sports physiotherapist James Vickers. But at the other extreme, you feel like somebody’s shot you in the back of the leg.’ For a significant tear you would be able to feel a gap, or a lack of continuation, in the muscle. You may also experience bruising, and the size of the bruise would also show how severe it is, though the bleeding might not necessarily come to the surface depending on where the tear is, and the bruising wouldn’t fully develop until a few days afterwards.

What are the different grades of severity in hamstring injuries?

hamstring strain
Different levels of pain can indicate the severity of the strain or tearGetty Images

The NHS grades hamstring injuries from 1-3:

grade 1 – a mild muscle pull or strain

grade 2 – a partial muscle tear

grade 3 – a complete muscle tear

However, the British Athletics Classification system, established in 2014 by Dr Noel Pollock from the British Athletics Medical Team, goes from 0-4:

0 – ‘generalised muscle soreness’

1 – a ‘small tear’ that still allows a normal range of movement 24 hours after the injury

2 – a ‘moderate tear’ that causes enough pain to stop the exercise, and still shows limited movement and pain 24 hours later

3 – an ‘extensive tear’ that may be sudden and painful enough to make the runner fall to the ground, with pain on walking and significantly reduced movement

4 – a ‘complete tear’ to the muscle or tendon that causes ‘significant and immediate limitation to activity’. You can feel ‘a palpable gap’ in the hamstring.

What causes a hamstring strain?

‘The hamstring muscle, like any muscle would fail because it’s been put past its capacity,’ says James Vickers. ‘That might be a length capacity or it might be an output force capacity. Those two things can go hand in hand – muscles that are small are not very strong, and can’t work over a bigger range of motion. So creating stronger, longer hamstrings is a good way of injury prevention.’

Sarah Connors, who is also the co-author of the book Running Well, adds a general observation about injury likelihood: ‘Some of the external factors that can tip a runner into injury include changes in mileage, speed and intensity of training, running shoes and hill work,’ she wrote in the clinical journal In Touch. ‘Changes and increases in running speed and intensity can be instrumental in overloading the body, especially in individuals who are not strong enough to maintain a good physical form.’

What else could be causing hamstring tightness?

The most severe hamstring injuries are more common in athletes that are trading in speed and power. In endurance runners, a milder pain can be caused by wider biomechanical problems. ‘A lot of apparent tight hamstrings aren’t necessarily a strain of the muscle,’ Connors points out. ‘Quite often it’s a tightness that comes from the lower back and pelvis not working as effectively as they should. With endurance athletes I do a lot of spinal work. If the back and the joints of the spine aren’t moving properly, you’ll find it harder to do a straight leg raise.’

What should you do when a hamstring tear occurs?

The common strategy for treating a muscle injury in the first few days is to try RICE. That’s:

R – Rest

I – Ice, to apply to the painful area every few hours for around 20 minutes. Use a cold pack or something that won’t put ice directly on the skin.

C – Compression, with an elasticated bandage to keep swelling down and prevent unnecessary movement.

E – Elevation, keeping the leg raised, which should also reduce the swelling.

Can you keep running with a hamstring strain?

Let the pain be your guide, suggests Connors: ‘With any injury, give it 24 hours of rest first, to see how it is. Then, if it’s painful to walk, don’t run. If you can jog slowly, you can do a loose, easy bit of running or cycling. If the pain is only one or two out of 10, you can probably carry on a bit as long as it doesn’t feel worse for more than half an hour afterwards.’

What can you do to prevent a hamstring injury, or prevent a hamstring injury from recurring?

If you do have a hamstring strain or tear, you need to rest and allow the tissue to heal first, before beginning to do strengthening exercises. Vickers advises bridging exercises lying on your back with your knees bent and your feet flat on the floor, then raising your hips. ‘It lets you start the process of strengthening up without overstretching the muscle. The hamstring remains in a fairly short position but you can still start to put some work through it.’

Connors encourages people to think about fixing their injuries with the acronym CRL: ‘You find the CAUSE, you RELEASE what’s tight, and then you LOAD it.’ With recovery from a hamstring injury, you should look at strengthening your body more broadly. ‘The stronger your glutes and core are, the more your pelvis will be stable and the less stress there will be on the hamstring,’ she says. ‘If your core and glutes aren’t working, the hamstring has to do the extra work to stabilise the pelvis. I encourage walking backwards, glute bridges and single leg glute bridges as well as general core work.’

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