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Hamstring Strain

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Hamstring Strain, Hamstring Sprain, Hamstring Tendinopathy

  • Risk Factors
  1. Quadriceps may be overdeveloped compared to Hamstrings
  2. Quadriceps to hamstring strength ratio
    1. Normal: 2 to 1 ratio
    2. Risk for Hamstring Strain: 5 to 1 ratio
  • Symptoms
  1. Cramping pain in posterior thigh or deep buttocks
  2. Pain radiation to popliteal fossa
  3. Insidious onset
  4. Provocative factors
    1. Running
    2. Sitting
  • Signs
  1. Ecchymosis may be present
  2. Indentation in hamstring muscle at defect or tear
  3. Palpate ischial tuberosity (insertion)
    1. Focal tenderness may be present
  4. Modified bent-knee test (LR+ 10.2, LR- 0.12)
    1. Patient lies supine
    2. Examiner lifts leg to 90 degrees with knee bent
    3. Examiner rapidly straightens leg (extends knee)
    4. Pain at hamstring insertion with maneuver
  • Management
  1. Eccentric Exercise
    1. Single leg squat
      1. Flex and extend knee
    2. Lunges
      1. Lower knee in large step
    3. Nordic curls
      1. Patient kneels with knees held
      2. Lower trunk forward
  2. Other measures
    1. Corticosteroid Injection
      1. Zissen (2010) AJR Am J Roentgenol 195(4): 993-8 [PubMed]
  • Complications