Hamstring Strain
and Hamstring Tendinopathy

Hamstring injuries are common among athletes and physically active people, especially tearing of the muscle tissue (strains) and injuries to the tendons. Once injured, runners have a high (30 percent) risk of re-injury, and recovery can take a long time. Rapid diagnosis and treatment after a hamstring injury can shorten recovery time and reduce the risk of re-injury.

The hamstrings are a group of four muscles, with the semimembranosus and semitendinosus located medially and the long and short heads of the biceps femoris locted laterally. Injury can occur in any of the muscles or their tendons, but the biceps femoris is most susceptible because of its load-bearing role in the gait cycle.

Hamstring Strain Causes

Certain things can predispose a person to hamstring injuries, including:

  • Poor timing and muscle coordination during the gait cycle
  • Inability of the muscle to sufficiently absorb shock and rebound
  • Previous hamstring injury
  • Over-striding and poor pelvic control
  • Inadequate warm-up
  • Fatigue

Hamstring Strain Symptoms

Symptoms of hamstring muscle strain can range from mild to severe, depending on the severity of injury. A mild strain may appear as tightness or a dull ache, while a severe strain can be extremely painful. However, even mild strains should be treated, as their underlying mechanism may lead to more serious injury down the road if not corrected.

Symptoms of a hamstring strain include:

  • Severe pain while exercising, accompanied by a snapping or popping sensation
  • Pain in the lower buttock and back of the thigh
  • Bruising
  • Tenderness in the muscle and/or tendon
  • Hamstring muscle stiffness

Hamstring tendonitis occurs when the tendon that attaches muscle to bone becomes damaged or inflamed. Lower hamstring tendonitis presents as pain in the back of the knee, where tendons attach at the top of the lower leg. High hamstring tendinopathy occurs near the hip, and presents as deep buttock or upper thigh pain.

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Hamstring Strain Diagnosis

The location and severity of hamstring injuries can be easily detectable with high resolution diagnostic ultrasound. Symptoms, inflammation and bruising are also indicators of injury.

Hamstring strains are graded by severity:

Grade 1: tightness, discomfort, spasm, mild swelling; able to walk normally but not run up to speed.
Grade 2: impaired walking with limping, twinges of pain with activity, swelling and tenderness; painful to bend the knee against resistance.
Grade 3: severe pain with tearing of half to all of the muscle; immediate swelling, bruising and weakness; crutches may be needed to ambulate.

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Hamstring Strain Treatment

Because of the high risk of re-injury, even mild injuries should be fully rehabilitated.

Treatment at NYDNR may include:

  • Ultrasound guided dry needling
  • Gait analysis and retraining
  • Core stability training
  • Lower limb muscle strengthening
  • Virtual reality intrinsic feedback with C.A.R.E.N. to improve proprioception, agility and balance
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Hamstring Tendonitis Treatment

Tendon tissue is unique from muscle and requires specific treatment. At NYDNR, we rehabilitate tendon injuries with extracorporeal shockwave therapy (ESWT), eccentric loading exercises, gait retraining, and strengthening of the muscles of the lower extremities.

130 West 42 Street Suite 1055, New York NY 10036
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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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