!Managing Hamstring Strains

Managing Hamstring Strains
and Hamstring Tendinopathy

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Hamstring injuries are common in athletes at all levels, from high school to the pros, especially in sports involving rapid acceleration, deceleration and sprinting. Dancers also experience frequent acute hamstring injuries, as their muscles are stretched and challenged to the max during practice and performance.

A hamstring injury can be devastating to a young athlete or dancer whose career hangs in the balance, and athletes are often eager to return to play as quickly as possible after an injury. However, early return to play sets a young athlete up for recurring injuries that can take them off the playing field for good. One-third of hamstring injuries recur within the first year after return to sport, and secondary injuries tend to be more severe than the initial injury. The high frequency of re-injury suggests that treatment strategies and recovery time may be insufficient to restore the injured tissue to pre-injury strength and function.

Nature of Hamstring Injuries

Your hamstrings are a group of three muscles, the semimembranosus, the semitendinosus, and the biceps femoris. All three muscles attach distally to the tibia, or shin bone, just behind the knee joint. At the proximal end (that closest to the trunk), the tendons attach to the ischial tuberosity, or sit bones. Hamstrings serve to produce two joint actions: knee flexion and hip extension.

Hamstring strains are a tearing of the muscle tissue, while tendinopathy is a chronic condition affecting the tendons that anchor the muscles to bones. High hamstring tendinitis is inflammation of the hamstring tendon where it attaches to the ischial tuberosity at the top of the back of the thigh. High hamstring tendonopathy can occur following a poorly treated tendon rupture, but it is more often an overuse injury. Because of their thick fibrous nature and poor blood supply, hamstring tendons heal slowly.

Three common types of sport or dance related hamstring injuries:

Sprinting related hamstring strains:

  • occur during high-speed running, in the terminal phase of the gait cycle
  • at this phase, the hamstrings are active, lengthening and absorbing energy from the decelerating limb to prepare for foot contact
  • during sprinting, the greatest stretch is incurred by the biceps femoris
  • strains to the biceps femoris typically occur along intramuscular tendons and the adjacent muscle fibers
  • during rehab, the biceps femoris must be trained to safely handle high eccentric loading

Kicking or leaping hamstring strains:

  • these types of strains can occur during slow or fast movements involving simultaneous hip flexion and knee extension
  • at the time of injury, hamstrings in a position of extreme stretch
  • kicking or leaping injuries commonly occur in the semimembranosus and its proximal free tendon
  • kicking and leaping injuries require a prolonged recovery period before return to the pre-injury performance level

Tendinitis from distance running and cycling:

  • proximal hamstring tendons connect the three hamstring muscles to the sit bone, or ischial tuberosity, located in the buttocks at the bottom of the pelvic bone.
  • these tendons are prone to repetitive use injury
  • high hamstring tendinitis is often seen in runners, cyclists, rowers, and activities that require prolonged sitting.

Three common types of sport or dance related hamstring injuries:

Despite their different locations and origins, hamstring injuries are been traditionally painted with a broad brush for purposes of diagnosis and treatment. However, when developing the treatment protocol, the therapist should take into account the nature and origin of the injury, and the activities to which the athlete will return after rehab.

Acute hamstring injury often presents as:

  • • sudden posterior thigh pain resulting from a specific activity
  • • an audible popping sound at the onset of pain
  • • inability to continue the activity that caused the pain
  • • pain when sitting (if the injury is at the ischial tuberosity)

Injuries to the biceps femoris from high speed running normally heal more quickly than injuries to the proximal tendons from kicking or leaping.

Diagnosis to determine the location and severity of hamstring injuries includes the following:

  • • isometric strength assessment and pain provocation
  • • range of motion assessment
  • • manual palpation
  • • ultrasonography to identify edema and hemorrhage


The primary objective of rehabilitation is to return the athlete to their pre-injury level of performance, with minimal risk of re-injury. In addition to reducing inflammation and pain in the initial stages, rehab will involve physical therapy that emphasizes eccentric strength training of the injured muscles, along with strengthening of adjacent muscles that interact with the hamstrings during play. Emphasis should also be placed on improved coordination and stabilization of the lumbopelvic region.

Phases of rehab include:

Phase I

  • • Restricted movement and limited stretching of the affected muscles
  • • Icing and pain management
  • • Therapeutic exercises to promote neuromuscular control without pain, avoiding overloading of the injured muscle.
  • • Criteria for progressi

Phase II

  • • Encouraged return to full range of motion, but avoiding extreme stretches.
  • • Icing and pain management
  • • Gradual hamstring lengthening, progressive agility drills and trunk stabilization exercises
  • • Criteria for progression to phase III include full strength muscle contraction without pain; pain-free forward and backward jogging at 50% of maximal speed

Phase III

  • • Avoid sprinting and explosive acceleration movements. Range of motion should be restored, and stretching is no longer restricted.
  • • Icing after exercises to reduce pain and inflammation
  • • Agility and sport-specific drills; advanced trunk stabilization exercises; progressive eccentric hamstring strengthening
  • • Criteria for return to sport: once full range of motion, strength, and function are restored without pain or stiffness, the athlete is ready to return to full sporting activities

Returning to sport or dance before your injuries are completely recovered puts you at risk for more severe re-injury that can take you off the playing field or off the stage for good. The sports medicine professionals at NYDNRehab work together as a team, using state-of-the-art technology to diagnose and treat your hamstring strain or tendinopathy. Do not trust your athletic or dance injury to just anyone. NYDNRehab offers the very best treatment for athletic injuries, so you can return to your sport or activity with strength and confidence to perform at your peak.

Hamstring Strain Rehabilitation

Considered fairly common among both amature and professional athletes, a hamstring strain involves some type of strain or injury to normal activities, can be greatly reduced.

New York Dynamic Neuromuscular Rehabilitation addresses common sources of hamstring tendon strain to make adjustments while recovering such as wearing lighter shoes and modifying their exercise routine.

Sympto promote effective healing.

The diagnostic process involves three simple stretches to be lengthy and more involved than a simple muscle strain, often involving hamstring compressions. Our comprehensive and regenerative treatment plans are based on each patient’s ability and severity of injury.

Our approach to fully recover.

A factore optimal patient function with a combination of advanced diagnostics and personalized treatments.

At New York Dynamic Neuromuscular Rehabilitation, patients have access to starting hamstring strain rehabilitation.

We’re constantly working to facilitate the healing process.

Our determination of how to previous activities following rehab.

Whether a patient is dealing with mild, moderate or a chronic hamstring strain, we provide a highly personalized approach to us following a hamstring strain.

As mentioned earlier, it’s important to strengthen hamstring muscles and nearby tendons and muscles through exercises that can be continued at home during and after the initial evaluation and treatment that takes place at our New York clinic.

Call New York Dynamic Neuromuscular Rehabilitation today for more information on our hamstring strain rehabilitation services and innovative treatment options.

Reactive Neuromuscular Training on Kineo


Kineo – the most versatile muscle testing using artificial intelegence


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)


Complete tear of rectus femoris
with large hematoma (blood)


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

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