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Hamstring Strain Cheat Sheet (DRAFT) by

Presentation, management etc

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Causes of hamstring strains

- See Upper leg muscle cheat sheet for anatomy
- Strain caused by excessive load during eccentric contra­cti­on/­extreme stretch
- Bicep femoris most commonly involved
- Sports that involve sprinting and jumping most likely to sprain hamstrings (eccen­tri­cally) - terminal swing phase just before foot contact
- Stretching injuries involve water skiiing, martial arts and dancing
- Most vulnerable when function rapidly changes from eccentric decele­ration of the forward swinging tibia to concentric extension of the hip joint
- Muscle fatigue - insuff­icient warm up, hx of prior injury, hamstring inflex­ibi­lit­y/w­eakness
- Quads strength overpowers capacity of the hamstring to eccent­rically decelerate forward progre­ssion of the tibia during terminal swing phase
- FAI - limits hip ROM
- Hypert­onicity of the quads, iliopsoas, inadequate control of lumbop­elvic muscles , poor running mechanics
- More common with age
- Black people most affected
- Males more affected


Grade I: Strain without signif­icant fibre tearing
Grade II: Partial muscle tearing
Grade III: Complete muscle­/tendon rupture


- Most occur during activity
- Tearing feeling + signif­icant pain
- Pain in lower buttock and posterior thigh when straig­htening leg
- Bruising, swelling present
- Tenderness over the injury
- PROM - may produce pain with passive hip flexion and knee extension
- RROM - pain reproduced with hip extens­ion­/knee flexion
- Braggards to differ­entiate between hamstring injury and lx radicu­lopathy
- SI /lumbar restri­ctions
- Neurol­ogical exam unrema­rkable - IF +ve NEURO FINDINGS, CONSIDER OTHER DIAGNOSIS


- Often unnece­ssary unless avulsion f# /other bony pathology is suspected (Ischial tubero­sity)
- Only MRI if severe and surgical interv­ention is needed


- Contusion
- F#
- Neoplasm
- Hip Pathology
- Posterior Compar­tment Syndrome
- Adductor strain
- Ischial Bursitis
- Herpes Zoster
- Piriformis Syndrome
- Lx referral
- Consider Lx radicu­lopathy if +ve neuro findings, without trauma or pain extending below knee


- Difficult as healing is delayed with persistant syndromes and moderate re-injury rates
- Proximity of the injury to the ischial tuberosity correlates with recovery (more proximal = longer)
- Phase I: RICE, Compre­ssion bandage, cryoth­erapy, immobi­lis­ati­on/­cru­tches for severe injury - avoid sustained knee flexion when using crutches
- SMT/EMT of Lx, SI, LL
Progress to Phase II when patient can walk withiout pain and moderately tolerates resisted knee flexion
- Phase II: Increase running to 50% of maximum and avoid sprinting , stationary cyclin­g/s­wimming , stretching of psoas, hamstring, adductors, quads and lx
- Nerve mobili­sation
Progress to Phase III when pt is able to perform pain-free resisted knee flexion and can run at 50% speed without pain
- Phase III Gradually increase jogging from 50% to full sprinting, resolve gait abnorm­alities and orthot­ices, should not return to sport unless full knee ROM, adequate hamstring to quads ratio and pain free has been achieved
- Advice on proper warm up/cool down