A Speedster’s Nightmare: The Hamstring Strain

Watching ESPN this past weekend while in Charlotte getting ready for our big game against the Cam Newton Panthers, I heard an amazing statistic:  Five (5) starting NFL running backs were listed as “questionable” or “out” because of hamstring injuries.

If you’re a “speed guy” or you play a “skill position” in football such as a RB, QB, WR or DB, having an injured hamstring is a nightmare. With the key role of assisting with acceleration and changing of direction, the hamstring muscles become a significant hindrance if they are not firing on all cylinders.

Getting to Know Your Hammys

You rely on them every day to move from here to there so now it’s time for you to get to know your hamstrings.  If you think about it, you sit on your hammy’s every day yet they are probably as foreign to you as your refrigerator’s owner’s manual.

Your hamstrings are made up of three (3) muscles.  All three muscles originate or start at the ischial tuberosity on the back underside of the pelvis. Two of them, the semitendinosis and the semimembranosis muscles, form the inner-back of the thigh and insert or attach just below the knee on the inner side of the tibia or shin bone.

The lateral or outer-back of the thigh is made up of the third hamstring known as the biceps femoris.  This lone lateral hamstring attaches to the head of the smaller bone of the outer shin know as the fibula.

The Functions of the Hamstring Muscles

Keeping it simple, the hamstrings flex or bend the knee joint and, more importantly, they slow the lower leg as it rapidly extends at the knee joint while running and changing directions.

This is a key function of the hamstrings because this eccentric or lengthening muscle contraction, commonly referred to as the “negative direction”, is the most difficult phase of the recovery for a speed guy to master when returning from a hamstring strain.

The hammy also assists with additional functions such as hip extension and lower leg rotation.  The bottom line is that the hamstring muscles play a vital role in normal lower extremity function.

What You Need to Know About Hamstring Strains

Whether you’re a loyal fan of the NFL or a guy looking for a better way to understand fantasy football injuries, here are my sports medicine bullet points on hamstring strains:

High Hammys are Hell – A “high hammy” is a strain to the upper tendon of the hamstrings close to the attachment at the pelvis.  It’s not a location where an athletes wants an injury.  The proximal or upper tendon is very dense and slow to heal.

Grading a Muscle Strain

  • Grade 1:  Minor strain, minimal disruption of the muscle fibers, minimal time lost.
  • Grade 2:  Moderate strain, some muscle tissue damage with a palpable location of injury, bleeding into the muscle with pain and swelling, typically out 1-4 weeks.
  • Grade 3:  Severe strain, significant muscle tissue damage with a visual defect noted in the muscle belly or upper tendon, extensive bleeding, poor muscle strength, pain with walking, typically out 3-8 weeks.

Waiting on 5th Gear – I tell my coaches that a player returning from a hamstring strain needs to “stay out of 5th gear” for the first few days.  That 5th gear will come back but if they try to test it too early during their return, it won’t be there and, by doing so, they will set themselves back for at least 1 week.  If your fantasy football star wide receiver is coming back from a hamstring strain, you’ll be more likely to see him running more out-routes and short slants than you are long go-routes 50 yards down the field.  Any smart DB will know that and play that WR tight, forcing him to “open up” his stride to stress his hamstring.

Avoid Stretching Early On – When I tell a player who just strained his hamstring to avoid all hamstring stretching on the involved (I never call it “bad”) side for the first 72 hours, they look at me crazy.  An athlete will feel tightness in the hamstring and get a sense that they need to just stretch it out and they’ll be fine.  That’s a mistake and it only prolongs the muscle’s bleeding and protective spasms.

Apply the Pressure – Most acutely strained hamstring will benefit from compression such as a custom sleeve, girdle or elastic wrapping.  It keeps the muscle and surrounding tissue supported, it minimizes the accumulation of inflammation and it keeps the muscle warm.

Most Like it Hot – Coming back to play in cold weather with a hamstring strain makes it harder, especially for the speed guys.  Warmer weather is a chronic hamstring’s best friend.

Drown Your Hammys – Dehydration is the secret x-factor for all soft tissue injuries.  Staying well hydrated with fluids and Gatorade is a common tip I share with my players and anyone who will listen.  Hydration is a key step for smart athletes wanting to keep their muscle functioning well and significantly reducing their chance of injury.

Two Minute Warning

The hamstring muscles are vitally important for any running athlete, especially the fast ones.  An injured hamstring muscle or tendon can be slow to heal and frustrating for players and coaches alike. The quads may get the hype by being front stage center but any sprinter or football player will tell you that it’s the hamstrings that keep them in the game.


Biceps Femoris Tendonitis: The Forgotten Hamstring

The truth is….athletes “pull” muscles. That is something everyone is at risk for with an active lifestyle. Biceps femoris tendonitis is typically an injury resulting from overuse or over stretching of the biceps femoris tendons of the most lateral hamstring on the back of the thigh.

The two most common locations for pain with this injury are at the ischial tuberosity, just below the buttock, or along the palpable tendon near the outside of the knee 2-4 inches above the joint. In other words, at the tendons at the top of the muscle or the longer tendon just below the muscle.

These are the locations of the tendons responsible for connecting the biceps femoris muscle to your pelvis and shin bones. Repeated injuries involving the muscle itself can create a chronic inflammation of the tendons and their enclosed sheath.  This is commonly referred to as a form of tendonopathy.

Tendonopathy is a general term used to describe a combination of ailments. It is often associated with repeated micro tearing and inflammation of a tendon and it’s surrounding sheath. Athletes of all ages and sports are prone to tendonopathies of all three (3) hamstring muscles.

The biceps femoris is one of those hamstring muscles.  It is located at the posterior thigh and moves down the back-outside of the upper leg where it inserts just below the lateral knee. This muscle assists in flexion or bending of the knee, extension of the hip and some rotation of hip movement while the knee is in a bent position.

Avoiding the complicated science behind the reasoning, the biceps femoris is very important for acceleration and deceleration with all running and jumping activities. Injuries involving any of the hamstring tendons or muscle bellies are painful and can easily take up to 4-6 weeks to properly heal.

Signs & Symptoms of Biceps Femoris Tendonitis

  1. Pain or tenderness just under the buttock or at the back-outside corner of the knee with motion.
  2. Palpable swelling and tenderness just under the buttock or at the outside of the knee.
  3. Increased pain with active or resistive flexion (bending) of the knee.
  4. Inability to perform simple exercises without pain anywhere along the length of the lateral hamstring. These activities include running, stair climbing, forward bending with the knees straight while reaching for your toes, pulling the knees towards the chest and backward walking.
  5. It is not unusual to feel a “squeaking” within the distal tendon sheath with slow active knee bending.
  6. Pain with lateral or external rotation of the foot and shin while sitting with the knee bent.

Professional Treatment for Biceps Femoris Tendonitis

  1. Immediately stop activity and apply compression to the area.
  2. Avoid all hamstring stretches for at least 4 days. (Trust me on this one…I’ve learned this valuable tip the hard way!)
  3. Apply ice packs to the lateral knee and/or back of the thigh for 15 minutes every hour.
  4. During and after every ice treatment, apply compression to the involved tendon and the hamstring muscles in that region of the hip/thigh/knee.
  5. When resting, elevate the affected lower limb to minimize swelling.
  6. Avoid prolonged sitting.
  7. Three days after you are able to walk pain free, initiate an easy stretching and non-running exercises plan.
  8. After three days of pain-free stretching and functional athletics, progress as tolerable with strengthening and running activities.  The two key variables at this point to avoiding a setback are Progression & Common Sense

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Are you certain of the diagnosis of biceps femoris tendonitis and do you have any other concerns with my injury?
  2. Are other hamstring muscles, nerves or tendons damaged?
  3. How long can I expect for this injury to properly heal?
  4. Do you suggest that I visit a physical therapist for a comprehensive rehabilitation program?

Elite Sports Medicine Tips from Mike Ryan

  • Check your strength – It would be beneficial to you to consult a physical therapist during your down time. Getting a professional option on your lower extremity strengthen might shed some light on why you got injured in the first place.
  • Stretch it out – Promise yourself that when you recover from this injury, you will spend 5-10 minutes stretching every day.
  • Ice – Regular application of ice on the biceps femoris muscle belly and the involved tendon will help control the inflammation.
  • Take your time – When returning to your sport, take your time. Stretch properly and gradually build up the intensity of your activities.
  • Pay attention – After returning to your workouts, monitor the hamstring signs and symptoms.  If it gets cranky, return to rest, ice aggressively, STOP stretching and try again in two days.