With the Rugby season well past mid-way, niggles are starting to turn into injuries. A very common injury that we see is hamstring strains, especially in sports that require high speed running.

The hamstrings consist of three muscles, the biceps femoris, the semimembranosus and the semitendinosus. It attaches from the bottom of the pelvis, and inserts into the tibia and fibula. Its actions are to extend the hip as well as flexing the knee. In a bent knee, the semimembranosus and semitendinosus will also cause the leg to rotate inwards, while the bicep femoris will cause the bent leg to turn outwards.

The most common mechanism of hamstring strains is caused from sprinting and kicking, when the hamstring is acting as an eccentric contraction (contracting while lengthening) to decelerate the leg during swing phase. Poor motor-patterning during this time can cause a contraction to occur while the muscle is being forcibly lengthened. This results in damage to the hamstring muscles.

Hamstring strains are often classified into 3 grades:

Grade I: Strain of the hamstring muscles. Tightness, spasm or small amounts of pain with running at high speeds or when tested under resistance. Your walking pattern is largely unaffected

Grade II: Partial tear of the muscle. Pain and flexibility reduced, walking pattern is affected, leading to limping, may have problems straightening the knee

Grade III: Severe or full thickness tear in the muscle. Greatly affected walking pattern. Surgical intervention may be required.

Several factors predisposes the athlete to hamstring strains

  • Poor hamstring strength/Muscle imbalance between quadriceps and hamstrings
  • Poor flexibility has been linked to a shortened optimum muscle length (length for muscle to generate maximum force)
  • Previous hamstring injuries have been shown to be the most accurate predictor for future hamstring strains. It is believed that the buildup of fibrous tissue in the injured site decreases the strength and length of the muscles
  • Fatigue in both locally (the muscle unable to provide the same amount of tension) or neutrally (poor motor patterning)
  • Increasing age of athletes

Recurrent Strains can lead to:

  • Scar tissue from previous injuries tethering to the sciatic nerve, leading to increased neurotension
  • Increased risk of developing ACL injuries: The hamstrings help the ACL stabilize the knee during phase by stopping the anterior translation (forward motion) of the tibia on the femur. If there is a strength imbalance between the quadriceps and the hamstrings, the ACL will have to absorb more force.


Immediate treatment should include the RICE protocol (Rest, Ice, compression, elevation), while avoiding HARM (Heat, alcohol, running/activity, and massage.

Rehabilitation timeframe depends on the severity of strain. As a rule of thumbs, Grade I requires 3 weeks for full return to play, Grade II 4-8 weeks, and Grade III may require surgical intervention, with the rehabilitation process taking up to 3 months for full return to activities.

We at Advanz Therapies are experts at assessing and managing hamstring issues, and will provide a thorough and comprehensive examination to identify and address all factors that may have contributed to the injury, allowing you to both return to the activities you love in the shortest amount of time, as well as minimizing the risk of reinjuries.