Hamstring strain – the most common muscle strain
Typical symptoms: Pain at the back of the thigh that, depending on the severity, may cause pain on walking.
The hamstring muscle group comprises three main muscles. These are semitendinosus, semimembranosus and biceps femoris. Their job is to bend the knee and extend the hip. Injuries to the hamstring muscles typically occur either through sudden acceleration or deceleration or through a fast stretching related type movement. A sudden sprint generates injury or through a fast stretch related type movement such as those performed in high kicks like the movements used in martial arts or kicking a football or rugby ball.
These scenarios will usually manifest as a sudden sharp pain that may have varying consequences depending on the exact related forces behind the initial movement.
Sprinting usually causes damage to the biceps femoris lower down the back of the leg at the point where the muscle begins to coalesce into tendon (musculotendinous junction). Essentially the change in materials of construction acts as a point of biomechanical weakness. Stretch-related issues, on the other hand, typically occur higher up in the actual tendon of the semimembranosus muscle rather than at the site of the musculotendinous junction. This is important for healing and repair as the vascular supply to tendons is lower than that of muscle, and hence sprinting type injuries can heal quicker and have a better prognosis.
Like any other muscle injuries, a hamstring issue will be graded as either as Grade 1, 2 or 3 and it is important to know, especially with this particular muscle group, the extent of involvement.
A Grade 1 or mild strain will typically reproduce a moderate tightness at the back of the leg. You will be able to walk normally but not to run at full speed, and bending the knee against resistance will not cause any pain. Grade 2, however, will be more profound with a degree of inflammation and the ability to walk will be affected and accompanied with sharp twinges of pain (this will also be recreated with bending the knee against resistance). Grade 3 injuries will involve a significant injury that may result in a full complete tear of the muscle; clearly in this instance any weight bearing will be accompanied by severe pain and crutches will be a necessity. Extensive swelling and bruising will appear within 24 hours.
Strains are initially treated with rest, ice, compression, and elevation (known as RICE) and medications to reduce inflammation. Injuries may require a degree of therapy in order to stimulate the healing process and increase range of movement. These injuries should gradually improve and a return to normal function should be possible within a few weeks, unless they are full tendon thickness tears.
Calf muscle strain
The calf muscle (Gastrocnemius and Soleus muscles) is the main muscle that helps control your foot when it lands (on heel strike) and when you push off (or toe off). As such, the muscle is always active and because it makes such a significant contribution to your gait cycle as you run or walk it is often involved in injuries. Typically, activities that include running or sudden stopping and starting and changes in direction are common denominators.
A Grade 1 calf strain is a minor tear with up to 10% of the muscle fibres damaged. There will be a slight twinge of pain in the lower leg. You may be able to carry on participating but in mild discomfort. There is likely to be tightness and aching in the calf muscles for a few days.
Symptoms of a Grade 2 calf strain will be more severe: with a sharp pain that will be more significant when walking. There is likely to be swelling in the calf muscle with mild to moderate bruising. Pain will be felt especially when pushing the foot downwards against resistance.
Grade 3 symptoms will imply considerable bruising and swelling as there will be a near or complete tear and you will be unable to weight bear or flex your foot.
Quadriceps or thigh strain
Typical symptoms: Pain at the front of the thigh that, depending on the severity of the trauma, will cause pain on weight bearing.
The quadriceps muscle group consists of vastus lateralis, vastus medialis, vastus intermedius and rectus femoris. A thigh strain (or quadriceps strain) is a tear/strain in any one of these muscles at the front of the thigh. Injuries often occur with actions that generate large forces in the thigh, such as kicking a ball or jumping.
As with other muscular issues, these can range from a mild discomfort or acute pain (e.g. a full tear).
Symptoms of a Grade 1 quadriceps thigh strain are not always serious enough to stop training at the time of injury. Grade 2 symptoms are more severe and you may feel a sudden sharp pain when running. Pain will make walking difficult and swelling or mild bruising would be noticed. Sharp noticeable pain would be reproduced when pressing in on the suspected location of the quadriceps muscle tear. Grade 3 thigh strain symptoms consist of a severe, sudden pain in the front of the thigh. A static muscle contraction will be extremely painful and is likely to produce a bulge in the muscle.
The patient can expect to be out of competition for 6 to 12 weeks. Strains are initially treated with rest, ice, compression, and elevation (known as RICE) and medications to reduce inflammation are recommended (under your GP’s guidance). We use electrotherapy (such as ultrasound therapy) in the early stages, which can help with pain relief and to reduce swelling, followed by sports massage techniques after the initial acute phase. We then prescribe a rehabilitation program with stretching and strengthening exercises.