Hamstring strains are common in sports that involve sprinting, kicking, and high-speed, agility type movements. Sciatic nerve symptoms can often be misdiagnosed as hamstring strains.
The hamstring muscle is made up of three linked muscles: semimembranosus, semitendinosus and biceps femoris. These muscles run the length of the back of the thigh, from the sit bones down to either side of the knee joint. The sciatic nerve descends along this same path, being closely related to and serving the hamstring muscles.
Mechanisms of Injury
Stride length, simultaneous hip and knee motion, pelvic position and pelvic control are all factors that may relate to the mechanisms responsible for hamstring injury. However, posterior thigh pain or weakness may also result from injury or compressive forces acting on the sciatic nerve, which could start in the low back. On examination, it should be determined which tissue (hamstring or nerve) is the source of the pain.
Most commonly, a hamstring strain has the following characteristics: sudden onset, a distinct time and mechanism of injury, pain that is provoked by movement of the hip or knee, difficulty walking or running, substantial tenderness on palpation, and mild to moderate pain, bruising, decrease in stride length and decrease in strength.
Pain referred to the thigh from neural tissue often has a gradual onset of occurrence, no known mechanism of injury, minimal to no local tenderness, and minimal decrease in strength or decrease in length. With neural pain however, there will most often be positive signs that point to lumbar spine and sacroiliac joint abnormalities, like weakness of the muscles served by the nerves that supply them or a feeling of being “uncoordinated” in lower body movement.
Differential diagnosis between sciatic nerve pain and hamstring strain is essential for appropriate treatment.
Acute treatment goals for a hamstring injury involve reducing pain and swelling. This can be facilitated by using modalities, such as ultrasound, laser and icing. As well, using a hip spica wrap can reduce the strain and swelling of the muscle.
Research has shown that stretching and strengthening of the hamstring muscle alone, after injury, delayed average time to return to play (15 days more on average). As well, those studied re-injured their hamstring muscle soon after returning to activity.
Similar research has found that the most effective rehabilitation programs for hamstring injuries include eccentric strengthening of the hamstring complex, neuromuscular control training of the pelvis, strength training for muscular imbalances between the quadriceps and hamstring muscles and hip flexor/quadriceps muscle stretching.
Our Athletic Therapist – Sherry Knight, can guide you to the appropriate exercises that employ the above principles. This will facilitate a faster, stronger return to activity for all!