Sports Medicine
Sports Injury Prevention & Rehabilitation

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Hamstring Contusion

(Also known as Corked Thigh, Hamstring Bruise, Corky, Hamstring Haematoma, Charley Horse, Dead Leg)
What is a hamstring contusion?
A hamstring contusion is a condition characterized by a bruise or 'corky' to the back of the thigh, usually as a result of a direct impact. The group of muscles at the back of the thigh is commonly called the hamstrings. The hamstrings comprise of three muscles:
  • biceps femoris
  • semimembranosus
  • semitendinosus
These muscles originate from the pelvis and insert into the top of the lower leg bones.
The hamstring muscles are responsible for bending the knee and straightening the hip during activity and are particularly active during running, jumping and kicking. The hamstrings also have a rich blood supply. Following a direct impact to the hamstrings, damage to the muscle fibers, connective tissue and small blood vessels of the hamstrings may occur. This results in a 'bruise' and is known as a hamstring contusion.
Hamstring contusions range from minor contusions, resulting in minimal pain and allowing ongoing activity, to severe contusions, resulting in significant pain and loss of function.

Causes of a hamstring contusion
Hamstring contusions occur following a direct impact to the hamstring muscle from an object or person. This most commonly occurs due to a collision with another player during contact sports such as football or rugby, or from an impact from a ball in sports such as hockey or baseball.

Signs and symptoms of a hamstring contusion
Patients with a hamstring contusion usually feel a sudden pain in the muscle at the time of injury. In minor hamstring contusions, pain may be minimal allowing continued activity. In more severe cases, patients may experience severe pain, muscle spasm, weakness and an inability to continue activity. Patients may also be unable to walk without a limp.
Patients with a hamstring contusion usually experience pain during activities such as bending forwards, going up stairs, walking uphill, running, jumping, lunging or kicking. It is also common for patients to experience pain or stiffness after these activities with rest, especially upon waking in the morning. Swelling, tenderness and bruising may also be present in the hamstring muscle, along with an inability to stretch the injured leg as far as usual. In severe cases a visible increase in size of the thigh may be detected due to bleeding and swelling. In these instances patients may be unable to sleep due to pain. Occasionally the swelling and bruising may track down to the knee joint or lower leg.

Diagnosis of a hamstring contusion
A thorough subjective and objective examination from a physician is usually sufficient to diagnose a hamstring contusion. Further investigations such as an MRI scan or ultrasound may be required, in rare cases, to confirm diagnosis.

Treatment for a hamstring contusion
Most patients with a hamstring contusion heal well with appropriate physical therapy. The success rate of treatment is largely dictated by patient compliance. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. Activities which place large amounts of stress through the hamstrings should be minimized, these include: running, kicking, jumping and lunging. Rest from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
  • Ignoring symptoms, or adopting a 'no pain, no gain' attitude is likely to lead to the problem becoming chronic and can lead to further complications (such as myositis ossificans). Immediate, appropriate treatment in patients with this condition is essential to ensure a speedy recovery.
  • Diligently adhering to RICE in the initial phase of injury (first 72 hours) will greatly assist in improving recovery time in patients with a hamstring contusion. This involves rest from aggravating activities, regular icing, the use of a compression bandage, and keeping the injured leg elevated above the level of the heart. The use of crutches when walking may also be necessary to protect the muscle from further damage and to hasten the healing process.
  • Care should be taken not to exercise or stretch into pain as this may lead to further bleeding. The use of heat, massage and the consumption of alcohol in the initial stages (for at least the first 72 hours) should also be avoided.
  • A graduated pain free flexibility and strengthening program guided by a physical therapist is essential to recondition the hamstring muscle and reduce the likelihood of injury aggravation following a contusion. A graduated return to running program is also required in the final stages of rehabilitation to recondition the hamstrings for running in a safe and effective manner.

Prognosis of a hamstring contusion

With appropriate management, patients with a minor hamstring contusion can usually recover in one to three weeks. With larger contusions, recovery may take four to eight weeks or longer, depending on the severity of injury. In rare cases, patients can sometimes develop myositis ossificans (bony growth inside the muscle belly). This condition is more common in severe contusions (especially those that are managed inappropriately) and may prolong recovery by weeks to months.

Physical therapy for a hamstring contusion

Physical therapy for patients with this condition is vital to hasten the healing process and ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage (after the initial 72 hour period)
  • electrotherapy (e.g. ultrasound)
  • joint mobilization
  • stretches
  • anti-inflammatory advice
  • the use of crutches
  • applying a compression bandage
  • the use of protective padding to the hamstrings to prevent re-injury
  • ice or heat treatment
  • exercises to improve strength and flexibility (particularly of the hamstrings)
  • education
  • activity modification advice
  • establishment of an appropriate return to activity or sport plan

Other intervention for a hamstring contusion
Despite appropriate physical therapy management, some patients with a hamstring contusion do not improve adequately. When this occurs, the treating physical therapist or doctor can advise on the best course of management. This may include investigations such as an Xray (to assess for myositis ossificans), ultrasound, CT scan or MRI, pharmaceutical intervention, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition.