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Question: Is there an easy way to tell if I have over stretched my hamstring- I believe it is the semi-membranosus since there is pain at the attachment of the hamstring to the ischial tuberosity- near the inner thigh. How to heal? How to avoid re-injury. I have been doing bent knee forward folds to avoid overstretching, other options?

Answer: The hamstring muscles run in 3 bands:
1) Semimembranosus- originating at the ischial tuberosity (sit bone) and inserting at the medial tibial condyle
2) Semitendinosus- originating at the ischial tuberosity and inserting at the medial surface of tibia
3) Biceps Fermoris- originating at the ischial tuberosity and at the linea aspera near the head of the femur and inserting at the lateral side of the head of the fibula

Given that you feel the over-stretched line runs from the ischial tuberosity and down the inner (medial) thigh, I would predict that this could be either the semimembranosus and/or the semitendinosus muscle that has been stressed. Both of these muscles run along the inner (medial) line of the thigh, but the semimembranosus muscle is located more medial than the semimembranosus.

Now, depending on the degree in which you have over-stretched the muscle, the approach in which you require recovery and reconditioning can vary. If you have a mild, over-stretched muscle, you may only require some light rest from deeply expanding and engaging the hamstring. If the over-stretched condition is substantial, you may need to consider applying focussed therapies.

Often these healing therapies involve taking time to reduce inflammation and to decrease the development of chronic conditions like tendonitis at the ischial tuberosity or at the tendon attachment below the knee. This initial recovery stage oftens involves the application of rest cooling packs followed by light warming and mild stretching (note: never place ice/cooling packs directly against the skin). This process will reduce inflammation and hopefully prevent the development of scar tissue (which can lead to chronic, reduced flexibility of muscle tissues). For more serious cases, the process of RICE - Rest, Ice, Compression, and Elevation may need to be applied.

After the inflammation has been brought under control, the therapy often advances into a combination of light strengthening exercises for the hamstrings and slightly more progressive stretching exercises. One needs to be mindful in this stage by not being aggressive or over zealous with the strengthening and stretching as pushing too quickly can redamage the tissues.

Following each therapy session, one should analyze the response of the muscle: How does the muscle feel the next day? Is there more mobility and reduced pain? Should modifications of the therapies be added to enhance the healing?

If the therapy does not achieve positive results within a relatively short period of time (relative to degree of the injury), one should then consider more extensive sports medicine therapy treatments (like physiotherapy). The longer the damage persists, the more the chance that scar tissue will form. This tissue can cause muscular imbalances that can act on the pelvis and spine.

To avoid re-injury, especially with Yoga and stretching, warmup the body substantially with non-stretching poses and flows. Explore modifications like slightly bending the knees in forward bends. By bending the knees, the muscle attachment below the knee holds the muscle much less (and decreases the distance between the main attachment points), therefore reducing the stretch at the top of the hamstring (ishcial tuberosity). Overall, this allows the pelvis to move with far greater mobility/much better forward bend, which keeps integrity in the spine (the primary focus of every yoga pose).

To summarize, I recommend that you consult a sports medicine professional/therapist to properly diagnose the degree of your hamstring injury. With this diagnosis, you should receive a specific program/recommendations for therapy and healing. During this healing stage, enjoy the modifications, embrace patience with your hamstrings, and allow your practice to be focussed on other areas that do not counter your healing. For more detail on the grades of muscle pulls and treatments, click here.

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