Welcome to

In Street Clothes

Covering sports injuries from the perspective of a certified athletic trainer and backed by analytics.

Understanding James Harden’s Grade 1 Plus Hamstring Strain

A relatively common injury has sidelined one of the NBA’s top stars as reigning MVP James Harden is expected to miss at least a week after suffering a hamstring strain Wednesday night. The New York Times’ Marc Stein reported the team diagnosed the injury as a Grade 1+ strain and plan on re-evaluating their star before their upcoming road trip.

Hamstring strains are a common occurrence in the NBA and have been detailed multiple times on InStreetClothes.com, including a breakdown during the 2015 playoffs when Chris Paul suffered the injury while with the Clippers. However, let’s reexamine an injury that has already occurred 19 times since the start of the preseason.

A strain occurs when a muscle is forced past a specific characteristic known as its yield point. Once damage has occurred, a MRI can be performed to determine the extent of the damage. Based on these findings, the injury is often assigned a grade. A Grade 1 injury is the least severe strain and is considered mild. In these injuries, microtearing of the tissue occurs and, though pain with movement is often reported, the individual generally experiences little to no loss of function. A Grade 2 strain is considered more moderate and involves damage to a higher percentage of muscle fibers. These injuries are often referred to as partial tears. Anything given a Grade 3 or higher is considered severe and the tear is often complete. Grade III injuries are accompanied by a loss of both stability and function and may require surgical intervention.

Harden’s injury was given a Grade 1 Plus designation, meaning muscle fibers have been damaged but the percentage is low enough that it won’t be considered a Grade 2 injury. Oddly enough the Rockets are already managing a similar injury with James Ennis currently sidelined by a Grade 2 hamstring strain.

Regardless of the severity, the manner in which muscle tissue heals is a detailed process. The healing process occurs in multiple stages, initiated by the inflammatory phase. During this first phase, swelling and clotting reactions occur at the injury site. As healing continues, the second phase, the proliferative phase, begins. The proliferative phase is the start of the actual repair work of the strained tissue. Scar tissue is laid down at the injury site as specialized cells begin repairing the damage using protein fibers, including collagen and elastin.

The proliferative phase is a lengthy process but must be completed before the the remodeling phase can begin. This final phase varies in length and is dependent on the assigned grade. During remodeling, collagen fibers within the fresh scar tissue are repeatedly broken down and remade. This process increases the strength of the scar tissue, pushing it closer towards healthy muscle tissue. Unfortunately the body’s healing response doesn’t generally occur in the appropriate pattern. Instead, the protein fibers are aimlessly and haphazardly placed. This random approach can have a negative impact on the athlete’s recovery. Fortunately, an athletic trainer or physical therapist can combat this ineffective approach by loading the injured muscle in a specific way during the rehab process.

Unfortunately even the best treatment can’t guarantee the newly formed tissue will be as strong as the original and the risk of re-injury is high. A functional muscle doesn’t always equate to a healthy muscle. This is particularly true with the hamstring muscle group. The muscles that make up the hamstring must be able to withstand high amounts of force due to their role in explosive movements like running and jumping. As a result, hamstring strains are often accompanied by long periods of recovery and are vulnerable to aggravation or re-injury.  If the injury is irritated, the entire healing process is forced to restart.

Furthermore, previous injury is a prevalent risk factor for future injury. This already applies to Harden as he has a history of hamstring strains. He missed six games during the 2009-10 season with a right hamstring strain and seven games last year following a Grade 2 strain of the opposite hamstring. Now he will spend the next few days working with the Rockets’ highly-rated medical team, eyeballing a quick return. However, Jason Biles and his team is fully aware of the complexity of the injury and will be sure to provide their superstar with the appropriate time to heal.