No laughing matter!
How often have you heard an athlete say they have ‘pulled a hami’. We tend to make a bit of a joke of it. But hamstring injuries are anything but. In fact, they can be extremely painful (in your butt as it turns out!) and take a very long time to heal.
What is a Hamstring?
The Hamstrings are a group of three – semitendinosus, semimembranosus and the biceps femoris – that run from the ischial tuberosity (base of the pelvis), crossing over each other at the kneed joint on their way to connect with the tibia and fibia. As with all muscles, they are attached to these bones via tendons.
The hamstrings are responsible for stretching our legs backwards, and bending at the knee. In fact, they are involved in most of the movements related to our hips and knees, and so are vital to activities like walking, running, jumping and dancing. These muscles, along with the quadriceps provide a good deal of our flexibility and grace of movement.
Who is at risk of Hamstring Injuries?
Hamstring injuries are common in athletes whose sports require sprinting – soccer, basketball, running. As it turns out, they are also common in elite ten pin bowlers. Teens and older athletes are most at risk. Teens because bones and muscles grow at different rates, and following a growth spurt, the muscle can be over-stretched while it catches up to the bone growth. In older athletes, whose training programme is not as rigorous, unexpected overload can occur.
Risk factors for a hamstring injury include muscle tightness or imbalance, poor conditioning and muscle fatigue.
Diagnosis
Generally, it is easy to identify if there is a hamstring injury. There will be pain, swelling, bruising and weakness in the leg. More complex is determining the severity of the injury. Muscle damage is graded:
Grade 1 – mild pull or slight tear causing minimal loss of strength and movement
Grade 2 – A more extensive tear, causing loss of strength and movement, but not involving the whole muscle
Grade 3 – Complete tear of the muscle causing extreme pain and inability to weight bear
Additionally, there can be what is called an Avulsion Fracture. This is where the tendon attaching the hamstring comes away from the bone completely, sometimes taking a small piece of bone with it.
In order to determine the severity of the injury, and develop a treatment plan, it is important to seek medical advice. If the pain, swelling and bruising is significant an MRI may be required.
Treatment
In the case of Grade 1 and 2 injuries, it may be sufficient to follow the RICE method:
- Rest – it may be advisable to avoid weight bearing and make use of crutches
- Ice – as soon as possible after the injury, apply an ice pack for 20 minutes at a time
- Compression – to reduce swelling, apply a compression bandage
- Elevate – try and rest with your leg higher than your heart – not an easy feat when the injury is in your thigh, but at least aim for horizontal!
In the case of a full tear, surgical repair may be necessary. Weight bearing will be difficult and crutches will be required.
Avulsion Injuries usually involve the tendon at the ischial tuberosity end of the hamstring, and definitely require surgery. These injuries will not heal by themselves even with physical therapy, and left untreated can cause ongoing problems. It is important to have treatment as soon as possible, as the untethered hamstring can damage the sciatic nerve, which will cause lower back and leg pain, and once damaged this vital nerve may not completely heal.
In these cases the tendon is reattached to the pelvis using anchor hooks and stitches. Crutches will be required, and sitting will not be possible for as many as 8 weeks after the surgery, and be limited for some time after that. Extensive rehabilitation will be required.
Rehabilitation & Recovery
Regardless of the severity of the injury, rehabilitation and recovery from a hamstring injury should be overseen by a health professional like a Sports Chiropractor or Sports Physio, who can determine the extent of the injury and develop a treatment plan that will provide you with the best outcome. The plan may incorporate exercises, soft tissue work, dry needling and massage therapy.
In the case of Grade 1 and 2 injuries, sports chiropractic or physiotherapy treatment may be required for a few weeks and will involve first stretching, then rebuilding strength in the muscles.
Grade 3 tears that require surgery may require around 3 months of sports chiropractic or physiotherapy treatment, starting with gentle flexibility exercises before building to strength exercises.
Avulsion Injuries will take at least 6 months of rehabilitation. Starting with gentle stretching, your sports chiropractor or physiotherapist will move on to strengthening. It is important not to rush this recovery, as the tendon takes time to firmly reattach to the pelvis.
Even the mildest hamstring injury can cause a great deal of pain, discomfort and inconvenience. It is important to seek the advice of a medical professional promptly after this sort of injury in order to determine the best treatment and achieve the optimum recovery.
If you have a hamstring injury, call our Baulkham Hills Clinic on 9639 7337 and make an appointment to see our specialist Sports Chiropractor who can develop an effective treatment plan and get you back on your feet as soon as possible.