There has been a recent increase in hamstring injuries which has sparked an interest in sports therapists. In fact, hamstring injuries ranks second in frequency among the athletic population only to knee injuries. Sports therapists and researchers have found that those who have previous hamstring injuries are twice as likely to re injure their hamstring tendon. Other predictive factors include increased age, overweight individuals, tight hip flexors, and hip muscle imbalances especially weak hamstrings.
This leads us to the best way to care for hamstring injuries. First, it must start with an accurate diagnosis from your orthopedist, or other physician. There are several categories of hamstring injuries, including acute strains, tendinopathies and avulsions. These diagnoses are usually made through a comprehensive evaluation, clinical tests, and imaging studies including X-rays, ultrasound, or an MRI.
Acute strains usually respond best to core strengthening and avoiding direct hamstring stretching and strengthening early on. Avoiding early stretching and strengthening allows scar tissue formation within the hamstring tendon. This produces stiffness within the tendon which gives the tendon rigidity to prevent micro trauma to this region during the healing process. A physical therapist will be able to identify when in the healing process flexibility and strengthening should be initiated. During rehab, agility training with sport specific exercises may be beneficial before return to full sporting activity.
Tendinopathies refer to a chronic injury with swelling, thickening of the tissue, and scarring but no active inflammation. Physical therapists will usually focus on posture, alignment, core strengthening, and soft tissue mobilization. Motor control along with muscle activation patterns may also be monitored as with chronic conditions muscle substitution patterns are often identified. These injuries can benefit from eccentric loading which strengthen from a shortened position and moving into positions of elongating the tissue.
Rupture and avulsion injuries are the most serious and occur where the hamstring tendon pulls away from the bone and sometimes pulls off a piece of the bone. These are identified through the use of medical imaging. When the tendon retracts from its bony attachment, surgical intervention may be required to reattach the tendon. Usually a lot of bleeding into surrounding tissues is noted with avulsion injuries and bruising is present. This sometimes can press on neurological structures and cause tingling in the back of the leg.
Hamstring injuries can be agitating but given the appropriate treatment most people can return to their leisurely or sporting activities with some medical attention and a little hard work.
By: Chris Athos, MPT COMT