Hamstring injuries remain a surprisingly common and often poorly managed soft tissue injury in both sedentary and athletically inclined people. Although often not as debilitating as back injury and joint irritations the mismanagement of these injuries can span weeks to months depending on type of injury and severity.
The Role of the hamstrings
When discussing these injuries its best to first have an understanding of what the hamstring group do as a unit. The colloquial term of hamstring is used to describe three muscles on the back side of your upper leg spanning a little over the length of the thigh. These muscles are the Bicep Femoris, Semitendinosus and Semimembranosus. Together they are responsible for extending the hip (pulling the leg behind you) and flexing the knee. Both actions of particular importance when performing actions like running and walking. Because of the location and role of these muscles they have significant involvement in the movement of the knee hip and back.
Common Causes of hamstring injury
Common causes of injury include over striding while running, bio mechanical or neural limitations, sedentary lifestyles and sudden overuse or increases in exercise load with the lower limb.
Types of Hamstring injury
Tendinopathy: Hamstring tendinopathies most commonly present in sedentary people who sit for large periods of time compressing the tendon itself, in athletes with high workloads (particular those with sudden increases in workloads) and in people with poor or faulty techniques. Significant signs of tendinopathy are soreness around the buttock that has come on gradually and is usually worse when waking and better with movement. Other signs include the consistency and length of the injury with tendinopathy based injuries lasting weeks to months with no resolve.
Muscular tears: The degree and location of muscular tear determines the severity and layoff time for a hamstring tear. This injury is more likely to be present in athletic populations and is commonly associated with over striding when running. Commonly patients who experience a hamstring tear will feel a sharp grabbing or cramping type pain in the back middle of the thigh when performing an activity. This pain will gradually recede over the next few hours to days and may result in localised bruising and swelling traveling down the leg.
Neural irritation/referred pain: Hamstring related lower back pain generally presents with a consistent pattern involving lumbar spine movement and a history of lower back pain or restriction. Although not always the case generally this injury will present as a pins and needles sensation, burning or sharp shooting type pain that may travel the length of the posterior aspect of the thigh and further. These injuries are generally associated with lumbar strains, poor bio mechanics with lifting, or prior injury to the hamstring creating adhesive scar tissue.
Hamstring injury management
Tendinopathy: most patients experience excellent outcomes in a relatively short amount of time pending on severity of injury. Management for this condition generally involves manual and soft tissue techniques to surrounding tissue, a targeted exercise program and avoiding irritating factors such as prolonged sitting.
Muscular tears: As with tendinopathies most patients experience a relatively short time for return to full function (4-8 weeks depending on the severity and size of tear). When first suffering a hamstring tear the first 72 hours are crucial. Because of this it’s best to follow the acronym POLICE.
2 and 3. O.L optimal load
Neural irritation/referred pain: Treatment for neural referral generally involve targeted manual therapies, lumbar and neural mobilisations soft tissue techniques and postural/biomechanical correction. The length of injury lay off for these conditions are highly patient specific.
Each of the above mentioned injuries are all manageable and treatable with patients experiencing excellent outcomes with the supervision of management of physiotherapy.