Thigh and Hamstring Injuries

Recurrent Hamstring Problems

The hamstring muscles are a group of three muscles which together make up the muscles at the back of the thigh. Injury to the hamstring muscles are common among athletes participating in sports involving sprinting and jumping.

Common problems and causes:

Hamstring strain occurs when the muscle is forced to stretch past its available length. Most hamstring strains are found to occur in that part of the running action where the hamstrings work to slow the forward leg down. This is termed the eccentric muscle contraction of the hamstrings and is where the hamstrings act to co-ordinate and control the forward movement of the shinbone.

The problem with hamstring strains is that unless recognition and correct treatment of the causative factor is performed, the athlete may experience further recurrent hamstring strains. Therefore the all too often scenario of a sports person simply resting and waiting for the muscles to repair and then resuming sport as per normal, may be insufficient to prevent further recurrence unless the predisposing factor is also addressed.

Some of the more common predisposing factors to hamstring injury include:-

Poor hamstring flexibility
Hamstring weakness
Muscle imbalance between the quadriceps muscles on the
Front of the thigh and the hamstring
Stiff low back
Inadequate warm up

Other causes of the same pain:

Some other causes of pain in the back of the thigh which can mimic

Hamstring strains include:-

Referred pain from the low back
Scar tissue impinging on the sciatic nerve which runs down
The back of the thigh

Treatment

Early treatment of a hamstring strain involves reducing any bleeding and inflammation. This requires using the RICER regime. It is then wise to seek help from a suitably qualified professional.

For more information contact us.

Quadriceps Contusions (Corked Thighs)

Quadriceps Contusions also called “Corks”, or “Corked Thighs” are one of the most common injuries in Sport.

These injuries are associated with an impact, or collision.

Physiotherapists and Sports Medicine Doctors/Physicians regularly deal with this injury, and they rarely if ever result in the Surgery.

Our Centres and the Physiotherapists, and Sports Medicine Doctors regularly diagnose and treat Quadriceps Contusions or “Corks”, and are important in getting athletes back to normal after this injury.

For more information contact us.

Hamstring Injuries 3

What are the hamstrings?

There are three muscles that make up the hamstring group at the back of your thigh
They bend the knee, help slow you down when running and help with the push off phase of running

What you may feel ?

During exercise/sport is the most common time to injury your hamstring
It is usually associated with sudden or very strong movements such as: sprinting, kicking, bending over quickly, and occasion all jumping.

The Grade and severity of the injury will determine what you feel:

Grade 1: A small strain of a few muscle fibres that you may not feel at the time but is sore in your hamstring the next day.
Grade 2: Approximately 50% of the muscle is damaged. As you are exercising you may feel an immediate tightening/cramp/ painful sensation in your hamstring. Walking may be painful.
Grade 3: A full rupture of the muscle. You may feel immediate pain and cramping in your hamstring. It may be very painful to walk on if some fibres are still intact.

What should you do initially?

You should perform the acronym:

Protect: Avoid further injury be ceasing exercise
Rest: Avoid vigorous exercise until cleared by your physiotherapist
Ice: Every hour place an ice pack on the sore area for 20 minutes
Compression: Use Tubigrip, skins or another compression garment around your thigh
Elevation: When resting keep it above your heart level to decrease swelling
Medicine: After the first 48 hours – anti-inflammatory drugs (neurofen) and pain relief straight away.

You should avoid:

Heat
Alcohol
Running
Massage

What is the best type of rehabilitation?

Rehabilitation is best guided by your Sports Medicine Doctor and Physiotherapist and depends on the severity of your injury and the amount of pain you are in
It can involve local treatment, gentle movements, stretches and strengthening in the initial stage
As your pain decreases and your strength improves you will begin more dynamic running exercises, more difficult strengthening exercises to target the injured muscle and you core stability.

How long before you return to sport?

It depends on the severity of the injury and how compliant you are with your rehabilitation:

Grade 1: 1-3 weeks
Grade 2: 4-6 weeks
Grade 3: Surgery and >6 weeks

Re-occurrence of Hamstring Injuries is very common.

This is mainly due to a return to sudden or very strong movements such as: sprinting, kicking, bending over quickly, and prior to the injury healing properly.
Hamstring injuries will usually feel substantially better 1-2 weeks prior to them actually having healed sufficiently to return to these activities.
Check with your Physiotherapist or Sports Doctor prior to returning to full activity.

FOR FURTHER INFORMATION contact us.

Hamstring Injuries 2

Hamstring injuries are one of if not the most common injuries in sport and normally occur during high intensity running or kicking activities. There is generally a sharp ‘catching’ or ‘grabbing’ pain in the back of the leg along with pain and loss of function/power. If the strain is not too severe you may be able to continue playing with limitations.

In the thigh there are 3 hamstring muscles, semimembranosus, semitendinosus and biceps femoris. Most hamstring injuries occur during take off to sprint or when trying to rapidly decelerate, it is during this transition that the hamstrings are vulnerable to strain.

Unfortunately hamstring strains have a high re-injury rate due to poor rehabilitation and/or returning to activity too quickly, therefore physiotherapy becomes vital for return to sport.

Physiotherapy

Physiotherapy plays a very important part in the rehabilitation of hamstring strains. A physiotherapist will diagnose the extent of the injury and help to exclude any additional muscle or tendon damage. Your physiotherapist may also grade your injury by the severity of your symptoms (e.g. loss of range and loss of power). Grading is usually done on a scale of 1-3 with 1 being minor and 3 more severe. A comprehensive rehabilitation program is required if the athlete is to return to sport and avoid re-injury.

Initial Management:

Initially this consists of trying to limit the extent of damage post injury and is important for commencing rehabilitation as quickly as possible.

Rest: You may need to limit the amount of weight put on the injured leg due to pain. Also try to avoid putting further strain on the affected muscle. This will help limit further injury.

Ice: Apply ice to the affected area continually alternating for 15 minutes at a time.

Compression: Using a compressive bandage can give support to the injured muscle and help to limit swelling.

Elevation: Keeping the injured area elevated can limit swelling and bruising.

Medication: Use of non-steroidal anti-inflammatories (NSAIDs) for muscle strains is debatable. One school of thought is to allow for the initial acute phase of 72 hours (3 days) to occur and then commence NSAIDs to limit any excessive irritation/inflammation of the surrounding tissue.

Rehabilitation:

The greatest risk of a hamstring injury is a previous hamstring injury. As soon as pain allows you to commence a guided rehabilitation process you should begin putting some load through the muscle. This may consist of simple range of motion exercises and stretching initially so the site of healing is not disrupted. At this stage simple walk/jog activities would be advised as long as they are pain free.

As you progress exercises may involve higher load and dynamic activities such as hamstring curls, dead lifts and arabesque exercises (or something similar). Conditioning should start to involve high intensity running of varying intervals again at a pace that is comfortable. The distance/duration of all exercises should be specific to your sport and take into account whether it is endurance or explosive efforts that will be required.

he eccentric component of loaded exercises is vital for rehabilitation from muscle strains. Basically this involves putting the muscle under load as it stretches, allowing the newly laid fibres to strengthen as they lengthen. This is important because while running or kicking the muscle must work to control this movement while stretching and in doing so can be more vulnerable to injury.

For more information contact us.

Hamstring Injuries

Damage to the Hamstring Muscles at the back of the thigh is one of the most common, and highly publicised injuries in Sport. These injuries can be associated with dramatic footage of the injury occurring when sprinting or kicking.

Did you know???

Hamstring injuries are the most frequently occurring injury in AFL (19% of all major injury episodes) and they account for the most missed matches of any injury.

Hamstring injuries also have high recurrence rate. Why???

The athlete returns to play too quickly
The athlete does not complete the appropriate rehabilitation after the injury
Once back playing, the athlete does not continue the rehabilitation process
The highest recurrence rate is in the first 6 weeks after return to sport

A little bit of information about the hamstring muscle group…

The hamstrings work to flex (bend) knee and extend hip, which is vital for running
Huge stresses are placed on the hamstrings during running activities
You will generally recall a sudden onset of sharp pain occurring during a specific event.
You may find difficulty with walk in the days following a hamstring injury.
The hamstring muscles will continue to heal for months after injury, even after you are able to return to sport.

I’ve just strained my hamstring. What now???

In the first 24-48 hours after the injury follow the RICER principle
no HARM (Heat, Alcohol, Running & Massage)
Get the injury assessed by Physiotherapist and/or Sports Doctor

When should I see my Physio and/or Sports Doctor??

As soon as possible post injury to assess severity and map out a graduated rehabilitation program which should safely guide you back to your sport, and prevent any recurrence of injury.

How many weeks should I miss??

Generally a low-grade hamstring injury can rule you out for anywhere between 2 – 6 weeks (in 2009 the AFL average of missed games per hamstring injury was 3.4 matches).

For a greater understanding of the severity of your injury, it is best to consult your Physiotherapist to put together the appropriate rehabilitation timeline.

When will I know I am ready??

This is a major problem as the hamstring will be pain free on normal activity long before it is ready to kick or sprint. However, you wont know that until you kick or sprint and re-tear the muscle.

Don’t attempt to retrun to these activities or full sport until you are cleared by your Physio or Sports Doctor.

You should then completed 1-2 weeks of pain-free full training including game-specific intensity and skill requirements (i.e. sprinting, changing direction at high speed, jumping, bumping, tackling, kicking, picking the ball up off the ground at pace, repeated efforts), without any pain or lack of strength during or after the sessions.

Our Centres and the Physiotherapists, and Sports Medicine Doctors regularly diagnose and treat Hamstring injuries, and are critical in getting athletes back to normal after this injury.

For more information contact us.

Sciatica

“Sciatica” has quickly become a broad term that people use to describe any pain at the back of the thigh and is commonly overused.

Even though pain at the back of thigh can be due to the Sciatic nerve, the reality is that pain in this area is often due to a number of other causes such as pain directly from your back, muscle strain of the glutes or hamstrings and even trigger points or muscle tension.

It is therefore important to have your pain thoroughly assessed, to get the correct diagnosis.

“Sciatica” is symptom caused by irritation of the Sciatic nerve. This irritation can be due to stiffness or inflammation at any point along the nerve’s line. Commonly, the irritation is at the roots of the nerve, as they pass out of the lower back.

Symptoms usually consist of:

Pain along the specific line of the sciatic nerve
Dull, pulling, heaving sensation along that line
Occasionally paraesthesia or a “numb” sensation

Sciatic nerve pain can be diagnosed with specific tests performed by your physiotherapist, that assess the nerve’s sensitivity to lengthening and stretching movements. This should be performed in conjunction with a thorough assessment of your lower back and thigh, to formulate a diagnosis as to why you are getting this pain.

Treatment involves treating the area around the nerve to reduce the irritation and reducing the nerve’s sensitivity to stretching. This can involve:

Electrotherapeutic modalities e.g. TENS etc
Specific mobilisations
Dry needling
Specific stretches and exercises
Modifying biomechanics and lifestyle factors

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