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Pulled Hamstring / Hamstring Strain

A hamstring strain or a pulled hamstring as it is sometimes called is a tear in one or more of the hamstrings muscles. Strictly speaking there are three hamstring muscles (Semitendinosus, Semimembranosus and Biceps femoris) which are known as the hamstring muscle group. These muscles all originate from the ischial tuberosity of the pelvis. Biceps femoris, in addition, has a second portion, known as the small head, that originates from the lower outer portion of the femur bone itself.

The rear portion of adductor magnus is sometimes also considered as a hamstring muscle due to its alignment. All of these muscles travel across the knee joint - semitendinosus and semimembranosus insert into the medial (inner) aspect of the tibia while the biceps femoris inserts at the head of the fibula bone on the outside of the lower leg.

The hamstrings function predominantly in extending the hip and flexing the knee joints. Understanding how the hamstrings work give vital clues as to their modes of injury. Acute, mild to severe hamstring strains are extremely common in sprinters and hurdle jumpers and in all sports that involve sprinting activities, such as football ,cricket hockey and rugby.

During sprinting the hamstring muscles work extremely hard to decelerate the tibia(leg bone) as it swings out. In addition, once the foot is on the ground the hamstrings function in extending the hip back which in turn allows the other leg to move forwards. It is in this phase just before the foot strikes the ground that the hamstrings, most commonly the biceps femoris muscle, become injured as the muscles are maximally activated and are approaching their maximum length. There are a number of factors that increase the risk of an individual to a pulled hamstring:

    Age: The older the individual the greater at risk to a pulled  hamstring.

    Previous Injury: Prior injuries to the hamstrings or adductor muscles can greatly increase the risk of the hamstrings to future damage.

    Flexibility: Research suggests that the greater the flexibility of the hamstrings the less prone they are to injury.

    Hamstring strength: Similarly studies have shown that lack of hamstring strength is strongly linked to a susceptibility to a pulled hamstring.

    Lumbosacral nerve impingement: Nerve impingement in L5-S1 can lead to associated hamstring muscle weakness.

    Tiredness and fitness:: When a player is fatigued he/she loses coordination between within certain muscle groups. The biceps femoris muscle is known to become damaged due its two portions being innervated by two separate nerves. In states of tiredness, lack of synchronization between these two nerves can lead to a mismatch in firing resulting in a pulled hamstring.

A pulled hamstring rarely manifests as a result of contact-If you have taken an impact to the back of the leg it should be treated as a contusion

     Symptoms of a Pulled Hamstring:

    A sudden sharp pain at the back of the leg during exercise-most probably during sprinting or high velocity movements

    Hamstring muscles going into spasm-will be associated with pain on stretch and contraction.

    Swelling and bruising.

    If the rupture is severe a gap in the muscle may be felt.

     Severity of Pulled Hamstring:

Strains are graded 1, 2 or 3 depending on severity. Grade 1 consists of minor tears within the muscle. A grade 2 is a partial tear in the muscle and grade 3 is a severe or complete rupture of the muscle...

 In Grade 1 injury

    May have tightness in the posterior thigh.

    Probably able to walk normally however will be aware of some discomfort

    Minimal swelling.

    Lying on front and trying to bend the knee against resistance probably won't produce much pain.

 In Grade 2 injury y

    Gait will be affected-limp may be present .

    May be associated with occasional sudden twinges of pain during activity.

    May notice swelling.

    Pressure increases pain.

    Flexing the knee against resistance causes pain.

    Might be unable to fully straighten the knee.

 In Grade 3 injury y

    Walking severely affected- may need walking aids such as crutches

    Severe pain- particularly during activity such as knee flexion.

    Noticeable swelling visible immediately.

     Treatment of a Pulled Hamstring:

See a sports injury specialistst

It is vitally important that treatment for a pulled hamstring starts immediately following injury. The most important phase for treatment is the first 48 hours post-injury. In this time the following can be carried out by the athlete themself:

    Use Cold Therapy (Rest, Ice, Compress, Elevate) technique

    Use a compression bandage to minimize intra muscular bleeding.

    Early mobilizationon of the injured lower limb is vital for the correct rehabilitation of the muscle. This includes stretching and strengthening exercises throughout the pain free range. These can aid with decreasing the swelling in the area. In addition, exercise will ensure that any new material will be laid down in correct orientation thus reducing the risk of subsequent injuries. 

What can a Sports Injury Specialist do?

    Use sports massagege techniques to speed up recovery- these are extremely important in the rehabilitation ultrasoundnd and electrical stimulation.

    Prescribe a rehabilitationon program

    Advise on specific stretches

    Provide mobility aids such as crutches

    Provide an MRI scan to ascertain the amount of damage sustained

    In severe ruptures surgery may be needed to repair the damage

    Prevention of Pulled Hamstrings:

    One of the most important methods of preventing a pulled hamstring is to warm upup correctly- this has been scientifically proven to reduce the risk of hamstring strain. This should consist of some light aerobic exercise.

    A specific strengthening programam for the hamstring muscle group is vital in those athletes regularly undertaking sprinting and high velocity sports.

    It is extremely important to continue to strengthen all other muscles in the region of the thighs, pelvis and lower back to ensure correct muscle balance

    Stretchingng both before and after exercise

    Regular deep tissue sports massagege

    Thermal pants are thought to decrease the risk of injury.

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