• Hamstring Injuries

      If you have ever pulled one, you need to read this; even if you haven’t, an ounce of prevention is worth a pound of cure. Lower extremity muscle strains are a very common injury in an active population.

      Acute trauma that causes a muscle to tear can occur during activities like sprinting. That is not always the inciting agent. For those of you who like to do repetitive activities like running, overuse strains of the hamstrings also occur. Repetitive loading to a muscle can over time cause tissue to fail and cause the feeling of muscle tightness, pain and disability even with activities like sitting in the chair. Some people even think that it might feel like so called sciatic pain because it can radiate down the leg.

      Most tears occur at the weak link of the muscle attachment site often referred to the musculo-tendinous junction. This is the transition spot where very rubbery muscle tissue becomes the stronger tendon tissue that attaches to the bone. Here the tissue can be torn/stretched or what we called strained. Tears do occur in the muscle itself as well as at the tendon attachment site to the bone. For the most part all hamstring injuries are treated the same. Only in the event of a large complete tear of the tendon off the bone do we consider performing surgery.

      The acute care of these injuries follow the same basic principle of any acute injury. First, recognize there is a problem. Easy for the guy who blows it out on the football field; Much more difficult for the individual who is a runner who feels a twinge in the back of the thigh and thinks they can run through it. Those are the tough ones because if we don’t catch those in the butt, no pun intended, they will become a source of continued disability.

      RICE is the acronym that describes initial management of these injuries. Rest or avoidance of activity implies that we take away the offending agent to allow our body to begin the process of healing. Those can be very variable depending on the extent of injury. Some individuals can’t walk and need to rest. Sometimes ambulatory assistance with crutches until normal activities can be resumed may be helpful. Some on the other hand, might feel that another activity like riding a stationary bike or using a rowing machine might be totally fine and cause no discomfort. In those cases I recommend that as long as there is no pain or discomfort with the activity or an exacerbation of discomfort after the activity that it is ok to do and can be of some assistance during the healing phase. Be careful with that suggestion. Go slow and do not push the envelope.

      Ice is an invaluable tool in the early phases of healing. When muscle tissue is torn or strained, even at the microscopic level, bleeding occurs. Ice causes vasoconstriction or a shutting off of the blood vessels which helps reduce the amount of bleeding and subsequent swelling. The first 36-72 hours is critical for using ice. There is no statistical evidence that using a treatment plan of alternating heat and cold during this period is better. I will say that after the first 72 hours that ice helps reduce pain and heat helps loosen the thigh.

      During the next phase of rehabilitation, restoration of Range of Motion (ROM) becomes essential. Hamstrings become tight which leads to lower back stiffness and calf tightness. Gentle stretching can be started as you start to feel better, walking seems easier and possibly you can spin easy on a bike. Easy stretches such as a standing hamstring stretch, hurdler’s stretch, single knee to chest, and runner’s calf stretches can be done. Overstretching your hamstring can reignite the fire and cause more pain. I actually prefer to do only minimal stretching, as with my own hamstring, it would often make it feel worse. If you are going to stretch only a gentle pull should be felt and the stretch should be help for a minimum of 15 to 20 seconds. If you have a large shower, take a nice warm one and do the stretching in there. Guaranteed to make you feel good. A thigh sleeve like a knee sleeve can be worn to ease discomfort and keep it warm.

      Although no scientific evidence to support it, my feeling is that strength training is potentially the most important step in rehabilitation. Like stretching there should be minimal discomfort while you are doing these exercises. The concept of “no pain no gain” is not acceptable in a rehabilitation program. Isometric exercises, those that are performed with little or no joint motion can be performed with minimal risk if reinjury. As you feel better more aggressive strength training can be added. Squats and lunges can be performed as they involve multi-joint motion, which help the return of functional strength. Core strengthening which is the buzzword of the new generation of health professionals is now being seen as the missing link to injury prevention. Our ability to maintain a stable spine while our lower body and upper body move, which requires an intricate coordination of muscle actions, is a significant factor in injury prevention. There are also many studies that show that plyometric exercises, high intensity jumping, can be an effective means to rehabilitate from these injuries. Great care must be taken when doing these exercises. Consult with a health or fitness professional to guide you with these exercises.

      Return to sports can sometimes take as much as 6-8 weeks of persistent attention to rehabilitation. Sitting on the couch will not make you better. Take the time to get better. Your hamstring will thank you and be stronger for it. Good luck!