Hamstring Strain/Tendinopathy

What is a Hamstring Strain?

 

The hamstrings are the three thigh muscles at the back of the thigh which connect between the hip and the knee.

  • Semi tendinosus

  • Semi membranosus

  • Biceps femoris

 

hamstring-muscles500

The hamstrings are quite susceptible to injury.Hamstring muscle strains occur during activities that produce excessive stress on one or more of the hamstring muscles. Hamstring strains typically occur at the junction where the muscle becomes tendon (musculotendinous junction). The most common way to strain a muscle is during an eccentric contraction.

 

 knee_hamstring_anatomy01

 

An eccentric contraction is a type of contraction that occurs when muscles are lengthening or stretching and contracting at the same time. For example the hamstring muscles have to lengthen or stretch as you extend your knee to kick a soccer ball. At the same time the muscles have to contract in order to generate force for the movement to occur. Therefore the most common ways to strain the hamstring are during the following activities:

  1. Rapid acceleration during running (sprinting)

  2. Repetitive hip stretches in large ranges of motion

  3. Jumping

  4. Kicking

  5. Lunging

 

There are 3 grades of hamstring strains:

  1. Grade I: Pain with minimal or no strength and range of motion loss. There is minimal disruption of the tissue itself.

  2. Grade II: Pain with decreased muscle strength and function. Muscle fiber disruption occurs.

  3. Grade III: Complete muscle disruption resulting in complete strength and loss of function.

 

Common Signs & Symptoms:

 

  1. Pain anywhere along the muscle.

  2. Reduced hamstring strength.

  3. Reduced hamstring range of motion.

 

 

What is a Hamstring Tendinopathy?

 

A muscle becomes tendon as it inserts onto the bone. A hamstring tendinopathy occurs when microtears and inflammation/degeneration occurs in the tendon itself. Hamstring tendinopathies occur when the hamstring tendon is exposed to repetitive loading during activities such as running and sprinting where traction is applied at the insertion. Repeated activity can lead to tearing and inflammation of the tendon. The rate of healing Is slow because blood flow to this area is relatively poor. Over time this can lead to weakening, thickening of the tendon, fluid collection and issues with the bone.

 

 1.1__hamstringsuppertendon-400x432

 

Common Signs & Symptoms:

 

  1. Pain at the hamstring tendon (since the hamstring originates at the ischial tuberosity of the pelvis it may actually feel like the pain is at the lower buttocks).

  2. Pain can radiate into the hamstring muscles.

 

Aggravating Activities:

  1. Running

  2. Sprinting

  3. Kicking

  4. Dance

  5. Yoga

  6. Martial arts

  7. Lunging

  8. Hiking

  9. Sitting

 

Treatment:

 

At Mountain Health & Performance we treat a wide variety of elite and recreational level athletes of all ages. During the acute phase (first few days after injury) we utilize laser therapy in order to decrease pain and inflammation. Laser therapy is light energy, which stimulates our cells to increase energy production for healing. It also leads to increased microcirculation, which improves blood flow to the injured tissues.

 

Once the pain and inflammation has settled myofascial release can be utilized and targeted towards surrounding muscles and fascia that may have tension, be creating abnormal biomechanics. Rehabilitation will focus on regaining range of motion, preventing atrophy and regaining strength and endurance.

Exercises will promote movement of the hip and knee in a pain free range of motion to start. Once the inflammation has settled abnormal biomechanics will be addressed with mobilizations, stretches and soft-tissue therapy.

 

The hamstrings will then be strengthened in various ways in order to rebuild strength and then prevent future injury. For example specific exercises such as the Nordic hamstring exercise is an eccentric exercise, which specifically helps reduce hamstring injuries. Because the exercise loads the hamstrings in the way they are most commonly injured