Download anatomy hamstring strains

ANATOMY
To schedule an
appointment, call
419-562-5281
Centers located in
Bucyrus, Crestline,
Galion, and Ontario.
CENTER FOR SPORTS HEALTH
www.avitahealth.org
01-09-2014
Your hamstring consists of three muscles on the back
of your thigh: Biceps Femoris, Semimembranosus, and
Semitendinosus. These muscles work together to allow
you to bend your leg at the knee. Injury to these muscles
commonly occurs due to:
• No warm-up before
activity
• Poor flexibility
• Muscle imbalance:
thigh muscles
(quadriceps) are
stronger than the
hamstrings
• History of
hamstring injury
• Poor running style
such as overstriding
• Teenagers going
through growth spurts
The best prevention is to always warm-up and stretch
before activity. Train smart; make sure that your exercises
include adequate hamstring strengthening.
HAMSTRING STRAINS
Hamstring strains can be graded into 3 different severities,
grades 1 (mild), 2 (moderate), and 3 (severe).
GRADE 1 involves less than 20% of the muscle fibers being
torn. GRADE 2 involves up to 70% of the muscle fibers
being torn. GRADE 3 is a complete tear of the muscle.
Symptoms include:
• Sudden, possibly severe pain with activity
• Snapping or popping feeling (can be an audible
sound)
• Pain with sitting, walking uphill, ascending stairs
and bending over
• Swelling, bruising (Grade 2 and 3) and tenderness
OVER
TREATMENT
RETURNING TO PLAY
Initially utilize the RICE Principle:
• REST: Stop activity and avoid putting
weight on your leg. Depending on the
severity, crutches may be used.
• ICE: Apply ice to the area often
throughout the day. Ice for 20 minutes,
and then remove for 2 to 3 hours
before icing again to help with pain
and swelling.
• COMPRESSION: Wrap the affected
area in an ACE bandage to help control
the swelling.
• ELEVATION: Elevate the leg when
sitting or lying down; this will also help
with any swelling.
Each grade of severity has a different time
frame for returning to activity, the more
severe the injury, the longer it will take to
return. Returning should be done gradually
and supervised so that injury is not repeated.
Follow the direction of your physician. There
are certain criteria that must be met before the
progression can begin:
• You must have full range of motion
• Strength must be back to 90% of the
healthy side
• Endurance must have been maintained
• Hamstring-Quadriceps strength is
equal
GRADE 1:
RICE and perform gentle stretching, just until
the point of pain. Mild cases usually resolve
within days if treated. Anti-inflammatory
medications should also be taken, such as
ibuprofen, Aleve or Advil. If pain lasts 5-7
days then seek the help of a sports medicine
physician or athletic trainer.
GRADE 2:
RICE and gentle stretching may also be
performed. Crutches may be needed to assist
with getting around. Make an appointment
with a sports medicine physician. They may
prescribe physical therapy to help with
recovery.
GRADE 3:
RICE and make an appointment with a sports
medicine physician as soon as possible.
Crutches and a knee immobilizer will be
necessary. Surgery may be warranted, followed
by physical therapy.
IMAGING
Imaging is not required for diagnosis of
hamstring strains. MRI’s may be performed for
complete tears, to diagnose, and for surgery
preparation. X-rays can be taken to check for
an avulsion fracture or apophyseal fracture in
adolescents, if suspected.
CENTER FOR SPORTS HEALTH
AVULSION FRACTURE
An avulsion fracture occurs when the tendon
of a hamstring muscle breaks off a piece of the
bone where it is attached in the pelvic region.
The symptoms of this condition are the same
as hamstring strains, the pain location will be
located high in the buttock/groin region. In
most cases, no surgery is needed and treatment
is the same as a strain, the bone will heal itself
back together. If the bone has been pulled more
than several centimeters away, then surgery will
need to be performed for proper healing.
APOPHYSEAL FRACTURE
An Apophyseal Fracture only occurs in
adolescents whose growth plates are still open.
It is similar to an avulsion fracture, where a
hamstring tendon pulls and actually breaks
the growth plate. Proper treatment for this
condition is important so that the growth of the
bone is not affected. Surgery will be performed
if the broken pieces are not aligned. If the
broken pieces are aligned or the adolescent is
old enough that the growth plate was almost
closed, then no surgery is necessary and it is
treated as a hamstring strain.
NOT READY TO RETURN?
Returning to activity too early can have some
consequences. There is a 77% re-injury rate of
hamstring strains if the injury has not had time
to heal.
The body needs time to heal and realign
the muscle fibers in the muscle. If this is not
completed and activity starts, scar tissue
formation occurs to make up for that weakness
in the fibers. This will result in limited range of
motion, pain, and/or inflammation. Seek the
help of a healthcare professional if an injury
is suspected; they can help you with returning
to activity.