Hamstring Strain: Difference between revisions
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The cause of a hamstring muscle strains is often obscure. In the late forward swing phase, the hamstrings are at their greatest length and at this moment, they generate maximum tension <ref name="Coole et al.">Coole WG, Gieck JH.(1987) An analysis of hamstring strains and their rehabilitation. J Orthop Sports Phys Ther 9(3):77-85. (Level of evidence = 2B )</ref>. In this phase, hamstrings contract eccentrically to decelerate flexion of the hip and extension of the lower leg <ref name="Petersen et al.">Petersen J, Hölmich P. Preventie van hamstringblessures in de sport, "evidence based” Geneeskunde en Sport 2005; 38: 179-185 (Level of evidence = 3A )</ref>. At this point, a peak is reached in the activity of the [[Muscle spindles|muscles spindles]] in the hamstrings. A strong contraction of the hamstrings and relaxation of the quadriceps is needed. According to “Klafs and Arnheim” , a breakdown in the coordination between these opposite muscles can be a cause for the hamstrings to tear.<ref name="Klafs et al.">Klafs CE, Arnheim DD: ( 1968 ) Principles of Athletic Training, Ed pp 370-372. St Louis: CV Mosby Co.</ref> | The cause of a hamstring muscle strains is often obscure. In the late forward swing phase, the hamstrings are at their greatest length and at this moment, they generate maximum tension <ref name="Coole et al.">Coole WG, Gieck JH.(1987) An analysis of hamstring strains and their rehabilitation. J Orthop Sports Phys Ther 9(3):77-85. (Level of evidence = 2B )</ref>. In this phase, hamstrings contract eccentrically to decelerate flexion of the hip and extension of the lower leg <ref name="Petersen et al.">Petersen J, Hölmich P. Preventie van hamstringblessures in de sport, "evidence based” Geneeskunde en Sport 2005; 38: 179-185 (Level of evidence = 3A )</ref>. At this point, a peak is reached in the activity of the [[Muscle spindles|muscles spindles]] in the hamstrings. A strong contraction of the hamstrings and relaxation of the quadriceps is needed. According to “Klafs and Arnheim” , a breakdown in the coordination between these opposite muscles can be a cause for the hamstrings to tear.<ref name="Klafs et al.">Klafs CE, Arnheim DD: ( 1968 ) Principles of Athletic Training, Ed pp 370-372. St Louis: CV Mosby Co.</ref> | ||
There are several predisposing factors to hamstring strains like fatigue, poor posture( anterior tilt of the pelvis), muscle strength imbalances, leg length inequality, non-flexibility and an insufficient warm-up <ref name="Sutton et al." /><ref name="Petersen et al." />. So reported Worrel et al. that the hamstring-injured group was significantly less flexible than the non-injured group. These factors have an influence on the tenderness of the hamstrings.<ref name="Worrell et al.">Worrell, T.W., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Perrin, D.H. (1992). Hamstring muscle injury: the role of strength (Level of evidence = 5)</ref><br> <br> | There are several predisposing factors to hamstring strains like fatigue, poor posture( anterior tilt of the pelvis), muscle strength imbalances, leg length inequality, non-flexibility and an insufficient warm-up <ref name="Sutton et al." /><ref name="Petersen et al." />. So reported Worrel et al. that the hamstring-injured group was significantly less flexible than the non-injured group. These factors have an influence on the tenderness of the hamstrings.<ref name="Worrell et al.">Worrell, T.W., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Perrin, D.H. (1992). Hamstring muscle injury: the role of strength (Level of evidence = 5)</ref><br> <br> | ||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
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[[Category:Vrije_Universiteit_Brussel_Project]][[Category:Condition]][[Category:Knee]][[Category:Musculoskeletal/ | [[Category:Vrije_Universiteit_Brussel_Project]][[Category:Condition]][[Category:Knee]][[Category:Musculoskeletal/Orthopaedics|Orthopaedics]] | ||
Revision as of 23:18, 5 October 2014
Original Editors - Bo Hellinckx
Top Contributors - Admin, Boddengeen Ben, Bo Hellinckx, George Prudden, Mandeepa Kumawat, Vinit Kothekar, Shaimaa Eldib, Evan Thomas, Aminat Abolade, Tomer Yona, Kim Jackson, Rachael Lowe, Uchechukwu Chukwuemeka, Shoko Otsuka, Fasuba Ayobami, Iris Roelandt, Daphne Jackson, Wanda van Niekerk, Kai A. Sigel, WikiSysop, Simisola Ajeyalemi, 127.0.0.1, Livia Hoeben, Tony Lowe, Tania Appelmans and Claire Knott
Definition/Description[edit | edit source]
Hamstring strains are caused by a rapid contraction or a violent stretch of the hamstring muscle group which causes varying degrees of rupture within the musculotendinous unit.[1]
Clinically Relevant Anatomy[edit | edit source]
The hamstrings are comprised of three separate muscles located at the back of the thigh. The biceps Femoris, Semitendinosus and the Semimembranosus. These muscles start at the ischial tuberosity, extending down the back of the thigh and along either side of the knee [2]. The Biceps Femoris exists out of two parts: the long head and the short head. These two parts are both attached to the head of the fibulae, but only the long head starts at the ischial tuberosity. The other part, the short head, starts at the lateral lip of the linea Aspera on the posterior aspect of the femur[3]. The Semitendinosus starts at the Ischial tuberosity but unlike the Biceps Femoris, it lays at the medial side of the thigh and is attached to the upper medial surface of the tibia. The Semimembranosus is the most medial of the three hamstrings muscles [4]. It also starts at the ischial tuberosity and is attached to the Pes Anserinus profundus.[2]
Because the Hamstrings cross two joints, there functions are varied.The muscles function as movers and stabilizers of the hip and knee. Contractions of the hamstrings causes flexion of the knee and extension of the hip. The hamstrings help to get from a crouched position to an erect position. This reffers to movements like getting up from a chair or in sprinting, where the front leg in starting position has to bear the effect of the start. [5]
Epidemiology /Etiology[edit | edit source]
Hamstring strains are caused by a rapid contraction or a violent stretch of the hamstring muscle group which causes varying degrees of rupture within the musculotendinous unit.[1]
Muscle strains can be divided into grades, dependable of their severity. The classification of hamstrings strains can be used to estimate the convalescent period and to design a rehabilitation program. [6] More information about classification: Muscle Injuries.
The cause of a hamstring muscle strains is often obscure. In the late forward swing phase, the hamstrings are at their greatest length and at this moment, they generate maximum tension [3]. In this phase, hamstrings contract eccentrically to decelerate flexion of the hip and extension of the lower leg [6]. At this point, a peak is reached in the activity of the muscles spindles in the hamstrings. A strong contraction of the hamstrings and relaxation of the quadriceps is needed. According to “Klafs and Arnheim” , a breakdown in the coordination between these opposite muscles can be a cause for the hamstrings to tear.[7]
There are several predisposing factors to hamstring strains like fatigue, poor posture( anterior tilt of the pelvis), muscle strength imbalances, leg length inequality, non-flexibility and an insufficient warm-up [1][6]. So reported Worrel et al. that the hamstring-injured group was significantly less flexible than the non-injured group. These factors have an influence on the tenderness of the hamstrings.[4]
Characteristics/Clinical Presentation[edit | edit source]
At the instant of an injury during sport activities, patients mostly report a sudden sharp pain in the posterior thigh. Also a “popping” or tearing impression can be described.[8] The patients may complain of tightness, weakness and impaired range of motion like knee extension with the hip in a flexed postion. Sometimes swelling and ecchymosis are possible but they may be delayed for several days after the injury occurs[9]. Rarely symptoms are numbness, tingling and distal extremity weakness. These symptoms require a further investigation into a sciatic nerve irritation. [9] Large hematoma or scar tissue can be caused by complete tears and avulsion injuries.
Differential Diagnosis[edit | edit source]
On examening the patient, the physiotherapist possibly has to differentiate between: adductor strains, avulsion injury, lumbosacral reffered pain syndrome, piriformis syndrome, sacroiliac dysfunction, sciatica, Hamstring tendinitis and ischial bursitis. [10][8]
Diagnostic Procedures[edit | edit source]
The purpose of the diagnosis is to determinate the location and severity of the injury. More information about the diagnostic procedures of a hamstring strain: Muscle injuries. (Diagnostic Procedures)
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
The physical examination begins with an examination of the running gait. Patients with a hamstring strain usually show a shortened walking gait. Swelling and ecchymosis aren’t always detectable at the initial stage of the injury because they often appear several days after the initial injury [9]. The physical examination also exists of visible examination. The posterior thigh is inspected for asymmetry, swelling, ecchymosis and deformity. When there is a palpable defect, it indicates a more severe injury, mostly with a full rupture of the muscle. Also the active and passive range of motion should be tested and compared with the other leg.
Medical Management
[edit | edit source]
Surgical intervention is an extremely rare procedure after a hamstring strain. Only in case of a complete rupture of the hamstrings, surgery is recommended. Almost all patients believed that they had improved with surgery. A study [11] shows that 91% was satisfied after surgery and rated their happiness with 75% or better. Hamstrings endurance tests and hamstring strength tests were better and highly scored after an surgical procedure. The muscle strength testing after surgery ranged from 45% until 88%. The hamstrings endurance testing ranged from 26% to 100% .The physical examination and follow-up reveals that all repairs stayed intact.
Physical Therapy Management
[edit | edit source]
The primary objective of physical therapy and the rehabilitation program is to restore the patient’s functions to the highest possible degree and/or to return the athlete to sport at the former level of performance and this with minimal risk of reinjury.
Rehabilitation programs are mostly based on the tissue’s theoretical healing response. More information: Healing
Taping may be effecitve:
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
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References[edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 1.2 Sutton G. (1984) Hamstrung by hamstring strains: a review of the literature*.J Orthop Sports Phys Ther. 5(4):184-95. (Level of evidence = 3B )
- ↑ 2.0 2.1 Schunke M., Schulte E., Schumacher (2005). Anatomische atlas Prometheus: Algemene anatomie en bewegingsapparaat. Nederland: Bohn Stafleu Van Loghum
- ↑ 3.0 3.1 Coole WG, Gieck JH.(1987) An analysis of hamstring strains and their rehabilitation. J Orthop Sports Phys Ther 9(3):77-85. Cite error: Invalid
<ref>tag; name "Coole et al." defined multiple times with different content - ↑ 4.0 4.1 Worrell, T.W.,Perrin, D.H. (1992). Hamstring muscle injury: the role of strength, flexibility, warm-up, and fatigue. Journal of Orthopaedic and Sports Physical Therapy, 16, 12-18. (Level of evidence = 5) Cite error: Invalid
<ref>tag; name "Worrell et al." defined multiple times with different content - ↑ Taylor M.P., Taylor K. D. (1988). Conquering athletic injuries. Illinois: Leisure press.
- ↑ 6.0 6.1 6.2 Petersen J, Hölmich P. Preventie van hamstringblessures in de sport, "evidence based” Geneeskunde en Sport 2005; 38: 179-185 (Level of evidence = 3A )
- ↑ Klafs CE, Arnheim DD: ( 1968 ) Principles of Athletic Training, Ed pp 370-372. St Louis: CV Mosby Co.
- ↑ 8.0 8.1 Bryan C. Heiderscheit, PT, PhD, et al. (2010) Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention. In Journal of Orthopaedic; Sports Physical Therapy (Level of evidence = 5) Cite error: Invalid
<ref>tag; name "Bryan et al." defined multiple times with different content - ↑ 9.0 9.1 9.2 Frontera WR, Silver JK, Rizzo TD Jr (2008) Essentials of physical medicine and rehabilitation. Muskuloskeletal disorders, pain and rehabilitation. Canada: Saunders Elsevier. Cite error: Invalid
<ref>tag; name "Frontera et al." defined multiple times with different content - ↑ Starkey C and Johnson G (2006) Athletic training and sport medicine. United States of America: Jones and Barlett publishers.
- ↑ Cross MJ, Vandersluis R, Wood D, Banff M (1998) Surgical repair of chronic complete hamstring tendon rupture in the adult patient. Am J Sports Med 26(6):785–788 (Level of evidence = 2B)
