Hamstring Strain
Original Editors - Bo Hellinckx
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
add text here related to databases searched, keywords, and search timeline
Definition/Description[edit | edit source]
add text here
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 [1]. The Biceps Femoris exists out of 2 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[2]. 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 [3]. It also starts at the ischial tuberosity and is attached to the Pes Anserinus profundus.[1]
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 in sprinting ( the front leg in starting position takes the brunt of the start). [4]
Epidemiology /Etiology[edit | edit source]
add text here
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.[5] The patients may complain of tightness, weakness and impaired range of motion lik knee exteinsion 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[6]. Rarely symptoms are numbness, tingling and distal extremity weakness. These symptoms require a further investigation into a sciatic nerve irritation. [6] 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. [7][5]
Diagnostic Procedures[edit | edit source]
The purpose of the diagnosis is to determinate the location and severity of the injury. A hamstring strain is diagnosed primarily by physical examination and history. 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 [6]. 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 rang of motion should be tested and compared with the other leg.
The diagnosis is typically clinical but some imaging studies may be useful if the clinical picture is unclear: [8]
- Radiographs
- MRI ( magnetic resonance) [5]
- Ultrasonographic studies.
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
add text here related to physical examination and assessment
Medical Management
[edit | edit source]
add text here
Physical Therapy Management
[edit | edit source]
add text here
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
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 Schunke M., Schulte E., Schumacher (2005). Anatomische atlas Prometheus: Algemene anatomie en bewegingsapparaat. Nederland: Bohn Stafleu Van Loghum
- ↑ Coole WG, Gieck JH.(1987) An analysis of hamstring strains and their rehabilitation. J Orthop Sports Phys Ther 9(3):77-85.
- ↑ 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.
- ↑ Taylor M.P., Taylor K. D. (1988). Conquering athletic injuries. Illinois: Leisure press.
- ↑ 5.0 5.1 5.2 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 Cite error: Invalid
<ref>tag; name "Bryan et al." defined multiple times with different content Cite error: Invalid<ref>tag; name "Bryan et al." defined multiple times with different content - ↑ 6.0 6.1 6.2 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.
- ↑ Starkey C and Johnson G (2006) Athletic training and sport medicine. United States of America: Jones and Barlett publishers.
