HamstringinjuriesHAMSTRING INJURIES R.L.Morgan-Jones, T.Cross, M.J.Cross
ABSTRACT Hamstring injuries are common and have a significant impact on athletic performance.Hamstring tightness is a contributing factor in pathological conditions of the knee and spine in non-athletic individuals.This article discusses the anatomy, physiology and pathology of hamstring injuries and related conditions.We also identify the injury patterns that respond to conservative therapy and those which require surgical The Hamstring muscle group consists of the Biceps Femoris, Semimembranosus and the Semitendinosus (1).The hamstrings form the bulk of the posterior femoral muscles.
One of their major characteristics is that they cross two major joints, the hip and the knee.The hamstring muscles are the major flexors of the knee and also aid hip extension.They are supplied by the Sciatic nerve (L5, S1,2) and branches of the circumflex vessels of the Femoral artery.
PHYSIOLOGY The amplitude of a muscle is the change in length from its state of full contraction to full stretch.Physiologically full stretch occurs in the hamstrings group only if the knee is fully extended with the hip fully flexed.Complete contraction occurs when the knee is fully flexed and the hip fully extended.Complete contraction and stretching rarely occur in normal daily activity and the hamstrings are therefore rarely put through their full physiological amplitude.This is a common phenomenon with two joint muscles.
For this reason two joint muscles are the ones most commonly injured in sport during acute stretching.Biomechanically the synchronisation between two joints is a complicated proprioceptive and mechanical problem.This is complicated further when muscle units cross both joints.Muscles, which have not been trained to employ their full amplitude, may fail when required to pass through their full amplitude under rapid and stressful situations.This results in varying degrees of muscle damage.Specific stretching programs are needed on a daily basis in all athletes in order to prevent injury.
Study of injury patterns helps us understand how the muscle unit fails under stress.
This is best seen in the severest injury, complete hamstring avulsion from the ischium.This commonly occurs when water-skiing.As the boat pulls forward and the ski tips get caught there is a sudden hyperflexion of the hip with the knee fully extended.Severe pain and often a tearing feeling are experienced as the muscles rupture completely at their proximal end.CONDITIONS ASSOCIATED WITH HAMSTRING TIGHTNESS Hamstring tightness, the inability to stretch the muscle through its full range of amplitude, Adolescents with bilateral anterior knee pain often have hamstring tightness.Bone growth particularly during the pubescent growth spurt often occurs more rapidly than muscle growth
.This produces relative hamstring tightness, which results in a flexion moment about the knee and thus excessive patello-femoral forces.The patho-mechanics are equivalent to walking on flexed knees and this in time will produce pain.Stretching of the hamstrings will help reduce the pain in most circumstances.Pathologically tight hamstrings are found in Cerebral Palsy, which can lead to flexion contracture of the knee (1).
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Concomitant Quadriceps spasticity can cause patella tendon lengthening producing gross patella alta.However in this group of patients the low demand placed on the knees avoids major symptoms of patella pain and instability.
Hamstring tightness has been documented in 75% of all cases of Scheurmanns disease.Excessive hip flexion forces decreasing lumbar lordosis and leading to increasing thoracic flexion (1).This increases the anterior forces on the discs producing mechanical and pathological changes.
Similar muscle imbalance can aggravate vertebral disc degeneration in the older population.
It is therefore important to check for hamstring tightness in all patients with back pain.MECHANISM OF HAMSTRING MUSCLE INJURY The synchronous flexion and extension of the lower limb joints propels the athlete forwards.Trunk rotation and upper limb movement aid this process.
The coordination of this complex activity has many influences including genetic, neurological, visual, auditory, proprioceptive and mechanical factors.Training through repetitive actions aids If a two-joint muscle is stretched in an un-coordinated manner it may exceed its physiologic amplitude and tear.The severity of the muscle tear is dependent on the force applied.Hamstring strain result from small forces producing tears of the muscle fibre bundles.
These can be treated by ice and early mobilisation.More severe forces will tear large muscle bundles and disrupt vessels causing intramuscular haemorrhage.These tears result in residual scar tissue within muscle, which act as stress risers, and may precipitate recurrent injury.Muscle tightness through inadequate warming up, or training, can aggravate injury as the muscle lacks the necessary flexibility.
Major forces are rare but can result in complete muscle rupture or tendon avulsion.
Such forces can occur however in water-skiing and competitive sprinting injuries.
Hamstring RehabilitationTreatment includes prevention and therapy.Early recognition and immediate treatment help the outcome.Ice therapy is required to prevent swelling and decrease haemorrhage.
Graduated stretching and exercise, depending on the degree of injury, follow initial rest.Excessive early stretching and exercise of large intramuscular tears is not recommended as there is a risk of further haematoma formation which may calcify leading to Myositis Ossificans.The effects of warming-up, muscle temperature and stretching all have beneficial effects on the mechanical properties of muscle potentially reducing the risk of strain injury.Factors protecting muscle such as strength, endurance and fle
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