The hamstrings are a muscle group which are situated at the back of the thighs and are commonly involved in injury from vigorous activities and sports. Hamstring injuries are more commonly involved in areas of the muscle which are closer to the buttock and on the outside of the back of the thigh. There are three muscles in the hamstring group and they do not have common names, being termed semimembranosus, semitendinosus and biceps femoris. The latter is the muscle most commonly involved in typical sporting injuries.
Injuries to the hamstring muscle group is classified by using grades of severity: grade one being a mild muscle strain with a number of torn muscle fibres, grade two is rated as a moderate strain with a noticeable loss of muscle strength and grade three is a complete tear of a muscle. The most common position for injuries to occur is where the muscle and tendon join on the upper part of the muscles near the buttock, although in the biceps femoris the muscle-tendon junction occurs over a significant length. The tendons themselves do not usually get injured within their own structure unless there is some already existing pathology.
The origin of the hamstring tendons is the bones in the buttock which we sit on, known formally as the ischial tuberosities. The tendons are attached to this bony area and a violent movement into hip bend with a large overall movement range can avulse (tear off) the tendon's junction from its bony bed. Water skiing is a risky activity for this problem. Most hamstring injuries occur in younger people who overwhelmingly perform athletic activities, with typical sports for this injury being field sports, contact sports, track activities such as sprinting, football or rugby.
The hamstrings start at the ischial tuberosity in the buttock, run down the back of the thigh and insert into varying places on the tibia or fibula. When these muscles are contracting and lengthening at the same time (eccentric contraction) such as in track events and rugby, there can be a high risk of injury. Direct muscle blows can result in contusions to the tissues while water skiers are more prone to avulsion injuries as they fall because they undergo rapid hip flexion with their knees straight. Onset of a hamstring strain is typically sudden and often when the person is moving quickly, with an audible pop in the muscle often reported
Immediate pain is noticed in the posterior thigh area and people may be vulnerable early in the process before they are warmed up or later on when they may be becoming tired. If the damage is not severe then function can be preserved although with pain such as on stair climbing or walking up a hill. Examination of the back of the thigh may reveal little but it may well be painful if the patient is asked to bend their knee and the physiotherapist resists the movement. Rupture of one of the hamstrings may show by it balling up on contraction along with reduced strength on assessment.
The likelihood of suffering from an injury to the hamstring is thought to be related to factors such as tiredness, inadequate warm up, flexibility restrictions or if the strength ratio between the hamstrings and the quadriceps is incorrect. Having previously incurred a hamstring injury is enough to raise the risk of having another one. How an injury will be treated depends entirely on its severity with one end of the spectrum seeing the physio progress the patient speedily on to strength work and at the other end of the spectrum some injuries require the intervention of a surgeon.
Physiotherapy for a moderate level injury initially addresses the reduction of local swelling and inflammation and control of the pain which is often significant. The physio will use the PRICE guidelines for treatment: Protection of the injured tissues is vital at first which can include crutch use or braces; Rest is essential to a degree to allow tissue healing to proceed; Ice application for up to 20 minutes reduces pain and inflammation; Compression can be effected by wrapping elasticated bandages around the limb; Elevation is not simple due to the area of the damage and that the patient may prefer a bent knee.
Injuries to the hamstring muscle group is classified by using grades of severity: grade one being a mild muscle strain with a number of torn muscle fibres, grade two is rated as a moderate strain with a noticeable loss of muscle strength and grade three is a complete tear of a muscle. The most common position for injuries to occur is where the muscle and tendon join on the upper part of the muscles near the buttock, although in the biceps femoris the muscle-tendon junction occurs over a significant length. The tendons themselves do not usually get injured within their own structure unless there is some already existing pathology.
The origin of the hamstring tendons is the bones in the buttock which we sit on, known formally as the ischial tuberosities. The tendons are attached to this bony area and a violent movement into hip bend with a large overall movement range can avulse (tear off) the tendon's junction from its bony bed. Water skiing is a risky activity for this problem. Most hamstring injuries occur in younger people who overwhelmingly perform athletic activities, with typical sports for this injury being field sports, contact sports, track activities such as sprinting, football or rugby.
The hamstrings start at the ischial tuberosity in the buttock, run down the back of the thigh and insert into varying places on the tibia or fibula. When these muscles are contracting and lengthening at the same time (eccentric contraction) such as in track events and rugby, there can be a high risk of injury. Direct muscle blows can result in contusions to the tissues while water skiers are more prone to avulsion injuries as they fall because they undergo rapid hip flexion with their knees straight. Onset of a hamstring strain is typically sudden and often when the person is moving quickly, with an audible pop in the muscle often reported
Immediate pain is noticed in the posterior thigh area and people may be vulnerable early in the process before they are warmed up or later on when they may be becoming tired. If the damage is not severe then function can be preserved although with pain such as on stair climbing or walking up a hill. Examination of the back of the thigh may reveal little but it may well be painful if the patient is asked to bend their knee and the physiotherapist resists the movement. Rupture of one of the hamstrings may show by it balling up on contraction along with reduced strength on assessment.
The likelihood of suffering from an injury to the hamstring is thought to be related to factors such as tiredness, inadequate warm up, flexibility restrictions or if the strength ratio between the hamstrings and the quadriceps is incorrect. Having previously incurred a hamstring injury is enough to raise the risk of having another one. How an injury will be treated depends entirely on its severity with one end of the spectrum seeing the physio progress the patient speedily on to strength work and at the other end of the spectrum some injuries require the intervention of a surgeon.
Physiotherapy for a moderate level injury initially addresses the reduction of local swelling and inflammation and control of the pain which is often significant. The physio will use the PRICE guidelines for treatment: Protection of the injured tissues is vital at first which can include crutch use or braces; Rest is essential to a degree to allow tissue healing to proceed; Ice application for up to 20 minutes reduces pain and inflammation; Compression can be effected by wrapping elasticated bandages around the limb; Elevation is not simple due to the area of the damage and that the patient may prefer a bent knee.
