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Hamstring Injuries

Young women sport has thigh muscles injury ,Health conceptDr. Stickney, a Kirkland orthopedic surgeon, is an expert in sports medicinehamstring injuriesexercise and health, and more.

Hamstring injuries are a common, and often frustratingly persistent, source of limitation for both elite athletes and weekend warriors. These injuries can involve either the muscle belly or the tendinous attachment of the muscle to bone. The hamstring is one of the longest muscle bellies in the body as it stretches from the pelvis to the tibia spanning the hip and the knee. Hamstring tears, knee muscle tears and related injuries make up nearly 30% of all lower extremity muscle tendon injuries. These injuries are commonly sustained while running particularly with running uphill. They are very common in soccer, football and all sports associated with acceleration or kicking. Hamstring injuries also are common in weightlifting, skating, or water-skiing. This can be the result of a rapid uncontrolled Hip Flexion with knee extension. If the injury is associated with a loud pop that often signifies a tendon avulsion. In that case, the tendon has pulled off of bone. On the other hand, if there is acute muscular tearing pain followed by bruising and a palpable defect in the muscle, this typically signifies an intermuscular tear. Injuries that do not adequately heal or get adequate therapy can result in scar tissue which is prone to reinjure.  Hamstring injuries have a very high rate of recurrence as a result.

    The hamstring muscles in the posterior thigh, as well as the quadriceps muscle in the anterior thigh, work in concert during running jumping, acceleration, and deceleration. A muscular balance between these 2 muscles as well as flexibility of both muscles is crucial to preventing injuries. Core muscle development and hip muscle strengthening can also help prevent hamstring injuries. Hamstring injuries more commonly occur during eccentric contraction. Eccentric contraction means the muscle is firing but at the same time it is lengthening. During running the quadriceps extends the knee as your foot reaches forward near the end of that extension the hamstring slows down the extension while the foot is still moving forward just before impact. This is an eccentric contraction of the hamstring and this is the phase of running most commonly associated with hamstring injuries. These are typically intermuscular injuries. These commonly lead to bleeding into the muscle and then the development of scar tissue in the muscle which is less flexible than muscle, and more vulnerable to tearing in the future. As a result, an athlete with a hamstring injury has a 25% rate of recurrence of hamstring injury in the following season despite rehabilitation.

     A very good study was done in professional soccer players to try and prevent initial hamstring injuries and to prevent recurrence of hamstring injuries. The results of that study is the Nordic hamstring exercise protocol. In professional athletes, this protocol led to an 80% reduction in primary hamstring injuries and a 65% reduction in recurrent injuries. The Nordic protocol is a progressive strengthening of the hamstrings through eccentric loading. This protocol is best visualized on a YouTube video.

     Once a hamstring injury occurs it is very important to establish whether or not the tendon has pulled off bone or if it is an intermuscular injury. If the tendon has pulled off bone it is important to repair it in the early period after injury. On the other hand, most intermuscular injuries require rest, elevation, icing, compression (RICE) and then range of motion with deep massage. There have been a few studies to suggest that injection of platelet rich plasma with growth factors can enhance healing.  And some other studies suggested injection of steroids may decrease the likelihood of developing scar tissue. The time to recovery is largely dependent on the location and extent of injury. Most minor hamstring injuries can be treated with physical therapy and return to sport in approximately 6-12 weeks. It is very important to regain full flexibility and equal strength before returning to competitive sports to prevent future recurrent injuries.

Hamstring Injuries: Risks, Treatment, and Rehab

hamstringDr. Stickney, a Kirkland orthopedic surgeon, is a sports medicine expert specializing in hamstring injuries, pitching shoulder injuries, Swiftpath knee surgery, and more.

Hamstring injuries are common among individuals with a hamstring injury risk–those living an active lifestyle, especially for athletes in sports that involve high speed running or kicking. Sports like track-and-field, soccer, dancing, football, long-distance running, and water-skiing all have a heightened risk for hamstring issues. Erratic contraction of the hamstrings while running at high speeds, quick-burst movements, and sudden trauma are believed to cause these injuries.

Three muscles make up the hamstring (semitendinosus, semimembranosus, biceps femoris), starting from the bottom of the pelvis (ischial tuberosity) down to the knee joint where the muscles connect with tendons to attach to the bones. Your hamstrings allow you to bend your knee and help with hip extension, though this is primarily done by the gluteus Maximus.

There are two prominent types of hamstring injuries – tears to the muscle belly (the thick part of the muscle or where muscle fibers join tendon fibers) and acute avulsions to the tendon (when the tendon completely tears away from the bone). The sciatic nerve running from the lower back down the back of the legs may also be compromised during hamstring trauma, due to its proximity.

Injuries arising from a single abrupt trauma rather than from smaller cumulative injuries tend to be more serious and affect younger patients (age < 25). However, with increasing age the likelihood of injury increases. The risk factors associated with this injury include, the type of sport, poor flexibility, asymmetric strength, and above all prior injury.

With so many variables to consider, how do you prevent hamstring injuries? What are the most important risks to be aware of, how should you treat a hamstring injury, and what is the best way to recover?

A review titled “Hamstring Injuries – Risk Factors, Treatment, and Rehabilitation” published by the Journal of Bone and Joint Surgery evaluated 9 different contemporary studies exploring predictive factors, diagnosis strategies, treatment methods, and recovery techniques for hamstring injuries. The studies involved varying sample sizes and methodologies tailored to their respective topics.

The findings:

  • The most predictive factor for a hamstring injury is any previous hamstring injury including sprains, tears, and avulsions. When a patient has a history of hamstring injuries, they’re also likely to have a longer recovery time – especially recreational athletes compared to professionals. The importance of early intervention cannot be overstated; one of the major reasons rec athlete’s recovery time is longer than the pros is because they prolong their first consultation and treatment. If you may have experienced hamstring injury, contact a sports medicine expert
  • MRI (magnetic resonance imaging) edges out ultrasound as the best means of evaluating the extent of a hamstring injury and whether surgical intervention is warranted.
  • Muscle belly tears are often better treated with conservative treatment, whereas hamstring avulsions may be better treated with surgery depending on the displacement of the tendon.
  • Conservative treatments such as RICE (rest, ice, compression, elevation), nonsteroidal injections (anti-inflammatory drugs), physical therapy, stretching, PRP (Platelet Rich Plasma) injections, and corticosteroid injections are indicated for acute hamstring strains, partial tears, and single-tendon avulsions. PRP injections combined with rehab exercises for hamstring injury, like physical therapy, is more effective than rehab exercises alone.
  • Surgical repair of complete proximal hamstring ruptures, both acute and chronic, results in improved postoperative outcomes compared with nonoperative management.
  • Repair of acute proximal hamstring tendon tears results in better functional outcomes than repair of chronic tears. Again, how long a hamstring injury takes to heal and the effectiveness of recovery depends on early intervention and careful rehabilitation.
  • Stretching and strengthening the hamstring tendons with eccentric exercise is helpful in conjunction with physical therapy after injury. Strengthening, Stretching, control of early inflammation, and massage of scar tissue all may reduce the risk of re-injury, or may prevent hamstring injuries altogether.

Having a better understanding of hamstring injuries allows clinicians to provide better treatment and patients to manage their injury most effectively. If you have questions regarding hamstring injuries or would like to schedule an appointment, contact our sports injury clinic.

Common Weightlifting Injuries

Weight training is a sport as well as part of someone’s exercise regimen.  Experienced weightlifters rarely suffer serious injuries but newcomers to the sport or exercise are more prone to musculoskeletal injuries.

Distal biceps rupture:

This is a rupture of the biceps tendon that attaches the biceps muscle in the arm to a bone of the upper forearm. A weightlifter can rupture this tendon at the elbow with a sudden force that extends the elbow while trying to contract the biceps. Performing a biceps curl and then losing control of the weight is an example. Surgery to reattach the tendon is usually needed. Less traumatic and sometimes requiring surgical repair, a biceps tendon tear can also occur. Choosing weights one can reasonably lift and fully control can help prevent a distal biceps rupture. 

Labral tear:

The labrum is a cartilage bumper in the shoulder that surrounds the glenoid (socket). With repetitive compression of the labrum or possibly an acute motion that injures the shoulder, the weightlifter can feel discomfort or a clicking sensation deep within the shoulder. An orthopedic surgeon can perform a physical exam and tests that suggest a labral tear. An MRI with contrast injected (MR arthrogram) can demonstrate a tear. Surgery is often required to treat a shoulder labral tear if it limits activity. Proper technique and having shoulder pain evaluated early if it is not improving can be helpful.

Shoulder impingement:

This is more of a cause of chronic shoulder pain in a weightlifter rather than an acute injury. Avoiding exercises that cause pain can help the problem. Working with a physical therapist to improve shoulder mechanics and strengthen the muscles around the shoulder can often speed recovery. Seeing an orthopedic surgeon or a physical therapist when this problem develops and starting a treatment program can often accelerate return to overhead lifting.

Lower back muscle strain:

A strain of the muscles of the lumbar spine can occur from using improper technique with exercises or picking up or putting down weights awkwardly. Fortunately most don’t require more aggressive treatment than rest and activity modification. Proper lifting technique is key. 

Quadriceps or hamstring muscle strain:

Acute strains of the quadriceps and hamstring muscles from squats, leg presses, lunges and other lower extremity exercises can occur. Most heal without surgery and require only rest and short-term exercise modification. Beyond strains, hamstring tears can happen, which is why proper exercise techniques and choosing an appropriate amount of weight can help prevent injuries.

Patellar or quadriceps tendonitis:

These are also more chronic issues with the tendons around the knee than acute injuries. Pain in the tendons above or below the kneecap with lower extremity exercises can develop and worsen over time. Often short-term avoidance of exercises that reproduce the pain, anti-inflammatory medication, and ice can resolve the problem.

In addition to the above mishaps are knee injuries, including  knee bursitis, knee tendinitis, and knee muscle tears. Many of the injuries listed here can be prevented by using proper technique. Often simply rest and short-term activity modification can prevent a minor pain from turning into a more serious injury.

If any musculoskeletal pain continues to limit your ability to work out the way you want, consider visiting Dr. Stickney to learn and understand possible treatments by calling 425-823-400 to schedule an appointment or email him at ProOrthoAppointment@proliancesurgeons.com.