The hamstring muscles are muscles that run along the back of the thigh from the hip to below the knee. These muscles are commonly injured in sports that involve sprinting. I frequently see hamstring strains most commonly in soccer players. The athletes often say that the hamstring injury occurred when they were at rest and started sprinting suddenly. Injury prevention tips.
Mechanism of injury
These injuries are usually fairly painful, and they significantly limit the athlete’s ability to continue playing. In my experience, if the athlete feels a very sharp pain immediately or feels or hears a pop, these are signs of severe injuries. Due to the fact that the muscle runs from the hip to below the knee, the injury can occur anywhere along this course.
Tests for a hamstring injury
In the training room or the office, physical examination of the injury can be very helpful. The athlete will usually have point tenderness at the site of the injury. It’s common to see a large amount of bruising along the back of the thigh and a fair amount of swelling. As you would expect due to an injury to a muscle, attempts to test the strength of that muscle – in this case having the athlete flex his knee against resistance – can demonstrate weakness.
Usually x-rays don’t show any significant findings. I will sometimes order x-rays if most of the pain is located at the ischial tuberosity (the bony prominence on the buttock where you sit). If the athlete pulled the tendon off the ischial tuberosity, an x-ray might show a piece of bone pulled off this area. This bony avulsion can indicate the need for surgery to reattach the tendon. Sometimes I will order an MRI to evaluate this injury further. While the diagnosis of a hamstring strain can be simple, MRI can indicate the severity of the injury and help estimate the length of time it will take to get the athlete back to sports.
Treatment of a hamstring injury
Most of these injuries fortunately do not require surgery. Typically the only hamstring injury that requires surgery is one in which the tendon is pulled off the ischial tuberosity at the hip. Initially rest and avoiding activity are the first-line treatments. Ice to the back of the thigh can help decrease swelling and bruising. Avoiding stress to these muscles can help the muscle fibers heal more quickly. When the athlete feels more comfortable with daily activities and basic motion of the hip and knee, I usually add advocate that the athlete works with a physical therapist for strengthening and motion exercises. When these exercises become more comfortable, we will allow the athlete to progress to conditioning exercises, such as jogging, before trying sport-specific exercises.
Return to sports
It can be difficult to predict how long it will take an athlete to return to sports. One of the risks of pushing an athlete too hard to get back is the risk of reinjury. It’s thought that once an athlete suffers a hamstring strain, especially if it has not fully recovered, he is much more likely to reinjure the hamstring again. Frequent examination by the sports medicine physician and regular work with the sports physical therapist can help get the athlete back to sports as quickly as possible.
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