Pulled hamstring

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Pulled hamstring
2010-10-02 pulled hamstring.jpg
Two images of the same strain. One of the pictures was shot through a mirror.

Straining of the hamstring, also known as a pulled hamstring, is defined as an excessive stretch or tear of muscle fibers and related tissues. Hamstring injuries are common in athletes participating in many sports. Track and field athletes are particularly at risk, as hamstring injuries have been estimated to make up 29% of all injuries in sprinters. [1] Hamstring injuries can also come with a hip injury from sprinting. Symptoms for a hip injury are pain, aching and discomfort while running or any physical exercise.

Contents

The biceps femoris long head is at the most risk for injury, possibly due to its reduced moment of knee and hip flexion as compared to the medial hamstrings. [2]

Causes of hamstring strain

The muscle group is prone to injuries due to the explosive nature of movement in sports and thus causing overload and overstretching of the hamstring musculature.

The other causes may be:

This condition is most commonly seen in:

Diagnosis

Grades

Pulled hamstring Pulled Hamstring.png
Pulled hamstring

Grade 1

Sensation of cramp or tightness and a slight feeling of pain when the muscles are stretched or contracted.[ citation needed ]

Grade 2

With a grade two hamstring strain there is immediate pain which is more severe than the pain of a grade one injury. It is confirmed by pain on stretch, swelling and contraction of the muscle.

Grade 3

Bruising due to strained hamstring; horizontal lines show where bandage was. Torn hammie.JPG
Bruising due to strained hamstring; horizontal lines show where bandage was.

A grade three hamstring strain is a severe injury. There is an immediate burning or stabbing pain and the individual is unable to walk without pain. The muscle is completely torn and there may be a large lump of muscle tissue above a depression where the tear is.

After a few days with grade two and three injuries, a large bruise may appear below the injury site caused by the bleeding within the tissues.

Treatment

Recommended treatment for this injury consists of the RICE protocol — rest, ice, compression and elevation. [3] The RICE method is primarily used to reduce bleeding and damage within the muscle tissue. Lower grade strains can easily become worse if the hamstring is not rested properly. Complete ruptures require surgical repair and rehabilitation.

Initial treatment of the injury, regardless of the severity of the strain, is the same. Within the first five days, the hamstring is rested in an elevated position with an ice pack applied for twenty minutes every two hours. A compression bandage is applied to limit bleeding and swelling in the tissues. After five days of rest, active rehabilitation begins.

Epidemiology

An academic study found that the most common and prevalent musculoskeletal injury in the world is a hamstring strain. [4] The study further explains that hamstring strains represented 15% of all injuries per club per season also had a 34% chance of recurrence. [4] Another study showed that a previous hamstring injury is one of the most cited risks for future injury, with as many as one-third of active individuals experiencing a re-injury within 2 weeks of returning to activity. [5] A meta-analysis article showed evidence that a history of hamstring injury and being of older age were associated with increased risk of hamstring strains. [6] One study found that men and master athletes (athletes older than forty) were at an increased risk of hamstring strains compared with women and younger athletes. [7] Women were approximately 3 times more likely to develop hamstring strain than males with the majority of these being non-sporting scenarios. [8] Similarly the average age of non-sporting hamstring strains are from the ages of 40–60. [8] Many of these non-sporting injuries are sustained during road traffic accidents, slipping, and falling. [8] These results also show that hamstring strains account for 50% of muscle injuries received by sprinters and are the most common injury in hurdling. [9] One explanation is that older active individuals may be at greater risk due to lower levels of eccentric knee flexor strength compared with their younger counterparts. [7] However, it is unclear whether flexibility serves as a risk factor; this topic should be researched in the future to further understand the relationship between flexibility and risk of injury. [10] Muscle weakness has also been an implication as a predisposing factor for both primary and recurring hamstring strain injuries. [11] Over a 10-year study more than 51.3% of hamstring strains occurred during the preseason of athletics. [11] In another study, that analyzed 25 NCAA sports over four years, it was clearly shown that hamstring strain rates are higher in the preseason. [10] The factors that are being implicated in this trend are the relative deterioration and muscle weakness that occur during the off-season. [9]

The hamstrings undergo a complex dynamic process during gait, making it unsurprising that they are frequently injured. They must first contract concentrically during the end of the stance phase in order to bend the knee and allow the foot (along with dorsiflexion at the ankle) to clear the ground. At the end of the swing phase, the hamstrings must eccentrically contract while applying a braking moment to knee extension, then immediately change functions to again concentrically contract and produce hip extension. Studies have shown that "the hamstring group reaches peak elongation and acts eccentrically at the hip and knee during the late swing phases of running" [12] and that "the hamstrings are most active and develop the greatest torques at the hip and knee during the late swing through midstance phase of running." [12] Thus, the hamstrings reach their maximum length while attempting to forcefully contract eccentrically and switch functions to immediately produce a concentric contraction, which makes the terminal part of swing phase the most vulnerable for injury.

There have been many other proposed predisposing factors to injury. These include muscle weakness, muscle imbalance, poor flexibility, fatigue, inadequate warm up, poor neuromuscular control, and poor running technique. [12] One of the few predisposing factors that most researchers agree upon however is previous hamstring injury. Brokett et al. (2004) [13] stated that "the athletes most at risk of a hamstring strain are those with a previous history of such injury" and noted that 34% of the hamstring injuries were recurrences." Cameron et al. also found that 34% of injuries recur in the same season. Arnason et al. [1] generalized these numbers, saying that previous injury was in itself an independent risk factor for re-injury.

When examining sprint related activities, strengthening programs should target exercises associated with horizontal force production and high levels of hamstring activity. [14] When analyzing correlations between exercises like the Upright-hip-extension and the Nordic hamstring curl without hip flexion, a demonstration of no more than an average of 60% hamstring activation was measured. This is not sufficient enough stress that is seen in maximal sprinting. Sprint related activities like the A-Switch, A-Skip, Bounding, dribbles, etc., progressed to maximal sprinting display better physical preparation and specificity. This is conjunction with isometric variations like the hamstring iso-hold, iso-switch, iso-catch, along with the Upright-hip-extension and Nordic hamstring without hip flexion compliment as strength exercises. Typical return to play protocols for hamstring strain for sprint demands must include the sprint related activities above progressing to qualities like acceleration, late acceleration, maximum velocity, and speed endurance for effective rehabilitation and preparation for sport demands. Thus exercises like the Upright-Hip-Extension and Nordic Hamstring Curl without Hip Flexion in isolation will not adequately prepare for sport related activities.

Related Research Articles

<span class="mw-page-title-main">Running</span> Method of terrestrial locomotion allowing rapid movement on foot

Running is a method of terrestrial locomotion by which humans and other animals move rapidly on foot. Running is a gait with an aerial phase in which all feet are above the ground. This is in contrast to walking, where one foot is always in contact with the ground, the legs are kept mostly straight, and the center of gravity vaults over the stance leg or legs in an inverted pendulum fashion. A feature of a running body from the viewpoint of spring-mass mechanics is that changes in kinetic and potential energy within a stride co-occur, with energy storage accomplished by springy tendons and passive muscle elasticity. The term "running" can refer to a variety of speeds ranging from jogging to sprinting.

<span class="mw-page-title-main">Human leg</span> Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The leg is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or buttock region. The major bones of the leg are the femur, tibia, and adjacent fibula. The thigh is between the hip and knee, while the calf (rear) and shin (front) are between the knee and foot.

<span class="mw-page-title-main">Sports injury</span> Physical and emotional trauma

Sports injuries are injuries that occur during sport, athletic activities, or exercising. In the United States, there are approximately 30 million teenagers and children who participate in some form of organized sport. Of those, about three million athletes age 14 years and under experience a sports injury annually. According to a study performed at Stanford University, 21 percent of the injuries observed in elite college athletes caused the athlete to miss at least one day of sport, and approximately 77 percent of these injuries involved the knee, lower leg, ankle, or foot. In addition to those sport injuries, the leading cause of death related to sports injuries is traumatic head or neck occurrences.

<span class="mw-page-title-main">Hamstring</span> Any of the three muscles in the thigh

In human anatomy, a hamstring is any one of the three posterior thigh muscles between the hip and the knee.

<span class="mw-page-title-main">Thigh</span> The part of the body between the pelvis and the knee; upper leg

In anatomy, the thigh is the area between the hip (pelvis) and the knee. Anatomically, it is part of the lower limb.

<span class="mw-page-title-main">Anterior cruciate ligament</span> Type of cruciate ligament in the human knee

The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee. The two ligaments are also called "cruciform" ligaments, as they are arranged in a crossed formation. In the quadruped stifle joint, based on its anatomical position, it is also referred to as the cranial cruciate ligament. The term cruciate translates to cross. This name is fitting because the ACL crosses the posterior cruciate ligament to form an "X". It is composed of strong, fibrous material and assists in controlling excessive motion. This is done by limiting mobility of the joint. The anterior cruciate ligament is one of the four main ligaments of the knee, providing 85% of the restraining force to anterior tibial displacement at 30 and 90° of knee flexion. The ACL is the most injured ligament of the four located in the knee.

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Plyometrics, also known as jump training or plyos, are exercises in which muscles exert maximum force in short intervals of time, with the goal of increasing power (speed-strength). This training focuses on learning to move from a muscle extension to a contraction in a rapid or "explosive" manner, such as in specialized repeated jumping. Plyometrics are primarily used by athletes, especially martial artists, sprinters and high jumpers, to improve performance, and are used in the fitness field to a much lesser degree.

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Patellar tendinitis, also known as jumper's knee, is an overuse injury of the tendon that straightens the knee. Symptoms include pain in the front of the knee. Typically the pain and tenderness is at the lower part of the kneecap, though the upper part may also be affected. Generally there is no pain when the person is at rest. Complications may include patellar tendon rupture.

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<span class="mw-page-title-main">Snapping hip syndrome</span> Medical condition

Snapping hip syndrome, also referred to as dancer's hip, is a medical condition characterized by a snapping sensation felt when the hip is flexed and extended. This may be accompanied by a snapping or popping noise and pain or discomfort. Pain often decreases with rest and diminished activity. Snapping hip syndrome is commonly classified by the location of the snapping as either extra-articular or intra-articular.

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Weighted clothing are garments that have heavy materials incorporated into them, to add weight to various parts of the body, usually as part of resistance training. The effect is achieved through attaching weighted pieces to the body which leave the hands free to grasp objects. Unlike with held weights or machines, weighted clothing can leave users more able to do a variety of movements and manual labour. In some cases certain weighted clothing can be worn under normal clothing, to disguise its use to allow exercise in casual environments.

<span class="mw-page-title-main">Anterior cruciate ligament injury</span> Ligament injury near the knee

An anterior cruciate ligament injury occurs when the anterior cruciate ligament (ACL) is either stretched, partially torn, or completely torn. The most common injury is a complete tear. Symptoms include pain, an audible cracking sound during injury, instability of the knee, and joint swelling. Swelling generally appears within a couple of hours. In approximately 50% of cases, other structures of the knee such as surrounding ligaments, cartilage, or meniscus are damaged.

<span class="mw-page-title-main">Golfer's elbow</span> Tendon inflammation disease of the elbow

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<span class="mw-page-title-main">Meniscus tear</span> Rupturing of the fibrocartilage strips in the knee called menisci

A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged 'wear and tear'. Especially acute injuries can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the joint. The joint will be in pain when in use, but when there is no load, the pain goes away.

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References

  1. 1 2 Arnason A, Andersen TE, Holme I, Engebretsen L, Bahr R (2008). "Prevention of hamstring strains in elite soccer: an intervention study". Scand J Med Sci Sports. 18 (1): 40–8. doi: 10.1111/j.1600-0838.2006.00634.x . PMID   17355322. S2CID   23545542.
  2. ↑ Carlson C (2008). "The natural history and management of hamstring injuries". Curr Rev Musculoskelet Med. 1 (2): 120–3. doi:10.1007/s12178-007-9018-8. PMC   2684206 . PMID   19468884.
  3. ↑ "Marshall University Orthopaedics". Archived from the original on 2008-02-03. Retrieved 2008-01-08.
  4. 1 2 Orchard, J., & Seward, H. (2002, February). Epidemiology of injuries in the Australian Football League, seasons 1997-2000. British Journal of Sports Medicine, 36(1), 39-45.
  5. ↑ Sherry, M. A., Johnston, T. S., & Heiderscheit, B. C. (2015, April). Rehabilitation of Acute Hamstring Strain Injuries. Clinics in Sports Medicine, 34(2), 263-284.
  6. ↑ Freckleton, G., & Pizzari, T. (2013, April). Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis. British Journal of Sports Medicine, 47(6), 351-358.
  7. 1 2 Opar, D. A., Drezner, J., Williams, M., Webner, D., Sennett, B., Kapur, R., Cronholm, P.F.(2014). Acute hamstring strain injury in track-and-field athletes: A 3-year observational study at the Penn Relay Carnival. Scandinavian Journal of Medicine & Science in Sports, 254-259.
  8. 1 2 3 Kuske, Barbara; Hamilton, David F.; Pattle, Sam B.; Simpson, A. Hamish R. W. (2016-05-04). "Patterns of Hamstring Muscle Tears in the General Population: A Systematic Review". PLOS ONE. 11 (5): e0152855. Bibcode:2016PLoSO..1152855K. doi: 10.1371/journal.pone.0152855 . ISSN   1932-6203. PMC   4856270 . PMID   27144648.
  9. 1 2 Ahmad, C.S., Redler, L.H., Ciccotti, M.G., Maffulli, N., Longo, U.G., & Bradley, J. (2013, December). Evaluation and Management of Hamstring Injuries. The American Journal of Sports Medicine, 41(12), 2933-2947.
  10. 1 2 Dalton, S. L., Kerr, Z.Y., & Dompier, T.P.(2015). Epidemiology of Hamstring Strains in 25 NCAA Sports in the 2009-2010 to 2013-2014 Academic Years. American Journal of Sports Medicine, 43(11), 2671-2679.
  11. 1 2 Kuske B, Hamilton DF, Pattle SB, Simpson AHRW (2016) Patterns of Hamstring Muscle Tears in the General Population: A Systematic Review. PLoS ONE 11(5):e0152855.doi:10.1371/journal.pone.0152855
  12. 1 2 3 Cameron, M.; Adams, R.; Maher, C. (2003). "Motor control and strength as predictors of hamstring injury in elite players of Australian football" (PDF). Physical Therapy in Sport. 4 (4): 159–166. doi:10.1016/s1466-853x(03)00053-1. Archived from the original (PDF) on 2014-03-19. Retrieved 2014-03-18.
  13. ↑ Brockett CL, Morgan DL, Proske U (2004). "Predicting hamstring strain injury in elite athletes". Med Sci Sports Exerc. 36 (3): 379–87. doi: 10.1249/01.mss.0000117165.75832.05 . PMID   15076778.
  14. ↑ Prince, Caroline; Morin, Jean-Benoît; Mendiguchia, Jurdan; Lahti, Johan; Guex, Kenny; Edouard, Pascal; Samozino, Pierre (2020). "Sprint Specificity of Isolated Hamstring-Strengthening Exercises in Terms of Muscle Activity and Force Production". Frontiers in Sports and Active Living. 2: 609636. doi: 10.3389/fspor.2020.609636 . ISSN   2624-9367. PMC   7859261 . PMID   33554110.
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