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Hamstring Injuries Explained
Hamstring injuries are classified for ease of diagnosis and treatment into various grades of severity. The least serious injury with a number of damaged muscle fibres is a grade 1 injury, rated as a mild muscle strain. More serious involves a larger number of muscle fibres being damaged and a reduction of muscle strength which is obvious on testing and this is a grade 2 injury. In the most serious or grade 3 injury there is a rupture right through the substance of the tendon and muscle. Most injuries are located at the muscle and tendon junction and high up near the buttock, although the biceps femoris has a very long junction, most of its length. The ischial tuberosity (the bones we sit on or the "bones in the buttock") is the originating point for most of the hamstring tendons. An avulsion fracture may occur at this point where a sudden, large range of motion occurs without warning and pulls off the tendon from the bony connection, an affliction most commonly seen in people who water ski. Younger people have larger numbers of such injuries as they are more active in sport and participating in risky activities such as contact sports, field sports, sprinting, rugby and football. Starting at the ischial tuberosity insertion in the buttock, the hamstrings course down the posterior thigh and insert into the upper areas of the shin bone. If the hamstrings are loaded at the same time as they are lengthening (so called eccentric contraction), often occurring in rugby and running events, the risk of injury can be high. Contusions to the muscles can occur from direct blows while if a water skier falls forward suddenly with a straight knee then the hamstring origin can be damaged by avulsion. When a hamstring injury occurs, the patient often reports a clearly audible pop of the muscle and the onset is sudden. When an injury occurs the patient reports an immediate pain in the back of the upper leg with the event occurring either when the patient has got tired late on in the activity or before they got warmed up in the beginning. In less severe injuries there might be minor interruptions in functional activities such as pain on going uphill or climbing stairs. Physiotherapy examination of the back of the leg will often reveal little but resisted knee flexion is often painful, where the physiotherapist pushes against the ankle as the knee is bending. An increase in the risk of suffering from a hamstring injury is thought to occur if the quadriceps and hamstring strength ratios are incorrect, the person is tired, there is a poor warm up or a limitation of flexibility. A previous history of hamstring injury is a significant risk of having a recurrent strain. The approach to treatment of the injury is dictated by the severity of the muscle and tendinous damage and a physiotherapist will progress someone with a minor strain quickly onto strength training from range of movement work while more serious injuries may even need surgery. The first aims of physiotherapy for an injury of a moderate level would be to limit the degree of local swelling and reduce the pain and inflammation from the soft tissue damage. Physios use the PRICE principles in these cases: Protection of the damaged tissues to prevent further damaging stresses being applied; Rest from normal activity and sport to allow the healing process to proceed; Ice in 20 minute bursts to control inflammation and pain; Compression over the damaged area with elastic wraps; Elevation of the part is not simple due to its location and that the patient wants to keep their knee bent. Article Directory: http://www.articledashboard.com Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Sheffield Physiotherapist visit his website. |
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