a couple of questions that i asked myself: what can i do better to prevent hamstring strains what...

A couple of Questions that I asked myself: What can I do better to prevent hamstring

strains What can I do better or different to prevent

a recurrence ?

Ins and Outs of the Hamstring

Goals of this Talk Anatomy of the Muscles Research of Hamstring Injuries. Intrinsic/Extrinsic factors of Hamstring

Injuries. Hamstring healing phase’s Hamstring Rehabilitation


Biceps Femoris Muscle - Short Head:Origin: Distal linea aspera and lateral supracondylar ridge of femur

Insertion: Head of fibula and lateral condyle of tibia

Actions on the legFlexes the leg at the knee: laterally rotates leg when the knee is flexed.

Biceps Femoris Muscle - Long head:Origin: Ischial tuberosity of os coxa

Insertion: Head of the fibula and lateral condyle of tibia.Actions: on the thigh: Extends the thigh at the hip ( it also flexes leg at knee and laterally rotates leg if knee is flexed )



Semitendinosus Origin: It arises from the lower and medial impression on the tuberosity of the ischium,

Insertion: into the upper part of the medial surface of the body of the tibia, nearly as far forward as its anterior crest.

Action: Flexes and medially rotates the knee joint.Extends and assists in medial rotation of the hip joint


SemimembranosusOrigin: is the ischial tuberosity

Insertion: medial condyle and nearby margin of tibia; intercondylar line and lateral condyle of femur; and the ligament of popliteal region.

Action: Flexes and medially rotate the knee joint. Extends and assist in medial rotation of the hip joint.

Marc A. Sherry, DPT, CSCS,1 Thomas M. Best, MD, Amy Silder, PhD Darryl G. Thelen, PhD,and Bryan C. Heiderscheit, PhD.

MECHANISM OF HAMSTRING INJURY Most hamstring strain injuries happen while running. In the terminal swing phase of the gait cycle. During the second half of the swing, the hamstrings

undergo an eccentric contraction and absorb energy from the swing limb before foot contact.

Thus, the hamstrings are stretched while subjected to load(eccentric contraction), with the biceps femoris incurring the greatest amount.


A historical perspective. 1902- first mention of muscle injuries 1906- management of muscle tears conservative

immobilization, cool water. 1930- first research increased interest in understanding the

histopathology . 1936- RTP to soon was discovered at this time 1950-1960 Cortizone injections were popular


1954- till present practice and principle of tx“…treatment must be designed to minimize the haemorrhage and inflammatory reaction so that there will be as little granulation (scar) tissue formed as possible…” Delarue NC

1960 -introduction NSAID 1970-1980 introduction physiotherapy Last 20 years seen explosion of research understanding of

epidemiology, etiology, pathophysiology


Research into Hamstring Injuries. Lot of research is done in conjunction with ACL

reconstructions. Some research has pointed to how many hamstring injuries

will cost a team in lost time. Some research has tried to look at intrinsic and extrinsic

factors.


Feeley at all reported that Muscle strains account for 46% of practice injuries Hamstring strains were the second most common preseason

injury 1.79 per 1000 athletes exposures for practices 4.07 per 1000 athletes exposures for games


Marcus C. C W. Elliot MD, Bertram Zarins, John Powell, Phd, ATC, Charles D Kenyon

10 year review Professional NFL players This study was done from 1989-1998 10 years 1716 hamstring strains 1129 different athletes. Mean of totally lost days was 2222 in the 10 years. About 47.3 % was during games About 52.7 % was during practice preseason most 16.5 % of re-injuries practices/22% during games Offensive more injuries than defense. Wide

recievers/runningbacks Secondary has the highest rate of injury.


Ekstrand J, Hägglund M, Waldén M 51 football teams, 2299 players, were followed during the

years 2001 to 2009. 2908 muscle injuries were registered. 92% of all muscle injuries affected the 4 major muscle groups

of the lower limbs: hamstrings (37%), adductors (23%), quadriceps (19%), and

calf muscles (13%). 16% of the muscle injuries were re-injuries. Re-injuries caused significantly longer absences than did first

time The incidence of muscle injury increased with age. When separated into different muscle groups, however, an

increased incidence with age was found only for calf muscle injuries


What can we conclude from this research Hamstring strain cost a lot of time of the

field . Hamstring strains have a high recurrent rate. Hamstring strains cost a team valuable

assets that are not able to perform.

Is there anything we can do? Some research on intrinsic/extrinsic factors


Burkett Lee 1970 Causative Factor in hamstring strains. 12 hamstring strain subjects/18 track athletes 32 football athletes/ 6 were predicted to strain hamstring Strength imbalance between knee flexors of both legs Strength imbalance between knee extensors of both legs Flexion-extension ratio Bilateral muscle strength Sit and reach test. Results: Strongly indicated that reduction of strength

imbalance between limbs will be useful in the prevention of hamstring strains.


Jean-Louis Croisier,* PhD, BenedicteForthomme, PT, Marie-Helene Namurois, PT, Marc Vanderthommen, PhD, and Jean-Michel Crielaard, MD, PhD.

2002 26 athletes w/ recurrent hamstring strains. Concentric/Eccentric isokinetic testing. Aim was to see if normalization of the differences in

hamstring/quadriceps ratio would decrease recurrence of hamstring

18 athletes had strength deficits, as determined by statistically selected cutoffs of peak torque, bilateral differences, and the flexors/quadriceps ratio.


Continued Showed a eccentric peak torque deficit and a significant

reduction of the mixed eccentric/concentric quadriceps ratio.

athletes with muscle imbalances followed a rehabilitation program individually adapted from their strength profile emphasizing eccentric training

10-30 sessions which resulted in normalization of the isokinetic strength testing.

After 12 months of following the athletes none sustained an recurrent injury


Fousekis, Tsepis,Poulmedis, Athanasopoulos, Vagenas.

Nov 2010 Prospective cohort study 100 soccer players intrinsic factors. Soccer players 19.4-27.8 old Looked at composite effects in asymmetry

muscle strength flexibility, proprioception, physical characters, knee joint stability previous history of strains.

Study looked at several different variables together


Results Cont’d: Three significant predictors for Hamstring strains when put

together are: Functional leg length asymmetry Excessive isokinetic asymmetry Previous hamstring strain

Other intrinsic factors such as age, cross sectional periphery, muscle flexibility, functional knee strength ratio, knee joint laxity and proprioceptive traits proved to be irrelevant


Marc A. Sherry, Thomas M. Best, MD, Amy Silder, Darryl G. Thelen, PhD and Bryan C. Heiderscheit, PhD,

June 2011 To decrease the recurrent rate this research proposes

to incorporate into the rehabilitation process: Dynamic warm-up Integrating Neuromuscular control Trunk stabilization Functional eccentric strengthening.


Brukner, Nealon, Morgan, Burgessand Dunn Dec 2012 Casestudy. Recurrent Hamstring injuries 12-63 % 1 month highest risk to

reinjure. 7 point program to reduce recurrent injury 26 year athlete ® 5 hamstring injuries in 5 months Prior injuries included ® MCL strain,® Achilles tendinopathy , (l) Add strain

Neurodynamics ( SLR and slump test) Biomechanical assesment Core stability/lumbar strengthening Increase strength thru eccentric Overload running program Injection therapy Stretching/yoga/relaxation.


More Intrinsic factors to keep in mind associated with Hamstring Injuries are :

Lumbo-pelvic status

Muscle flexibilityStrength trainingRunning mechanics


Lumbo-Pelvic Status:

pre-existing lumbar spine pathology pelvic muscle imbalance – pelvic muscle tone 80% population will have right TFL, Illiacus, Psoas

stronger then the left gluteal medius stability and joint control.


Muscle flexibility. Studies have not definitively concluded that

hamstring strains are due to inflexibility. Increase flexibility gradually . Look for tightness in the hip flexors for both legs.


Include in your Strength program Quad strength vs Hamstring strength Maximum strength and fatigue tolerance Eccentric strength.

Running Mechanics Over striding. Excessive force on the hamstring

leading to fatigue and possible strain


So where does this leave us athletic trainers. Athletes with previous Hamstring strains are

higher likely to pull again. Strength deficits in the hamstring/quad ratio

might be something to keep in mind. Leg length differences might be something to

look at. 1st month after strain high incidence of re tear Rehab an athlete with neuromuscular, eccentric

strengthening, core, and go slow. All points to keep in mind.


4 basic stages of healing The time of Injury Inflammatory phase Fibroblastic phase Remodeling phase


Time of Injury Protect the injury Immobilization The more severe the longer it takes.


The Inflammatory phase: Last approx. 4-6 days Bleeding- (inflammatory cells to injury) Delicate framework Scaffolding Prevent moving muscle. Clinically : Rest/immobilization Decrease inflammation via ice, rest compression,

ultrasound, avoid stretching or exercises


Repair/Regeneration phase 5 days to10-12 weeks Increased tensile strength in scar Stop immobilization. Clinically: Start rehab to increase strength, stretching,

soft tissue mobilizations starting slowly.


Remodeling phase Start 21 days continues 6-12 months Scar strength increases and becomes

smaller. Clinically: Stretching to optimal length Rehabilitation vigorous enough to keep up

with demands of sports (functional)


Rehabilitation Old and New Bridge Hamstring curls Lunges SLRDL Slide board SLB



Eccentric forward pull

http://www.youtube.com/watch?feature=player_detailpage&v=AS9eqB_hZqo#t=50s



Manual eccentric/concentric strengthening


Bridge on smaller ball

Leg dropping gently move the leg around and suddenly drop the leg tell the athlete to stop the leg


Pogo butt kicks

Below is Hamstring curls with feet stable on rolling cart


Heel Toss with Med ball

CONCLUSION.

QUESTION

Hamstring injury’s

a couple of questions that i asked myself: what can i do better to prevent hamstring strains what...

Documents

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hamstring strains

hamstring strain injuries

mechanism of hamstring

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