Full Answer
What is the primary objective of rehabilitation for a hamstring strain?
The primary objective of a rehabilitation program following a hamstring strain injury is to rehabilitate the athlete to return to sport with a good level of performance and minimal risk of injury recurrence. There are three levels of hamstring strain. Grade1 : Mild muscle strain.
Can cryotherapy be used to treat a torn hamstring?
There is a lack of randomized controlled trials in their use for the treatment of hamstring tears (29,33,35). Cryotherapy appears safe and can be used for pain relief, and it is the only modality other than mobilization (manipulation) that has evidence to support its use.
What is a Grade 3 hamstring tear?
INTRODUCTION Hamstring muscle injuries are common in both recreational and elite athletes. Depending on the severity of the injury, the athlete may require considerable time off from sport (9,11,14,29,31,33,35,41). Hamstring tears traditionally have been classified as mild (grade I), moderate (grade II), and severe (grade III).
What are the treatment protocols for hamstring injuries?
Rehabilitation and treatment protocols for hamstring injuries: Acute phase: (1 to 5 days) Initial management of RICE protocol (Rest, Ice, Compression and Elevation) has been done immediately following hamstring strain to minimize further tissue damage, bleeding,to settle down the acute inflammatory reaction and to control pain.
How to treat hamstring injury?
In the acute stage of hamstring rehabilitation the treatment should focus on protecting the injury and minimizing range of motion and strength loss. Modalities such as ice, pulsed ultrasound, and laser are commonly utilized at this time. The athlete may begin pain free submaximal isometric strengthening at multiple angles (Figure 1) beginning at 48 hrs to allow the scar between fractured muscle fibers34to achieve sufficient strength to avoid extensive separation of fiber stumps. These should be completed as a set of isometric knee flexion contraction at 30, 60, and 90 degrees of knee flexion by placing the injured limb on top of the into contralateral limb and contracting the strained hamstring. The hamstring should not be stretched into a painful range at this time but available hip and knee ROM should be maintained. Motion is also good for aligning fibers and increasing the strength of the lateral adhesion of fibers which protects the injured fibers from stump separation.35The goals of this stage are to normalize gait and to obtain knee flexion strength at greater than 50% of uninjured length upon manual muscle testing at 90 degrees of knee flexion. Once these milestones are met the athlete may begin the next phase.
How to prevent hamstring strain?
It has been well established in the literature that eccentric training is effective in the prevention of hamstring strains.1,30–33The authors feel that the eccentric training should be done not just in the seated position from 90 degrees to full knee extension, but should include training in the lengthened state. We hypothesize that training in the lengthened state may help shift the curve to acquire the necessary eccentric strength at the end of the range of motion to avoid susceptibility to further injury. The absence of rehabilitation focusing on lengthened state eccentric training may explain the disproportionally high rate of recurrence. Therefore, it is the belief of the authors that complete rehabilitation of a strained hamstring should include lengthened state eccentric training in order to minimize exposure to further muscle strain. Unfortunately, despite the best prevention programs hamstring strain injuries still occur.
What muscle is used in high speed running?
High speed running requires eccentric strength when the hamstring muscles are in a lengthened state. The lengthened state occurs when the hip is in flexion and the lower leg moves into extension, thus lengthening the two joint hamstring muscle over both articulations upon which they act. There is evidence to suggest that athletes who have sustained ...
What are the risk factors for hamstring strain?
Several risk factors for hamstring strains have been proposed in the literature, including: decreased flexibility,9–10strength deficits,11muscle fatigue,12poor core stability,13lack of proper warm-up,14poor lumbar posture,15and a prior hamstring injury.16,17Previous hamstring injury appears to be the most consistent risk factor for restraining the hamstring. Engebretsen et al17examined over 500 amateur soccer players prospectively and among all the risk factors examined, previous acute hamstring strain was the strongest risk factor for recurrent strain. In fact, a previous hamstring strain has been shown to increase the risk of a recurrence two to six times.16–18
Can a hamstring strain cause a recurrence?
In fact, a previous hamstring strain has been shown to increase the risk of a recurrence two to six times.16–18. MECHANISM OF INJURY. Hamstring strains can occur during a variety of athletic maneuvers and situations, resulting in several distinct types of injuries, each with a unique mechanism.
Can you do a single leg eccentric windmill without weights?
Single leg eccentric hamstring windmills, which can be performed without (early) weights and progressed to use of hand-held weights or kettlebells, as shown.
Does eccentric strength increase after hamstring injury?
Failing to increase an athlete's eccentric strength in a lengthened position after a hamstring injury may predispose an athlete to subsequent reinjury. Incorporating lengthened state eccentric training may help reduce the rate of reinjury. Level of Evidence:
What is hamstring rehabilitation?
The goals of hamstring injury rehabilitation are to achieve the same functional level observed prior to injury and to allow for the return to sports practice with minimal risk of recurrence .6Many interventions are widely used to achieve full rehabilitation. These include PRICE (protection, rest, ice, compression, and elevation), to control the inflammatory process7; therapeutic exercises to strengthen and restore the functionality of the musculature8; photothermal therapy for inflammation modulation9; massage and mobilization to realign and relieve tension of soft tissues10; joint and nerve manual therapy11, 12; and functional rehabilitation. However, evidence of the effectiveness of these treatment modalities is not yet fully established, due to the sparse scientific research on the subject.
Why is hamstring injury important?
The treatment goal is to provide the athlete the same functional level as before the injury . Thus, functional rehabilitation is very important to the success of the treatment.
Why is cryotherapy important?
It is believed that the most important goal of cryotherapy is the reduction of metabolic rate of the cold tissue. This reduction is beneficial, as it increases the ability of a tissue to survive the events of secondary injury following the primary trauma. Thus, the total amount of injured tissue is limited, reducing the time required to repair the damage and return to activity.7, 36
What are the different types of muscle disorders?
The first group is the functional muscle disorders, comprising type 1 (disorders related to overexertion) and type 2 (disorders of neuromuscular origin). These disorders are characterized by not presenting evidence of macroscopic lesions in the muscle fiber. The classification also includes structural muscle disorders, comprising type 3 (partial muscle injuries) and type 4 (total or subtotal lesions that may present tendon avulsion). In these cases, there is macroscopic evidence of injury, i.e., structural damage. Sub-classifications are given for each type.
What is muscle injury?
Muscle injury is characterized by changes in the morphological and histochemical aspects that create a functionality deficit in the affected segment.13
Why is it important for a physiotherapist to understand the healing process?
The physiotherapist needs to understand the healing process in order to use the adequate therapeutic approaches in the appropriate period, so that rehabilitation can be conducted properly.
Which muscle is most affected by hamstring injury?
In this phase, muscles become more susceptible to damage; the biceps femoris muscle is the most affected, as it is more active than the semitendinosus and semimembranosus muscles.17, 18
What is the course of treatment for myotendinous junction tears?
The course of treatment for myotendinous junction tears is usually non-operative (conservative), in which rehabilitation is followed by a properly-timed return to play. 1-5 Conservative management is divided into three phases based on the phases of healing. 3,4 Patients with a myotendinous junction injury typically have a faster recovery and a higher rate of return to prior level of function than those who experience an avulsion type injury. 6-8
What is the third phase of rehabilitation?
During the third phase of treatment, it is important to customize the rehabilitation to the patient’s specific needs. Sport or activity-specific exercise and agility drills are recommended to promote tissue remodeling and help prepare the patient for return to his or her previous level of function. 3,4 Drills that emphasize quick movements and change of direction, such as plyometric exercises, are ideal and will help prepare the patient for return to activities. 3 As in the previous phases of healing, it is important to have a qualified clinician involved to guide the rehabilitation and recovery.
How much displacement does a proximal hamstring avulsion have?
If a proximal hamstring avulsion has more than 2 mm of displacement, a surgical consultation for reattachment is recommended. 12,14 Early surgical repair can yield superior results over both conservative treatment and delayed surgical repair of proximal hamstring avulsions. 12,14
What is a proximal hamstring avulsion?
A proximal hamstring avulsion refers to when the tendon has torn away from where it inserts into the pelvic bone, possibly pulling away a small bone fragment with the tendon. Advanced imaging is important in cases of proximal injuries in order to expedite surgical consultation and possibly improve outcomes and return to play. 10,11
What should a patient do during the reparative phase of treatment?
During the reparative phase of treatment, the patient should try to regain full range of motion, with continued caution to avoid overaggressive stretching. 3,4 Over time, the patient can do more challenging exercises as tolerated, remembering always to do these in a pain-free manner.
What is the first phase of a tendon?
Phase 1: Inflammatory phase. During the initial inflammatory phase of healing, the goal should be to control pain, decrease inflammation, and protect the tendon so scar tissue can develop. 3,4 This stage may require crutches and taking weight off the injured leg in order to facilitate recovery, healing, and protection.
How to treat a swollen thigh?
In addition, patients should: 1 Avoid excessive stretching during this stage, because it may be detrimental to the recovery process. 3,4 2 Use ice, elevation, rest, and non-steroidal anti-inflammatory medications (NSAIDs) as needed for inflammation and pain control. 3 Limit exercising to a protected and pain free range of motion. 3
What is the best treatment for hamstring tears?
Physical therapy treatment modalities such as cryotherapy , heat, compression, elevation, ultrasound, electrical stimulation, and massage frequently are used to treat muscle injuries. There is a lack of randomized controlled trials in their use for the treatment of hamstring tears (29,33,35). Cryotherapy appears safe and can be used for pain relief, and it is the only modality other than mobilization (manipulation) that has evidence to support its use. However, there is some evidence suggesting that early heat application to the injury may prolong rehabilitation (21). Multiple meta-analyses have found therapeutic ultrasound to be no better than placebo, and there is conflicting evidence regarding the use of electrical stimulation and laser therapy in muscle injury (21,29). A PubMed search and review did not find any adequately powered human trials to recommend for or against anti-fibrotic manual therapy, such as ASTYM or Graston techniques.
What is a hamstring tear?
Hamstring tears traditionally have been classified as mild (grade I), moderate (grade II), and severe (grade III). Grade I injuries signify a small tear of the muscle or tendon, minor swelling, and pain with no or minimal strength loss. Grade II strains are more complete partial tears, with definite loss of strength and pain. Grade III tears are complete ruptures of the musculotendinous unit with a complete loss of muscle function, and they typically develop a large hematoma.
How does age affect hamstrings?
Increasing age appears to be the most prominent intrinsic risk factor for hamstring injury, with several studies of Australian footballers reporting a significant relationship (14,15,17,18,31,45). Specifically, athletes older than 23 yr were 1.3 to 3.9 times (17,31) and athletes older than 25 yr were 2.8 to 4.4 times (14,15) more likely to suffer a hamstring injury than younger players. Data suggest that risk of injury increases by 30% annually (45). Different theories have been proposed linking hamstring injury and age. One theory suggests that age promotes a reduction of cross-sectional area of the hamstrings such that the muscles can no longer produce sufficient tension to resist load before failure (35). Confounders in this observation include that the pivotal studies were performed on athletes who were relatively young. A second novel theory is that hamstring strain may be caused by age-related lumbar degeneration leading to L5 and S1 nerve impingement and subsequent hamstring muscle fiber degeneration (31).
What are the risk factors for hamstring injury?
Modifiable risk factors include fatigue, low hamstring strength, lack of warm-up, greater training volume, poor muscle flexibility, cross-pelvic posture, poor lumbo-pelvic strength, and biomechanical problems. Nonmodifiable factors include age, previous hamstring and lower extremity muscle injuries, and being of black or Aboriginal ethnic origin ( 9,11,30,31 ).
Where do semimembranosis and biceps femoris tendon originate?
The length of the hamstring should be palpated for tenderness or any muscle defects from the popliteal fossa to the ischial tuberosity, where the semitendinosus, semimembranosis, and the long head of the biceps femoris originate. The semitendinosus can be followed to its insertion at the pes anserinus, where it is felt as the most posterior and inferior tendon. The biceps femoris tendon is found easily on the lateral knee where it should be palpated to its insertion on the fibular head. The semimembranosis inserts deep to the pes anserinus on the posterior tibia and can be felt through the semitendinosus and gracilis tendons (25,38,39).
How long does a hamstring injury last?
Researchers theorize that regeneration and remodeling of an injured muscle may continue for up to 9 months after injury.
Which muscle is most commonly injured in hamstrings?
In the majority of studies, the biceps femoris was the most commonly injured hamstring. Injury to the semimembranosis was less common, followed by the semitendinosus ( 4,13,23,45 ). However, these numbers differ in other studies and are complicated by the fact that more than one muscle often is injured ( 5,13 ).