Recurring Hamstring Strains in Athletes

Recurring Hamstring Strains in Athletes Blog

Hamstring strains are common in sports like football, soccer and other sports that demand high speed kicking, rapid directional changes, and quick deceleration. Dancers are also prone to hamstring strains, with 34 percent reporting at least a single incident.

Once an athlete injures a hamstring, re-injury risk goes up, causing the athlete to miss out on training and competition, and leading to a shortened career. Recurring incidence of athletic hamstring injuries have been estimated to range from 12 to 63 percent, with the greatest risk during the first month of an athlete’s return to play. The risk remains elevated for an entire year.

Considering the high stakes of hamstring strains, much research has been devoted to reducing the risk of re-injury. Data reveals that certain conditions may predispose an athlete to a repeat hamstring injury.

Types of Hamstring Strains

Because the hamstrings are made up of three long muscles that act at both the hip and the knee, hamstring injuries should not be painted with a broad brush, but should be given individualized diagnosis and treatment.

Three factors that influence the location and severity of hamstring injuries include:

  • Type of activity: Kicking injuries differ from sprinting injuries, and both differ from sliding injuries. High speed running injuries often involve the long head of the biceps femoris muscle, while hamstring lengthening movements more often affect the semimembranosus proximal tendon.
  • Muscle architecture: Certain athletes may be genetically predisposed to increased risk of hamstring injury. A structurally narrow aponeurosis of the long head of the biceps femoris is an example of a higher risk structural anomaly.
  • Referred pain from the lumbar spine: Sometimes what feels like a hamstring injury can originate in nerves branching from the lumbar spine. Injury to the gluteal muscles or fascia may also feel like hamstring pain.

Risk Factors for Hamstring Injury

Playing sports has its own inherent risks, but certain things can up the ante for hamstring injuries.

  • Unequal leg length: even a slight difference in length can affect movement mechanics
  • Altered optimal muscle length: the optimal length for force production may be shortened after a hamstring injury, changing knee flexion torque
  • Tight hamstring muscles: Tight inflexible hamstrings are more vulnerable to injury
  • Imbalance between right and left hamstring strength: Muscle imbalances reduce coordination and overall performance
  • Playing with cold muscles: Muscles that are warmed up are more elastic and less subject to strain
  • Fatigue: Overworked muscles are more likely to become injured
  • Lumbar spine disorders: Low back pain and sciatica can affect pelvic position, which in turn affects hamstring function
  • Muscle fiber distribution: Hamstrings with a higher ratio of fast twitch vs slow twitch muscle fibers are more prone to strains
  • Core instability: A weakened and unstable core causes inefficient load transfer between upper and lower body during play, increasing the risk of hamstring injury

Diagnosis

Hamstring injuries can be diagnosed with a patient history and clinical exam. At NYDNR, we use diagnostic real time ultrasound to accurately identify the location and severity of injury. Rapid on-site diagnosis enables us to begin treatment immediately, to speed up the athlete’s recovery.

Treatment and Rehabilitation

There is a great deal of incentive and pressure for an athlete to return to play as soon as possible after a hamstring injury. However, returning to play too soon before all issues are addressed can extend the total time they are out of play in the long run. Premature return to play can result in re-injury that can be career ending.

Fear of re-injury is an often overlooked factor in assessing an athlete’s readiness to return to play. An athlete who is not mentally ready may hesitate or second-guess a movement strategy, rather than relying on instinctual motor responses.

The time necessary for rehabilitation varies with each individual athlete. Besides structural healing, the athlete’s confidence in their ability to perform must be restored.

Effective rehabilitative treatment strategies include:

  • Sport-specific movement analysis and retraining
  • Gait analysis and retraining
  • Neurodynamic assessment and treatment
  • Core stability training
  • Eccentric hamstring strengthening exercises
  • Yoga-based stretching of the hamstring muscles
  • Injection and needling therapies
  • Real time ultrasound evaluation

Treatment to Reduce Recurring Hamstring Injury in NYC

Effective and thorough rehabilitation is key to safe return to play with a low risk of re-injury. The sports medicine specialists at NYDNR pull out all the stops to make sure an athlete is physically, mentally and emotionally ready to return to play with confidence.

At our Manhattan sports rehab clinic, we use state-of-the-art technologies to diagnose and retrain sports injuries. Diagnostic real-time ultrasound, 3D motion capture force plate technology, C.A.R.E.N, our virtual reality rehab environment and other technologies are available on-site. We use innovative therapies like DNS, shock wave therapy, dry needling and other treatments that can only be found at NYDNR.

For your best shot at returning to play with improved performance and reduced risk of injury, contact us today.

130 West 42 Street Suite 1055, New York NY 10036
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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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