Managing Hamstring Strains
and Hamstring Tendinopathy

Hamstring injuries are common in athletes at all levels, from high school to the pros, especially in sports involving rapid acceleration, deceleration and sprinting. Dancers also experience frequent acute hamstring injuries, as their muscles are stretched and challenged to the max during practice and performance.

A hamstring injury can be devastating to a young athlete or dancer whose career hangs in the balance, and athletes are often eager to return to play as quickly as possible after an injury. However, early return to play sets a young athlete up for recurring injuries that can take them off the playing field for good. One-third of hamstring injuries recur within the first year after return to sport, and secondary injuries tend to be more severe than the initial injury. The high frequency of re-injury suggests that treatment strategies and recovery time may be insufficient to restore the injured tissue to pre-injury strength and function.

Nature of Hamstring Injuries

Your hamstrings are a group of three muscles, the semimembranosus, the semitendinosus, and the biceps femoris. All three muscles attach distally to the tibia, or shin bone, just behind the knee joint. At the proximal end (that closest to the trunk), the tendons attach to the ischial tuberosity, or sit bones. Hamstrings serve to produce two joint actions: knee flexion and hip extension.

Hamstring strains are a tearing of the muscle tissue, while tendinopathy is a chronic condition affecting the tendons that anchor the muscles to bones. High hamstring tendinitis is inflammation of the hamstring tendon where it attaches to the ischial tuberosity at the top of the back of the thigh. High hamstring tendonopathy can occur following a poorly treated tendon rupture, but it is more often an overuse injury. Because of their thick fibrous nature and poor blood supply, hamstring tendons heal slowly.

Three common types of sport or dance related hamstring injuries:

Sprinting related hamstring strains:

  • • occur during high-speed running, in the terminal phase of the gait cycle
  • • at this phase, the hamstrings are active, lengthening and absorbing energy from the decelerating limb to prepare for foot contact
  • • during sprinting, the greatest stretch is incurred by the biceps femoris
  • • strains to the biceps femoris typically occur along intramuscular tendons and the adjacent muscle fibers
  • • during rehab, the biceps femoris must be trained to safely handle high eccentric loading

Kicking or leaping hamstring strains:

  • • these types of strains can occur during slow or fast movements involving simultaneous hip flexion and knee extension
  • • at the time of injury, hamstrings in a position of extreme stretch
  • • kicking or leaping injuries commonly occur in the semimembranosus and its proximal free tendon
  • • kicking and leaping injuries require a prolonged recovery period before return to the pre-injury performance level

Tendinitis from distance running and cycling:

  • • proximal hamstring tendons connect the three hamstring muscles to the sit bone, or ischial tuberosity, located in the buttocks at the bottom of the pelvic bone.
  • • these tendons are prone to repetitive use injury
  • • high hamstring tendinitis is often seen in runners, cyclists, rowers, and activities that require prolonged sitting.

Three common types of sport or dance related hamstring injuries:

Despite their different locations and origins, hamstring injuries are been traditionally painted with a broad brush for purposes of diagnosis and treatment. However, when developing the treatment protocol, the therapist should take into account the nature and origin of the injury, and the activities to which the athlete will return after rehab.

Acute hamstring injury often presents as:

  • • sudden posterior thigh pain resulting from a specific activity
  • • an audible popping sound at the onset of pain
  • • inability to continue the activity that caused the pain
  • • pain when sitting (if the injury is at the ischial tuberosity)

Injuries to the biceps femoris from high speed running normally heal more quickly than injuries to the proximal tendons from kicking or leaping.

Diagnosis to determine the location and severity of hamstring injuries includes the following:

  • • isometric strength assessment and pain provocation
  • • range of motion assessment
  • • manual palpation
  • • ultrasonography to identify edema and hemorrhage

Rehabilitation

The primary objective of rehabilitation is to return the athlete to their pre-injury level of performance, with minimal risk of re-injury. In addition to reducing inflammation and pain in the initial stages, rehab will involve physical therapy that emphasizes eccentric strength training of the injured muscles, along with strengthening of adjacent muscles that interact with the hamstrings during play. Emphasis should also be placed on improved coordination and stabilization of the lumbopelvic region.

Phases of rehab include:

Phase I

  • • Restricted movement and limited stretching of the affected muscles
  • • Icing and pain management
  • • Therapeutic exercises to promote neuromuscular control without pain, avoiding overloading of the injured muscle.
  • • Criteria for progressi

Phase II

  • • Encouraged return to full range of motion, but avoiding extreme stretches.
  • • Icing and pain management
  • • Gradual hamstring lengthening, progressive agility drills and trunk stabilization exercises
  • • Criteria for progression to phase III include full strength muscle contraction without pain; pain-free forward and backward jogging at 50% of maximal speed

Phase III

  • • Avoid sprinting and explosive acceleration movements. Range of motion should be restored, and stretching is no longer restricted.
  • • Icing after exercises to reduce pain and inflammation
  • • Agility and sport-specific drills; advanced trunk stabilization exercises; progressive eccentric hamstring strengthening
  • • Criteria for return to sport: once full range of motion, strength, and function are restored without pain or stiffness, the athlete is ready to return to full sporting activities

Returning to sport or dance before your injuries are completely recovered puts you at risk for more severe re-injury that can take you off the playing field or off the stage for good. The sports medicine professionals at NYDNRehab work together as a team, using state-of-the-art technology to diagnose and treat your hamstring strain or tendinopathy. Do not trust your athletic or dance injury to just anyone. NYDNRehab offers the very best treatment for athletic injuries, so you can return to your sport or activity with strength and confidence to perform at your peak.

Hamstring Strain Rehabilitation

Considered fairly common among both amature and professional athletes, a hamstring strain involves some type of strain or injury to a group of muscles located along the back of the thigh. Typical causes of hamstring strain include not warming up before exercising, having a previous injury in the same general location or a previous hamstring injury and going through a growth spurt (for teenage athletes). With proper attention following a hamstring injury, the odds of a recurrence, usually taking place within the first week of returning to normal activities, can be greatly reduced.

New York Dynamic Neuromuscular Rehabilitation addresses common sources of hamstring tendon strain to promote healing and shorten the recovery time as much as possible. We realize that any injury can be an annoyance to a dedicated athlete. Determining how to treat a hamstring strain starts with evaluating the severity of the sprain and taking measures to prevent the strain from becoming a more serious injury. Our unique approach to rehabilitation is designed to facilitate the healing process and reduce the risk of re-injury. At the same time, patients are encouraged to make adjustments while recovering such as wearing lighter shoes and modifying their exercise routine.

Symptoms of a hamstring strain include sudden pain while exercising or playing sports, pain in the back of the thigh while straightening a leg or walking and bruising. While anyone can suffer a hamstring strain, male athletes tend to be more vulnerable to this type of injury. Hamstring strains not properly addressed can sometimes have longtime consequences, which means that treatment and hamstring strain rehab should be started as quickly as possible to promote effective healing.

The diagnostic process involves three simple stretches to gauge the level of pain at certain points. These tests include performing an assisted hamstring stretch and quickly straightening the knee, also with assistance. If testing fails to pinpoint a source of the discomfort from the hamstring tendon strain, an MRI scan may be necessary. After we determine how to treat a hamstring strain as it pertains to a specific patient, the next step is to develop a customized hamstring strain rehab plan. The treatment for hamstring tendinitis, for example, is going to be lengthy and more involved than a simple muscle strain, often involving hamstring compressions. Our comprehensive and regenerative treatment plans are based on each patient’s ability and severity of injury.

Our approach to hamstring strain rehab also includes encouraging home exercises. Sets and reps vary based per patient, ranging from basic workouts to specific exercises to improve core strength, stability, and flexibility. Corticosteroid injections, while effective in some cases, may weaken tendons. For this reason, we emphasize non-invasive treatment methods to promote natural healing. Surgery is rare, often requiring nearly six months to fully recover.

A factor in determining how to treat a hamstring strain is the level of activity the patient wishes to return to following recovery. An occasional athlete, for instance, may fully recover within a month while a runner may need about two months to return to competitive or daily running. Our ultimate goal is to restore optimal patient function with a combination of advanced diagnostics and personalized treatments.

At New York Dynamic Neuromuscular Rehabilitation, patients have access to a Computer Assisted Rehabilitation Environment (CAREN). Consisting of a motion base, a projection screen and related software and motion capture, this uniquely controlled environment can be tailored to individual rehab needs. The severity of the hamstring strain is also a contributing factor to our rehabilitation efforts. A patient with chronic hamstring strain likely requires more attention than a mild hamstring strain. At the same time, our comprehensive diagnostics rule out any potentially serious issues that should be addressed prior to starting hamstring strain rehabilitation.

We’re constantly working to determine how to treat hamstring strain in a way that reduces overall recovery time while still maintaining our commitment to exceptional customized rehabilitation methods. Gait analysis helps us determine which exercises to recommend, to prevent re-injury by focusing on the three hamstring muscles and surrounding muscles and tendons. For chronic hamstring strain where neuromuscular balance needs to be restored, we include eccentric exercises into the treatment plan. Extracorporeal Shockwave Therapy (ESWT) can be used for both severe and mild hamstring strain involving degenerating tendons to facilitate the healing process.

Our determination of how to treat hamstring strain also involves preventing scar tissue from forming, which can lengthen recovery time or necessitate a need for surgery in the future to remove the scar tissue. To prevent scar tissue from forming, we recommend an at-home treatment planned coupled with the treatments provided during each session at our clinic. We strive to prevent subsequent injuries by encouraging a gradual return to full activities along with preventative measures such as stopping to address any instances of pain or discomfort when returning to previous activities following rehab.

Whether a patient is dealing with mild, moderate or a chronic hamstring strain, we provide a highly personalized approach to recovery through various therapies and treatments. At the NY Dynamic Neuromuscular Rehabilitation clinic, we believe that resources such as CAREN, state-of-the-art diagnostics and customized treatments make a difference in the level of healing many of our patients experience when coming to us following a hamstring strain.

As mentioned earlier, it’s important to seek treatment for a suspected hamstring issue as soon as possible to restore full function. We further encourage patients to take measures such as resting, icing or elevating the leg if they experience signs of a possible recurrence during normal activities. The most effective approach when it comes to preventing renewed hamstring injuries, however, is to strengthen hamstring muscles and nearby tendons and muscles through exercises that can be continued at home during and after the initial evaluation and treatment that takes place at our New York clinic.

Call New York Dynamic Neuromuscular Rehabilitation today for more information on our hamstring strain rehabilitation services and innovative treatment options.

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