Yudu - sportEX medicine - 1999-2010

PATIENT ADVICE Hamstring muscle injuries

Your injury The hamstring muscle group is found in the back of the thigh. The group is composed of three muscles shown below. They are described as two-joint muscles because their contraction brings about movement at both the hip and the knee. This makes them particularly vulnerable to injury.

Regaining strength In order for the scar to gain strength the hamstring muscles need to be exercised. The exercises have been chosen specifical- ly to strengthen your hamstrings in a pro- gressive, graduated manner. Initially the muscle is contracted

against a resistance

but the limb is held in a fixed position and so no actual movement takes place. Your therapist will guide you on the number of repetitions for each exercise.

The three muscles that make up the ham- strings

When this has been accomplished without pain, exercise can progress to dynamic muscle contraction (ie. where the limb actually moves) with a gradually increasing load (resistance) and speed (Exercise 1).

Regaining flexibility During the first two weeks following injury you should not stretch the injured muscle as this is likely to pull apart the healing tissue. After 14 days the scar begins to shrink and then stretching exercises are required in order to maintain normal exten- sibility of the involved muscle.

Exercise 3 outlines a stretching exercise for the hamstrings. Both stretches achieve the same effect – choose whichever is most comfortable.

Exercise 1: Exercise position for mid range ham- string strengthening

Diagram of hamstring muscles

Damage to the muscle can take several forms ranging from minor to major damage. ● Grade 1 - a minor tear of a few fibres ● Grade 2 - tearing of a greater number of fibres, but the muscle is still intact ● Grade 3 - total rupture of the muscle

Any injury to muscle will cause pain and inflammation of the tissue involved and possibly limitation of future function. Follow the instructions below for the first 72 hours after injury.

When these exercises can be done success- fully, then the starting position for Exercise 1 changes to one where the ham- strings are in a lengthened and potentially more stressful position (Exercise 2). This is achieved by lowering the bottom half of the couch so the muscle is stretched. The process above is then repeated. The next

Exercise 3a

step is to carry out some sport specific exercises for your hamstrings which mimic the stresses of your particular sport. Your therapist will advise you on these only when you can achieve the exercises described above satisfactorily.

Exercise 3b

Exercise 2: Exercise posi- tion for outer range ham- string strengthening

Treating inflammation with PRICE - immediately after injury and for 72 hours afterwards Tissue injury usually involves damage to small blood vessels that results in bleeding at the site of injury. This bleeding leads to the four main signs of inflammation: heat, redness, swelling, pain and loss of function. The inflammatory reaction is necessary as it is part of the natural healing process. However the body tends to overreact to sudden traumatic injury and as a result more inflamma- tory fluid accumulates than is necessary for healing. This fluid contains a protein that turns into replacement ‘scar’ tissue, too much scar tissue may prevent the structure returning to normal function with reduced flexibility and increased risk of re-injury. The advice below should be followed for 3-5 days depending on severity. It can be remembered by the acronym PRICE.

● ● ●

PROTECT - Protect the injured tissue from undue stress that may disrupt the healing process and or cause further injury. Make sure the mode of protection can accommodate swelling.

REST - This reduces the energy requirements of the area, avoids any unnecessary increase in blood flow, ensures protection of the area and optimises healing. Slings, crutches or static rest (ie. sitting or lying down).

● COMPRESSION - Simple off-the-shelf compression bandages such as Tubigrip™ and adjustable neoprene support are best. ● ELEVATION - Lowers the blood pressure and helps limit bleeding and encourage drainage of fluid through the lymphatic system.

ICE - The ice helps constrict the blood vessels thereby limiting bleeding and reducing the accumulation of unnecessary scar tis- sue. Crushed ice wrapped in a damp towel (to prevent ice burn) is best (ice cubes can be wrapped in the cloth and smashed against a wall to crush the cubes). Ice should be applied immediately after injury for between 20-30 minutes every 3-4 hours.

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for special- ist medical advice in each individual case. To the extent permissable by law, the publisher, editors and contributors accept no liability for any loss, injury or damage howsoever incurred (including negli- gence) as a consequence, whether directly or indirectly, of the use of any person of the contents of this article.