SOFT TISSUE TREATMENT FOR THE HAMSTRING CONDITION

BY STUART HINDS CERT RM, DIP RM

INTRODUCTION The objective of this article is to broaden the understanding of the potential influence that soft tissue therapy can have in the assessment and treatment of hamstring pain and dysfunction, particularly but not exclusively, in elite Australian Football League (AFL) players. Hamstring strains are the most

common injury in the AFL, contributing to 13% of all missed playing time (1). The majority of hamstring injuries occur during the three months of the playing season (March, April, May), and there is a decline in frequency as the season progresses. The most common mechanism of injury is when the player accelerates rapidly. It has been documented that the position of lumbar flexion with a straight leg, as happens when a player attempts to pick up the ball while on the run, is the most common position for hamstring injury to occur. One reason for this is because it places an excessive tensional load on the hamstring whilst it is under an eccentric contraction thus creating an indirect overload injury of the musculoskeletal unit.

PREDICTORS OF HAMSTRING INJURY Screening protocols developed by Gabbe and colleagues for predictors of hamstring injury at the elite level of AFL, highlight a history of hamstring injury in the previous 12 months and increasing age as independent predictors of hamstring injury (2). In particular, players who reported sustaining a hamstring strain during the previous year, and players over 24

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The term “hamstring condition” refers to the possible injuries that can occur in the hamstring area. The mechanics of injury fall into one or more of the categories “biomechanical”, “referred” and “local”. In this article we look at hamstring problems in the Australian Football League. We provide an overview of the mechanism of injury for hamstring strains, stiffness, soreness and restriction, predictors of injury and treatment considerations.

years of age, were four times more likely to experience a hamstring injury compared with other players. Players with restricted ankle dorsiflexion on the lunge test were also at an elevated risk of sustaining a hamstring injury.

HAMSTRING ANATOMY As a starting point, it is worth revising the key points of hamstring anatomy.

Innervations The innervations are the branches from the tibial portion of the sciatic nerve, the fifth lumbar nerve and the first two sacral nerves.

Function Movement of the hip ■ Extends thigh at hip ■ Decelerates forward-moving limb at terminal swing ■ Semimembranosus and semitendinosus assist in internal rotation of hip only when hip is straight ■ Long head of biceps assists in external rotation with the hip in extension.

Movement of the knee ■ Short head of biceps femoris is a flexor at the knee ■ Semitendinosus and

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semimembranosus internally rotate leg in knee flexion ■ Both heads of biceps femoris externally rotate the leg.

CLASSIFICATION OF THE HAMSTRING CONDITION The hamstring condition can be classified into four categories: ■ Biomechanical ■ Referred ■ Local ■ All of the above.

Figure 1: Posterior muscles around the hip

Gluteus medius Piriformis

Superior and inferior gemellus

Semimembranosus

Semitendinosus Biceps femoris

Quadratus femoris