SOFT TISSUE TREATMENT HAMSTRING INJURIES BIOMECHANICAL

HAMSTRING CONDITION A biomechanically-oriented hamstring condition can be described as a biomechanical anomaly relating to the lumbar-pelvic/thigh/leg region, creating an overloading of the muscle group. In this case the hamstring acts like a tensional barometer for the lumbar-pelvic region. A biomechanical hamstring condition usually includes pelvic anomalies such as iliosacral fixations, up-slips, sacral torsions and pelvic torsion, which are commonplace in the contact athlete. Soft tissue therapists deal with a large range of signs and symptoms when treating the hamstring component. It is important to note, therefore, that treatment can be of a structural nature, and so interaction with practitioners who focus heavily on structural restrictions is integral.

Pelvic anomalies

Pelvic anomalies are common. Many players present with congenital postural types such as anterior pelvic tilts and posterior pelvic tilts, which respectively place the hamstrings in a state of tension or compressional tension.

These common postural types should not be confused with unilateral iliosacral anomalies. For example, a player may present with a postural type of bilateral anterior pelvic tilt but also with a unilateral right-sided posterior inferior external rotation of the iliosacrum.

Iliosacral dysfunction Iliosacral dysfunction includes two common variations: anterior superior with internal rotation (ASIR) and posterior inferior with external rotation (PIEX).

ASIR

Anterior superior with internal rotation indicates that the ilium rotates anteriorly on the sacrum, with an inflare or internal rotation tendency creating a muscular tensional change. Signs and symptoms of right-sided ASIR include the following: ■ Pain:

Diffuse right posterior lumbar- www.sportEX.net

sacral and sacroiliac pain with referral into right buttock and posterior thigh Sitting is usually more comfortable than standing

■ Structural signs:

Left iliac crest high Right iliac crest low Right positive standing flexion test (superior posterior superior iliac spine movement on trunk flexion) (Box 1) Right positive stork test (Box 2) Right hip external rotation restricted

■ Muscular signs: Right positive Thomas test restricted range of movement (Box 3) Right hip flexor (especially iliacus) shortened, tight and tender Right hip adductors shortened Right gluteal medius and minimus increase in tone/ sensitivity trigger point referral Right hamstring lengthened. Note that straight leg raise will need to be modified for true hamstring length. Due to shortened hip flexors, bring hips into flexion to counteract the increase in lordosis, before performing the straight leg raise

■ Palpation: Increase in tone/tension trigger point activity in gluteus medius, minimus and tensor fascia lata Right sacrotuberous ligament is lax (Box 4) Right Baer’s sacroiliac point is tender; this is a painful point on a line from the umbilicus to the anterior superior iliac spine (ASIS), two inches from the umbilicus; pain is related directly to the sacroiliac joint

The hamstring will feel under a tensional load.

PIEX Posterior inferior with external rotation (PIEX) indicates that the ilium rotates posteriorly on the sacrum, with an external rotation tendency creating a muscular tensional change. Signs and symptoms of right-sided PIEX include the following: ■ Pain: usually localised to the right sacroiliac joint and ipsilateral buttock. Pain may be described as “deep”,

“achy”, “sore”, “tight”, etc. Pain may be referred down to the posterior thigh but not below the knee as with neurological or radicular pain ■ Structural signs:

Right iliac crest high Left iliac crest low Right positive standing flexion test (superior posterior superior iliac spine movement on trunk flexion)

Right positive reverse stork test (see Box 3)

Right medial malleolus is shorter than left Restricted right hamstring range of movement

Restricted right hip internal rotation

Posterior iliac rotations produce a shortened stride length on affected side

■ Muscular: Right hamstring shortened, hypertonic and tender Right piriformis/gluteus maximus shortened

Right hip flexors lengthened Bilateral quadratus lumborum

■ Palpation: Right hip flexor/quadratus lumborum increased trigger point activity Right sacrotuberous ligament taut and tender (Box 4) Right Baer’s sacroiliac point tender.

Figure 2: Anterior muscles around the hip

Quadratus lumborum Psoas major

Iliacus Gluteus medius

Gluteus minimus Conjoined muscle and tendon of psoas major and iliacus

Pectineus

Vastus intermedius Vastus medialis

Adductor brevis Adductor longus

Gracilis

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