SOFT TISSUE TREATMENT HAMSTRING INJURIES Figure 3:

Piriformis trigger points

■ Assess and treat soft tissue component ■ Bilateral lower rectus abdominis/ external obliques trigger point activity?

Reassess. Treat. Reassess.

and inferior gluteal nerves and vessels could cause buttock pain; in extreme cases, atrophy may develop. Pain in the region of the sacroiliac joint could be due to local dysfunction of the joint. Pressure on the sciatic nerve or on the post-femoral nerve could augment thigh pain. Symptoms in the calf and foot and paraesthesiae could be similarly explained. The pudendal nerve could be involved, leading to sexual dysfunction and groin pain. This syndrome may be easily confused with radiculopathy.

Activation Trauma resulting from a fall can precipitate trigger points in this muscle, as can forceful rotation with body weight on one leg or resisting forceful medial rotation of the thigh during running. Perpetuation comes about through immobility of the sacroiliac joint, driving for long periods of time, and osteoarthritis of the hip.

Patient examination ■ Test hip adduction strength in 90 degrees flexion ■ Piriformis stretch position test.

Increased neural tension Symptoms of peripheral nerve entrapments of the posterior femoral cutaneous nerve are to the posterior thigh and do not extend below the knee. The posterior femoral nerve runs adjacent to the sciatic nerve and can be compressed by piriformis.

LOCALLY-ORIENTED HAMSTRING CONDITION A locally-oriented hamstring condition is described as a local pathology from

www.sportEX.net

an overloading of the hamstring by indirect overload, or direct injury from collision or from delayed-onset muscle soreness (DOMS). There may be a past history of injury.

Common sites of strains include

the mid-belly, semitendinosus and biceps femoris and the attachments at the ischial tuberosity. In hamstring syndrome, the sciatic

nerve is constricted between two fibrotic bands of the hamstrings at the lateral proximal attachment to the ischial tuberosity. Trigger points in the hamstring muscles are responsible for tightening and shortening, which produces a posterior tilt of the pelvis, reducing normal lumbar lordosis, a secondary compensatory overload to quadratus lumborum, iliopsoas, thoracic paraspinals and rectus abdominus. Adductor magnus tightness of the

posterior part blocks full hamstring lengthening, especially of the medial hamstrings. More obscure conditions

such as snapping syndrome of the semitendinosus tendon, semimembranosus tenosynovitis, snapping bottom or bursitis of the biceps femoris superior bursa are rare but are to be kept in mind as possible considerations.

TREATMENT CONSIDERATIONS Check the following: ■ Standing/sitting iliac heights ■ Standing/sitting flexion tests/stork test ■ PIEX/ASIR innominate as above ■ If present correct innominate dysfunction (muscle energy technique)

Consider the following: ■ Lateral flexion of trunk: quadratus lumborum tension versus compression symptoms ■ Flexion of trunk: lumbar, buttock, hamstring or calf complex ■ Extension: tensional versus compression symptoms ■ Hip range of movement: look for adductor magnus or medial hamstring tightness on straight leg raise ■ Piriformis (myofascial dysfunction) ■ Slump test: treat restriction myofascially ■ Clear antagonist, quadriceps tension and range of movement ■ Due to the prevalence of reduced dorsiflexion range of movement as one of the key predictors in hamstring injuries, assessment and treatment of the anterior and posterior compartments of the leg are worthy of consideration.

References 1. Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997–2000. British Journal of Sports Medicine 2002;36:39-44. 2. Gabbe BJ, Finch CF, Bennell KL, Wajswelner H. Risk factors for hamstring injuries in community level Australian football. British Journal of Sports Medicine 2005;39:106–110. 3. Simons DG, Travell JG, Simons LS. Travell and Simons’ myofascial pain and dysfunction: the trigger point manual, 2nd edition. Williams & Wilkins 1999. ISBN

0683083635.

THE AUTHOR

Stuart Hinds is a lecturer in remedial soft tissue techniques at Victoria and RMIT Univeristy, Australia. Stuart has been

involved with elite cycling (national and international) and a range of athletes from all professional levels of sport. Stuart was a part of the International Olympic Committee’s massage services for the 2000 Sydney Olympic Games/and soft tissue services for the Australian Olympic Team for the 2004 Athens’ Olympic games. He is also soft tissue therapist for the Geelong Football Club and has just returned from the Beijing Olympics.

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