HAMSTRING STRAINS

BOX 2: FACTORS TO CONSIDER IN INTERPRETING THE CLINICAL FINDINGS

■ Look for evidence of leg length discrepancy (LLD): a. Shoulder/hip dipping stationary and/or walking/ running

b. Increase in lateral/medial rotation of a limb c. Hyperpronation d. Intoed and out-toed gait cycle e. Knee joint positional abnormalities (genu valgum/ varum)

■ Look for evidence of an increase or loss of minimum rotation at the hip joint during the 90-90 test (normal range of movement 45o

). !

Remember that semimembranosus and semitendinosus muscles both assist with internal rotation and

adduction of the hip joint. Whereas biceps femoris muscle assists with external rotation and adduction of the hip joints. This enables the clinician to isolate the hamstring portions during the 90-90 test and identify which portion is problematic.

Consideration should also be given to the hamstring pain that is accompanied by low back pain and/or hip rotator pain. Biceps femoris muscle connects to the sacro-tuberous ligament which in turn attaches to the sacrum and the gluteus maximus muscle. The area is innervated by the sciatic nerve and due to its close proximity to piriformis muscle the well-known syndrome may present. The clinician should be aware of this particular differential diagnosis.

■ Video evidence of a tight or torn biceps femoris muscle is often revealed during the running phase where a lateral flick occurs with a high back lift of the foot.

■ Where hyper-pronation is evident an increase in medial rotation of the tibia is apparent. This situation often compromises the knee joint and causes problems for the hamstring insertions.

Figure 1: Trigger points of the piriformis muscle

Treatment Treatment should be formulated by the physiotherapist and podiatrist and may or may not involve the prescription of in-shoe casted orthoses. These are in-shoe devices used for the correction of biomechanical dysfunction particularly where musculo-skeletal problems are involved. The process of prescription of orthoses involves video gait analysis, full biomechanical evaluation, plaster of paris casting (Figure 1) to create an accurate and unique replica of the foot, and prescription writing. Materials used are generally carbon fibre or orthopaedic grade polypropy- lene and the orthoses are manufactured at the largest orthotics laboratory in the USA using the very latest computerised technology. Orthoses are used to successfully treat biomechanical dysfunction of the lower limb and low back where indicated.

Particular attention should be given to the medical assessment of soccer players. It is possible to accurately predict the likelihood of hamstring portion injury by video gait analysis and biomechanical evaluation, so that appropriate preventative action may be taken.

VGA should be completed by a clinician who has had considerable experience in the field - otherwise faulty technique will tend to omit important VGA data. A minimum requirement should be a posterior and lateral view: ■ Stationary with the feet a pelvic width apart ■ Walking at a comfortable pace ■ Running at a speed which is desirable. Data should be carefully compiled and a report completed.

Assessment Full biomechanical evaluation is necessary to formulate an accurate diagnosis and treatment plan (see Box 1). The above is a basic requirement and clinicians generally record much greater information particularly where there are other symptoms relating to lower limb pathologies.

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AN ORIENTAL MEDICINE PRACTITIONER’S PERSPECTIVE As a more holistic and eastern approach to the prevention of hamstring injury, there are a number of things which could be undertaken. When muscles sit for long periods, toxins build up causing fatigue. Unlike the cardio-vascular system, the lymphatic system has no pump, so this can be dispersed by a long deep massage action up the length of the hamstring muscles muscle. This technique is effective but can be uncomfortable and at worst very painful. An indirect technique of dispersing lymph build up was developed in the 1930s; the neurolymphatic reflexes (NLR). This mapped out certain reflex points to the organs or glands, when these points are massaged it effects the flushing of the lymphatic vessel of each organ and gland to strengthen its

function. In the 1960s it was discovered this map of reflexes had an association between these and the muscles as well as the meridians in chinese acupuncture.

The NLR point for the

hamstrings is on the proximal part of the thigh on the adductor area coming anterior and posterior. By massaging this area for 30 seconds to 5 minutes you should feel a lightness come into the

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