Structure and Function:

• Three muscles
• Crosses two joints; they start above the hip and below the knee.
• Complex balance of concentric and eccentric actions.
• Greatest function is eccentric and very demanding; control.
• Acute hamstring injuries come from sprinting most often. People feel something rip – like carpet tearing.
• Check the spinal movements e.g. sciatica as hamstring pain can often be neurological rather than something genuinely wrong with the muscle.

Pathology:

• Tears
  • Grade 1 – microscopic damage; mild muscle pull or strain
  • Grade 2 – majority of tears; partial muscle tears
  • Grade 3 – one bit torn away from the other; complete muscle tear
• Tendonopathy
  • Proximal
  • Distal
  • How much of the muscle is involved?

Diagnosis:

• Clinical
  • Strength; will hurt them, assess strength and pain
  • Stretch; also going to hurt, assess flexibility and pain
• Investigation
  • Ultrasound
  • MRI; looking for the size of the injury, not the size of the edema

Treatment:

• Interventional
• Rehabilitation – a lot more options available
  • Pathology
  • RICE – limit secondary muscle damage
  • Mobilise
  • Strengthen – weights, open and closed chain; look what strength they have within a comfortable range.
  • Return to function
• Strength
  • Low level of activity: knee flex and extend hip so leg raise. Hamstring and gluteals extend hip so need to strengthen glutes to prevent future hamstring injury.
  • Build up to low resistance flexion with the rubber bands around ankles or hips and a post.
  • Resisted weight machines as these are closed chain activities; it strengthens the muscle but it is not functional.
  • Put the closed chains together, making it open chained, so squats, lunges, and dead lifts.
  • Must be able to walk before they can run.
  • Cycling – mainly concentric, low risk, protects cardiovascular fitness and gets muscle working.
  • Cross trainer is a good progression from walking with reduced loading compared to running, but is a similar action.
  • Walking then uphill or backwards then jogging.
• Speed
• Acceleration
  • Acceleration/deceleration are very important in sports but likely to damage hamstring, so this must be put into rehab
  • Can use GPS tracking to get a look at speeds etc
  • The quicker you push an injured athlete and harder, more likely they will break
  • Have to introduce sport specific skills e.g. spring to this cone then kick a ball
• Endurance
• If fibres heal shorter than others then they will take all the stress so need to make sure they’re flexing and lengthened