Hamstring problems are amongst the most common lower limb injuries that are seen in Swissphysio. Unfortunately, they tend to be one of the most stubborn injuries of any body part. Frequently we will see someone, with a hamstring problem, many weeks or months after the initial damage. This can make rehabilitation more of a challenge: but never impossible. This article will briefly look at the anatomy and some of the related factors involved with injury and rehab of the hamstrings.
The hamstrings are composed of 3 muscles the Biceps Femoris, Semimembranosis and Semitendinosis. All 3 muscles originate from the pelvis, the Ischial Tuberosity (aka the sitting bone). The Biceps Femoris also attaches to the upper part of the back of the thigh. The Semimembranosis and Tendinosis insert into the inside (medial) part of the upper Tibia whilst the Biceps attaches to the head of the Fibula which is situated on the outside (lateral) of the Tibia. The end result is a muscle that crosses 2 joints makings its role both complex and demanding from a strength/endurance perspective. A detailed break down of its functions is not possible in this article but it is involved in movement and control of the pelvis, hip, knee, lumbar spine and ankle/foot. Lots of potential for things to go wrong!
Clearly prevention is always preferable to cure. Within research there are a few predictors of potential hamstring injuries: Pure hamstring strength is important and must be part of any preseason preparation and part of any training schedule. One of the most widely used and studied is the Nordic curl protocol. Its use can dramatically reduce hamstring problems. Isolated hamstring strength is vital but this must be balanced with the strength of the quadriceps: basically the stronger the quadriceps the stronger the hamstrings need to be as they act as the decelerating brake. Large imbalances between these 2 muscle groups cause the hamstrings to overwork and become injured. One common idea is that the hamstrings must be well stretched in order to prevent injuries. Unfortunately, this is not reflected in research and ironically tight quadriceps is a more important predictor of hamstring problems.
These a just the tip of the iceberg when it comes to prevention as all leg muscle groups and joints must be assessed to in order to appreciate good hamstring function.
Sadly injuries do happen and can be split into two basic types: those that are close to the upper insertion and those that are further away. As a rough rule of thumb the closer the injury is to the insertion the longer it will take to recover. Often these injuries involve the hamstrings to be both fully stretched and have a certain degree of compression due to the angle of the pull on the pelvic insertion. This a bad combination with any contractile complex and can take many months to rehab back to full activity. Fortunately, this is less common highlights the need for correct diagnosis as the treatment is quite different for the 2 different types of injuries.
So the take home message from this article is: do not neglect hamstring strength, quadriceps must be correctly stretched and if there is any hamstring problem it must be correctly diagnosed in order to prescribe the most appropriate rehab programme. As always if you have any questions then do not hesitate to get in touch with us here at Swissphysio.
Graham Smith, Physiotherapist