Hamstring Strain Treatment in Singapore

• The hamstrings are long muscles in the posterior thigh that extend from the ischial tuberosity behind the hip, down to the knee.
• A hamstring strain is a stretch-induced muscle injury.
• Tears result from the hamstring muscle suddenly changing from a stabilizing flexor to an extensor.
• It usually is caused by quick starts with sudden hamstring contraction.
• Strain classification:
  • Mild: Muscle spasm only, with no evidence of tear, with minimal discomfort and with only minimal loss of strength
  • Moderate: Muscle fiber tear that results in a loss of strength and pain
  • Severe: A tear across the entire muscle or tendon

• Stretching the hamstrings while muscles are fatigued
• Anaerobic interval training
• Sport-specific training drills

• Common in athletes, especially those who sprint or jump
• 12% of the injuries in professional football players
• 34% of injuries have a later recurrence.

• Age
• Low muscular strength
• Previous hamstring injury
• Tight hamstrings

• The hamstring muscles are the biceps femoris, the semitendinosus, and the semimembranosus muscles.
  • All 3 arise from the ischial tuberosity and extend in the posterior aspect of the thigh and cross the knee.
  • The biceps femoris also has a short head that inserts into the femur.
  • The hamstring muscles contract eccentrically to absorb kinetic energy during gait.
  • Muscle strain most commonly occurs at the proximal musculotendinous junction of the biceps femoris.
• Children and adolescents may avulse the bone at the hamstring origin, resulting in an ischial fracture.
• Adults may avulse the tendon.

• Predisposing factors:
  • Poor flexibility
  • Inadequate warm-up
  • Fatigue
  • Dehydration
  • Deficiency in the reciprocal actions of opposing muscle groups
  • Strength imbalance between the quadriceps and hamstring muscles
• Movements that commonly result in strain:
  • Flexing the leading hip during a hurdle
  • Sprinting out of the start-up blocks
  • Charging by a football lineman
  • Take-off by a jumper
  • Water-skiing falls

• Back strain
• Groin strain

Tests

• Acute fracture
• Stress fracture
• Muscle contusion

• Acute (1st week after injury):
  • RICE protocol
  • Early gentle motion
• Subacute (up to 3 weeks):
  • After inflammation resolves, concentric strength exercises should begin with cross-training.
• Remodeling phase (2-6 weeks):
  • More aggressive stretching
  • Eccentric strengthening
  • Progressive agility and trunk stabilization exercises
• Functional stage (up to 6 months):
  • Gentle return to running and sports activities when the patient is pain free
• Competitive phase:
  • Focus on prevention, strengthening, and stretching

Special Therapy

• Surgery is not indicated for musculotendinous junction injuries.
• Ischial avulsion fractures:
  • >2 cm displacement: May be considered for internal fixation
  • >2 cm displacement can lead to a symptomatic nonunion.
• Tendinous avulsions may be considered for operative repair.

• Mild strains heal in a few days to a week.
• Moderate strains heal in 1-3 weeks.
• Severe strains involving avulsion fractures at the ischial tuberosity or fibular head may take a month or more to heal.

• Patients with a hamstring strain are at high risk for recurrent strain.
• Patients with ischial avulsion fractures with substantial displacement are at risk for chronic symptomatic nonunion.

Miscellaneous

• Explain the importance of hamstring stretch before activity.
• Explain the importance of maintaining strength in these muscles as well as the quadriceps.

FAQ