Common Sports Injuries - Treating the Hamstrings
Most hamstring injuries will respond well to self help and conservative treatment
The hamstrings are a set of muscles that extend the hip and flex (bend) the knee. They start at the bottom of the hip bone and run all the way to the shinbone before crossing the knee joint.
An injury to the hamstring can cause a sudden, radiating pain in the back of the leg that's hard to control. It can also make it difficult to stand up straight or walk normally.
Massage
The hamstring muscles are a group of muscles and tendons that help your leg flex and extend. If they are tight, it can lead to a hamstring strain or tear, which can be painful.
If you have a hamstring injury, massage may be helpful to help ease your pain and speed up the healing process. It may also help reduce swelling and bruising.
Some people use massage to reduce aches and pains from common hamstring injuries, like shin splints or runner's knee. Massage helps break down any scar tissue that may be present, and it can also help relax tight muscles and increase blood flow to the area.
Cupping
During high-intensity exercise, the hamstrings become fatigued faster than the quadriceps and can lead to a hamstring strain. In addition, past injuries such as ankle sprains can predispose a person to hamstring injury in the future.
To treat a hamstring injury, we can use cupping to break up trigger points, release muscle tension and relieve pain. Cupping is also a great way to increase blood flow, which helps the muscles heal and repair themselves.
During the procedure, a therapist places warm-to-hot cups on your skin to create suction and stimulate blood flow. They may also apply a flame to the cups to heat them, but the flame is not used near the skin. During this process, the skin will rise and redden. This is normal, and will typically fade after a few days to a week.
Acupuncture
Acupuncture is one of the most common forms of treatment for hamstring injuries. It can be a valuable tool for addressing inflammation, rebalancing muscle groups, and increasing blood flow to the injury.
It is also useful to address any underlying imbalances or weakness that may have caused the injury in the first place. This can make recovery faster and more efficient.
In addition to acupuncture, physical therapy and massage can be helpful in helping patients recover from hamstring strains. These approaches can help improve muscle strength and balance, increase mobility, and prevent future injuries.
Injuries to the hamstrings are often an overuse issue. This can cause muscles to become overly stiff and trigger points to develop. These trigger points can lead to lower-back, hip, and thigh pain.
Dry Needling
As runners increase mileage and frequency, they may develop pain, weakness or fatigue in their hamstrings. Physiotherapy can help improve these symptoms and get them back to the activities they enjoy without pain.
Dry needling is a minimally invasive technique that is used to treat underlying muscular trigger points and dysfunctional muscles. A thin monofilament needle, similar to acupuncture needles, penetrates the skin and releases trigger points in the muscle and surrounding tissue to reduce pain and stiffness, decrease banding, and increase blood flow.
The American Physical Therapy Association recommends that dry needling be performed by a trained and certified physical therapist to ensure safety. This is because it may cause bruising and infection at or near the injection site, so physical therapists must be properly trained on the procedure to avoid these side effects.
However, depending on where you are being treated, there are various professionals who are trained and licensed to practice dry needling. The important point here is to do your research; always "interview" any proposed therapist (together with your list of prepared questions); check with professional associations where necessary to fact check or for advice; and never be afraid to ask questions regarding the therapists training, qualifications, and experience.
Hamstrings - Trigger Point Anatomy
Ultimately, the hamstrings are trying to be gluteal muscles, while the lumbar muscles are trying to be hamstrings
The hamstrings eccentrically contract during gait in order to decelerate extension of the knee joint and hip flexion, while also playing a very important role in pelvic stability.
The hamstring muscles decelerate internal rotation on heel-strike
The hamstrings disappear under the gluteus maximus and provide force closure of the sacroiliac joint through the coupled action of the force provided by the contralateral latissimus dorsi.
This force is transmitted through the sacrotuberous ligament and further up to the thoracolumbar fascia.
Hamstring trigger points are often mistaken for Sciatic Pain
Typically, pain from trigger points is referred up toward the gluteal muscles, with some residual pain spreading down just below and behind the knee into the medial gaster of the gastrocnemius.
This pain can often be mistaken for sciatic pain. Weak inhibited gluteal muscles, including the gluteus medius, can lead to myofascial trigger points forming in the hamstrings and lumbar erector muscles, including the quadratus lumborum.
Ultimately, the hamstrings are trying to be gluteal muscles, while the lumbar muscles are trying to be hamstrings.
Hamstrings Muscles
Anatomy
The hamstrings consist of three muscles. From medial to lateral they are the semimembranosus, semitendinosus, and biceps femoris.
Origin
Ischial tuberosity (sitting bone). Biceps femoris also originates from back of femur.
Insertion
Semimembranosus: back of medial condyle of tibia (upper side part of tibia).
Semitendinosus: upper medial surface of shaft of tibia.
Biceps femoris: lateral side of head of bula. Lateral condyle of tibia.
Action
Flex knee joint. Extend hip joint. Semimembranosus and semitendinosus also medially rotate (turn in) lower leg when knee is flexed.
Biceps femoris laterally rotates (turns out) lower leg when knee is flexed.
Antagonists: quadriceps.
Nerve
Branches of sciatic nerve, L4, 5, S1, 2, 3.
Basic Functional Movement
During running, the hamstrings slow down the leg at the end of its forward swing and prevent the trunk from flexing at the hip joint.
Biceps Femoris - Typical Referred Pain Pattern
Semimembranosus/ Semitendinosus - Typical Referred Pain Pattern
Trigger Point Referred Pain Patterns
Semimembranosus and semitendinosus: strong 10 cm zone of pain, inferior gluteal fold, with diffuse pain posteromedial legs to Achilles tendon area.
Biceps femoris: diffuse pain posteromedial legs, with strong 10 cm zone posterior to knee joint.
Indications
Posterior thigh pain sitting/walking (worse at night), tenderness in back of legs may cause limping, pain worse on sitting, post back surgery, hamstring pain cycling/soccer/ basketball/tennis/football.
Causes
Prolonged driving, improper sitting/ work chair that digs into back of thighs, hip surgery, sitting cross- legged, hip/knee/ankle injury/ fracture, leg casts, high-heeled shoes, PSLE, sacroiliac joint dysfunction, improper stretching before/after sport.
Differential Diagnosis
Sciatica. Radiculopathy. Muscle tears. Osteitis. Bursitic osteoarthritis of knee. Knee joint dysfunction. Tenosynovitis.
Connections
Piriformis, popliteus, gluteal muscles, obturator internus, vastus lateralis, plantaris, gastrocnemius, thoracolumbar paraspinal muscles.
Self Help
Trigger points in hamstrings often occur from improper stretching before and after sports. It is very important to get the stretching techniques down pat. Balls and foam rollers can be very good for relieving pain and stiffness when you are at home.
Trigger Point Treatment Techniques
| Spray and Stretch | YES |
| Deep Stroking Massage | YES |
| Compression | YES |
| Muscle Energy Techniques | YES |
| Positional Release | YES |
| Dry Needling | YES |
| Wet Needling | YES |
Links
Dry Needling for Trigger Points
Certify as a Trigger Point Therapist
Education Membership Plans from $19.95/monthly
This blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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