The hamstring
Hamstring injuries are common in football. Often seen as the player pulling up having been sprinting, he clutches the back of his thigh, then hopping or hitting the floor. The amount of pain can vary as in any injury as pain is not an accurate indicator of the amount of actual damage.
The hamstring group is made of three muscles situated on the back of the thigh: biceps femoris on the outside, and semimembranosus and semitendinosis on the inside. They run from the pelvis to the lower leg, bending the knee but also slowing the knee down as it straightens. It is often in this latter phase that the ‘pull’ occurs.
When the muscle is pulled it can be difficult to walk. There can be bruising and swelling in the thigh, although sometimes this is deep in the leg and therefore not immediately visible. With rupture of the muscle fibres, the blood and fluid may track down the leg, causing bruising and swelling to appear lower than the injury.
With an acute injury, ‘PRICE’ is the management strategy of choice where P is protection, R is rest, I is ice, C is compression and E is elevation. In the early stages of an injury and the healing process there is pain, redness, swelling and heat. These are all manifestations of the inflammation that starts healing. Despite the unpleasantness, the signs and symptoms are the body’s responses to injury and are normal. Seeking the advice of a health professional is advisable so that you can fully understand the problem and what you must do to facilitate the most effective recovery.
When we have recovered from the acuteness of a hamstring injury, an individualised training programme must be designed, explained and implemented by a trainer or physiotherapist. This should be followed, progressed and completed to reduce the risk of future problems in the same area. The exercises and drills become increasingly functional, rehearsing the types of movements and skills needed to perform. This routine is practiced so that the player is ready physically and mentally for the demands of the game.
It is not uncommon for a twinge or similar pain to be felt in the back of the thigh sometime after the original injury. Of course there can be a re-injury where actual muscle fibres or tissue can be damaged. However, there can equally be cases whereby it feels like the original injury but there is no actual damage. In this situation, the brain has recognised the pattern of movement, determines a potential threat and responds with a pain in the back of the thigh, more as a warning shot. This means that there is still an underlying sensitivity that may have been felt as a persisting tightness (‘my hamstrings are always tight’, I often hear) or some discomfort with running or sitting with pressure on the muscles. This low level sensitivity and tightness requires a different treatment and training approach. To determine the difference, you should see a physiotherapist or other healthcare professional who can assess your situation and advise you on a specific course of action.
Richmond
Richmond Stace MCSP MSc (Pain) BSc (Hons) Specialist Pain Physiotherapist Specialist Pain Physio Clinics | Harley Street | Chelsea | Temple | New Malden Richmond is a Chartered Physiotherapist with a background in pain science. He specialises in the treatment of pain and injury using the latest model of care (biopsychosocial) and sciences to optimise individual performance and living. Commonly, individuals with complex and persisting pain problems visit the clinics for this modern approach that offers contemporary treatments that address the sources and influences upon pain. Richmond has a strong interest in pain education and writes several blogs on the subject of pain to help individuals understand their pain, the underlying mechanisms and treatment approaches. Additionally he is currently writing articles for scientific publication and a book. www.specialistpainphysio.com www.crpsuk.com
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