Over the past two weeks I’ve seen 4 soccer players/runners with “thigh pain”. Turned out that they were all hamstring tears of varying degrees. Hamstring injuries are a widespread sporting hazard and as the soccer season continues, we are seeing more and more “thigh” pain sports injuries in our Practice. Research has shown that about 6 players per squad will pick up a hamstring injury each season in professional soccer and AFL. (1)
A wide range of injuries may result from acute muscle strains including DOMS, or Delayed Onset Muscle Soreness to partial or complete muscle or tendon rupture. Avulsion fractures (where the tendon is pulled off the bony attachment and takes a small part of the bone with it) can happen occasionally and occurs mainly in children.
Hamstring injuries in sport usually happen as a result of rapid acceleration or deceleration while running or very quick changes in direction. Interestingly, most of the injuries happened during Training sessions. These usually are avoidable injuries and the main modifiable risk factors include:
- Poor warm up
- Muscle fatigue
- Muscle tightness
- Muscle imbalance (poor hams to quad strength ratio.)
- Previous injuries and scarring.
Warm ups DON’T have to be too arduous. Research coming out of the George Institute and Sydney University has shown that even a few minutes warm up session is better than nothing. Remember though that Warm Ups won’t necessarily stop you from getting an injury but it does decrease your chances of having an injury. A good “Cool Down” stretching session is much more beneficial getting rid of Lactic Acid and helps your heart rate and breathing to return towards resting levels gradually.
Signs & Symptoms
Most commonly I find there is pain in the back of the knee, thigh or buttocks. There may be swelling and/or bruising on the rear of the thigh and local tenderness. I have quite often treated patients who didn’t realise they had bruising on the back of their thigh because they couldn’t see it. Symptoms such as numbness, muscle weakness, loss of motion of knee flexion and extension are also common. In these cases I usually seek early diagnosis of a tear by ultrasound or MRI.
Management (On field)
Initial management of a hamstring injury is the usual RICE Regime.
Rest. Ice. Compression. Elevation.
Early diagnosis is critical to repair. Where I suspect a complete rupture is suspected a conservative approach is not recommended, and surgery is really the option of choice.
With the everyday common Hamstring injury I concentrate on a specialised rehabilitation programme of soft tissue massage, stretching and a specific strengthening regime.
Most patients regain full strength and range of motion in 4-6 weeks.
Re-injury to the affected muscle is not uncommon and maybe the result of risk factors associated with the original damage. Tears usually heal with scare tissue and scar tissue is weaker than the original tissue (2). Ineffective treatment and poor Rehab. results in the accumulation of scar tissue (Medically called Adhesions) – predisposing the athlete to re-injury. Injured muscle is weaker than normal tissue and more susceptible to eccentric loading damage and that’s why you keep injuring the same joint over and over again! (3)
Advice in this article is meant for information only. Discuss all cases with your Health Care Provider
(1) Woods et al. The Football Association Med Research Programme An audit of
Injuries. British Med Journal of Sports Medicine 38: 36-41
(2) Croisier. JL (2004) “Factors associated with recurrent hamstring injuries.”
Sports Med. 34 (10) p681-95
(3) Brockett, CL et al (2004) “Predicting hamstring strain”
By Ashton Lucas
CBD Physio on Google+
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