A MOST COMMON SPORTS INJURY

1. HAMSTRING
STRAIN

2. Contents :
 Anatomy of the hamstring
 Movements of the hamstring muscles
 Physiology of the hamstring
 Definition
 Young athletes and hamstring strain
 Aetiology
 Grades of hamstring strain
 Mechanism of injury
 Symptoms
 Clinical diagnosis
 Differential diagnosis
 Treatment

4. Anatomy of hamstring(posterior
compartment of thigh)
The hamstring comprises of three major muscles
Biceps femoris(long and short head)
Semitendinosus
Semimembranosus

5. Movements of the hamstring muscles :
The semimembranosus and semitendinosus performs
hip extension, knee flexion and hip internal rotation.
The biceps femoris performs hip extension ,knee
flexion and hip external rotation.

6. Physiology of hamstring muscles
Eccentric contractions of the hamstring are believed to
result in microscopic muscle damage to muscle fibres.
A local inflammatory response is initiated following
injury.

7. Definition :
A muscle strain can be defined as excessive stretching or
tearing (complete or partial) of the muscle fibres.
Hamstring strain is called as pulled hamstring ,it
happens when one or more of these muscles get
stretched too far and start to tear.

8. Young athletes and hamstring strain
 During growth periods ,muscle and bones
have the tendency to grow at different
rates .
 Young athletes may be subjective to
hamstring strain injuries if their bones
grow at faster rate than their muscles .
 This causes great stretch on the muscle
fibres and therefore a sudden motion
such as jumping may lead to exaggerated
stretch or muscle tearing from the bone.

9. Aetiology
 Poor flexibility and strength
 Strength imbalance between quadriceps and hamstring muscles
groups.Imbalance between gluteal and abdominal muscles.
 Over extension
 Muscle fatigue
 Differences in leg strength(increased strength or shorter leg).

10. Grades of hamstring strain:
Grade 1:
1. Might have tightness in the back of the thigh
2. May be able to walk properly
3. Probably wont have much swelling .
4. No bruising and minimal or no swelling

11. Grade 2:
1. Bending the knee against resistance causes pain
2. Might be unable to fully straighten the knee
3. Some swelling and bruising present.
4. A moderate tear

12. Grade 3 :
1. Unable to walk properly without the aid of crutches
2. In severe pain
3. Bad swelling appear immediately

14. Mechanism of the injury:
It is proposed that microscopic damage is caused by
the lengthening of the sarcomeres in a non- uniform
manner
Muscle fibres that exhibit short optimal length
capabilities are more at risk of microscopic damage.

15. Symptoms:
 Pain in the hamstring usually when sprinting or change the direction
quickly
 Pain causes you to stop straight away.
 Even walking may be difficult and painful
 There may be swelling and bruising depending on the severity
 The back of the thigh will feel tight
 Tenderness
 A popping sensation at the time of injury.

16. Clinical diagnosis:
Diagnosis involves evaluation of
1. Past history
2. Type of action or activity
performed and physical
examination.
3. MRI scan –intramuscular strains
or tearing of the hamstring

17. Straight leg raise-passive
leg raise with straight
knee.
• Normal ROM 80-90
• Pain may be
reproduced
• Comparisons are made
between opposite
limbs

18. Resisted knee flexion-passive resistance as
patient bends knee
•Causing hamstring contraction and pain
• Strength of movement is compared to opposite Limb.

20. Slump test
 Determines if any neural involvement is
present.
 Patient straighten out one leg,bends
head downwards and point toes
 Stretch is enhanced by pushing patient
forward
 Shooting pain down the leg is positive
indication of neural involvement.

21. Palpitation:
 Physician will touch or palpitate
the muscle to detect any
deformity,pain,tension or hole
within muscle belly and
structure.

22. Differential diagnosis :
 Sciatic nerve passes through the hamstring muscle group and therefore
an injury to the lower back may refer pain to the hamstring region.
 Hamstring pain may also be a symptom of other injuries such as
adductor strains ,sacro-iliac joints, gluteal trigger points and bursitis

23. Treatments:
Treatment of the hamstring injury should straight away be
started to help limit the damage and reduce pain:
 use R.I.C.E( rest ,ice ,compress, elevate )technique
It is important to rest the hamstring as much as possible for
the first few days .
However gentle stretching and mobilizing exercises can begin
as soon as they are pain –free.

24. Conservative management:
 Non-steroidal anti-inflammatory drugs (NSAIDs) like
 Ibuprofen(advil,mortin)
 Naproxen(alves,naprosyn) will help with pain and swelling .
However these drugs may have side effects such as an increased risk of
bleeding and ulcers.

25. Physiotherapy management:
Practice stretching and strengthening exercises
Straightening your hamstring is one way to protect
against hamstring strain
 put your weight on the affected leg and bend your knees
slightly
 sit or lie with your leg straight out and pull the top of
your foot towards your head.

26. THANK
YOU