Monday, September 27, 2010

Resolving Hamstrings Injuries Part 3

Imaging a Hamstring Tear
X-Rays are only taken in a hamstring injury to rule out fractures (avulsion injury) and pathological processes. An X-Ray will not provide information about the actual tear.
The best imaging modality for viewing a hamstring injury is magnetic resonance imaging (MRI). Both computer tomography (CT) and ultrasound can be useful, but are not as definitive as an MRI. The advantage of ultrasound is the low cost.

Major sport teams often use MRI to determine if an athlete is going to recover from a hamstring injury. Research has shown that there is a direct correlation between the size and the number of tears seen on MRI imaging and the number of days that will be lost for athletes in competition.

Treatment of Hamstring Injuries

Initial Acute Injury
Right after the injury in the acute stage you should use RICE. RICE is an acronym for rest, ice, compression and elevation. If you have access to laser therapy this will also reduce the inflammation and speed the healing process.

NSAID’s are often immediately prescribed for hamstring injuries. For short periods of time, these mediations may be beneficial. Taking NSAID’s may not be the best advice if taken longer than seven days, as they can slow the healing response and decrease the overall quality of tissue leading to further injury.

Steroid injections at one time were often used to treat hamstring injuries, but these injections are no longer advised by many practitioners. Corticosteroids have been linked to poor healing, infections, and even ruptures of the tissue.

There are several natural alternatives that can be used to decrease inflammation without inhibiting the healing process or causing further injury. See our Blog on decreasing inflammation and speeding healing.

Start Treatment ASAP
  • Mobilization of the injured hamstring as soon as possible is essential in achieving a speedy recovery. This would include passive stretching and strengthening exercises that should be performed in a pain free range of motion.
  • Initially isometric strengthening exercises are recommended, followed by a gentle progression into isotonic exercises. Isometric exercises use static contraction of a muscle without any noticeable movement in the angle of the joint. In an isotonic exercise, tension remains unchanged but the muscle's length changes. An example would be weight lifting.
  • Upper body exercises should also be performed to maintain physical conditioning. Aerobic exercise should also be performed.
  • Aerobic exercise will speed the healing process by increasing cellular energy (ATP production) and increasing circulatory function. Improving circulation will increase oxygen input to the muscles and increase the removal of waste byproducts. Swimming is an excellent exercise for a hamstring injury (Stay within a pain free range of motion).
Manual Therapy
Manual therapy can reduce the formation of scar tissue and speed the overall healing. The longer that the injured person waits for therapy to begin the longer the resolution time may be.

The removal of any physical restrictions that form in the hamstrings, or other related areas, is essential for a full resolution. Some of these restrictions can be removed through the process of self-myofascial release (foam rollers, self massage, and gentle stretching). If the restrictions are severe enough then a manual therapy practitioner (ART, Graston, Massage) will be needed to break the restrictions.

It is important to note that any time a restriction is removed from one muscle, the antagonistic and synergist muscles must also be assessed for restrictions. This is a key point that many manual therapists overlook. For a full resolution of a hamstring injury, myofascial adhesions must be removed from the entire kinetic chain not just at the site of pain. Many of these restrictions will only be found with a more in depth biomechanical analysis and palpatory examination.

The following list of structures are common sites where restrictions are formed. These restrictions can form in a very short period of time. Common restriction sites are:

· Biceps Femoris (Long head - hamstring)
· Semimembranosis (hamstring)
· Semitendinosis (hamstring)
Antagonistic Muscles
Synergist Muscles

In part four of Resolving Hamstring Injuries we will cover Myofascial Considerations.

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