Participating in spring sports in the cool temperatures of NEPA presents many challenges, not the least of which are hamstring injuries. New research shows that these injuries can be prevented by following a specifically designed intensive training program. Last week we presented the definition, cause and symptoms of the problem while this week will be dedicated to diagnosis, treatment and prevention.
A hamstring strain is a tear of the muscle fibers of the muscle group in the back of the thigh called the hamstring. The hamstring muscle is a group of three muscles that run from the back of the hip (lower pelvis), crossing the back of the knee and attaches to the knee bone (tibia). The hamstring muscles work to extend the hip and bend the knee during running and walking activities. They are very active when an athlete changes direction, especially forwards and backwards or decelerating.
Your family physician will examine the back of your leg to determine if you have hamstring strain. Sometimes, pain in the buttocks and back of the leg can be referred from you lower back if the sciatic nerve is inflamed. In more advanced cases, you may be referred to an orthopedic surgeon for further examination and treatment. An X-ray, MRI or bone scan will show the extent of the tear and if the bone is involved. The diagnosis will determine if your problem is minor, moderate or severe.
There are many conservative options. You and your family physician or orthopedic surgeon will decide which choices are best.
- Anti-inflammatory Medications: such as aspirin, acetaminophen or ibuprofen to reduce pain and swelling.
- Orthopedic Physical Therapy: such as heat, cold, ultrasound, electrical stimulation, joint mobilization, massage, range of motion exercises, strengthening exercises, and supportive compression strapping. Once painfree, a preventative training program is essential to prevent reinjury.
- Activity Modifications: if it is not the week of the district tournament, rest, avoid running or stretching/stressing of the thigh muscles.
- Supportive Devices: such as thigh wraps or sleeves, compression shorts (like those worn under basketball shorts) can provide compression and relief.
A recent study in the British Journal of Sports Medicine determined that a training program specifically designed to prevent hamstring injuries is effective, especially for the competitive athlete. This program includes:
- High Intensity Training- regardless of the speed of your sport, high intensity, interval anaerobic training is critical. Interval sprints are the best example.
- Simulate the Demands of the Sport – when training, simulate the specific demands of your sport… “train the way you play.” For example, in football, the average play lasts 7-10 seconds. Therefore, sprint on a count from the line of scrimmage for 7-10 seconds. First, sprint in a straight line. Then, sprint and cut at 3-5-10 yards. Then, sprint, cut and spin. Then, sprint figure 8’s.
- Weight Train for Power and Strength/Weight Train for Speed and Endurance- traditionally, weight training is performed with high weights and low repetitions to increase power and strength and both arms and both legs are used at the same time. However, to prevent hamstring injuries, add a few sets of speed/coordination training by performing lifting with low weights and high reps. Also, alternate right and left legs to simulate a walking speed.
- Weight Training Using Negatives/Eccentrics – weight training with a concentration on lowering the weight against gravity, not raising it.
- Exercise All Muscle Groups – of the lower body, not just the quads and hams. Include: Hip flexion, extension, abduction, adduction, internal & external rotation
- Knee: flexion, extension
- Ankle: flexion, extension, inversion, eversion
- Warm -Up: a preactivity slow jog or exercise bike and/or massage to the area to warm up the muscles prior to play.
- Stretching: Indian sit stretch, Hurdler stretch, Lying hamstring wall stretch
- Strengthening Exercises: weight training for legs, including inside and back leg muscles, use weights or resistance tubing for leg curls and hip extensions.
- Agility Drills: figure 8, cross-over, tire or disc running
- Compression Shorts: like those worn under basketball shorts
- Cool Down: use ice to the effected area after exercise or sport
SOURCES: Journal of Physical Medicine & Rehabilitation and American Academy of Orthopaedic Surgeons
Visit your doctor regularly and listen to your body.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.