Author: Ciara Shields

Hamstring Muscle Injuries

If you are involved in sport, at any level, you will know someone who has had a hamstring injury, or you may have even had a hamstring injury in the past yourself.

What are the hamstrings?

They are a group of muscles located at the back of your thigh. Their primary function is to flex (bend) the knee and extend (straighten) the hip. They also have other functions, such as stabilising the knee joint and the pelvis.

They are named Bicep Femoris, Semitendinosus, and Semimembranosus.

There is also a 4^th muscle that blends with the hamstrings called Adductor Magnus

How do they get injured?

There are a few ways in which a hamstring can get injured, but typically the mechanism of injury may be:

• Running / sprinting

• Kicking

• Bending over from the hip

Rehabilitation

Adequate rehabilitation is essential, and your chartered physiotherapist will guide you through this process. The length of time from injury to a safe return to your chosen activity will largely depend on the severity of the muscle injury.

Muscle injuries are graded either: Grade I, Grade II, or Grade III.

Grade I muscle injury: A mild muscle strain

Grade II muscle injury: A partial muscle strain

Grade III muscle injury: A complete muscle tear or rupture

Thankfully the most common injuries are the Grade I and Grade II strains.

Rehabilitation Process

The overall aim of the rehabilitation period will be to strengthen your hamstring back to its pre-injury level and stronger.

Your physiotherapist will structure your rehabilitation into phases. Initially the goal will be to eliminate pain from walking and day to day activities. Once that landmark is achieved you can start loading (strengthening) your hamstring.

As the primary functions of the hamstring muscle group include flexing the knee and extending the hip, the strengthening exercises prescribed will reflect this.

Your program may include the following exercises:

• Bridge

• Squat

• Split Squat

• Deadlift

As well as strengthening exercises your physiotherapist will aim to include running as early as possible into your program. As you progress and get closer to full fitness some plyometric exercises will be added as well as some running drills.

Return to sport

You will set specific goals around return to sport with your physiotherapist. Your physiotherapist will explain and set out the specific criteria that you must meet in order to achieve these goals. This will help you understand your progress and achieve a successful outcome.

Patient education leaflet, taken from international experts in Patellofemoral pain- Barton and Rathleff 2016.

Which of the following statements are True or False:

1. Bed rest is helpful for back pain.
2. Back pain is caused by something being out of place
3. Exercise is safe and good for back pain.
4. Heavy school bags cause back pain
5. Stress, low mood and worry influence back pain

Answers:

1.False. In the first few days after the initial injury, avoiding aggravating activities may help to relieve pain, similar to pain in any other part of the body, such as a sprained knee.  However, there is strong evidence that getting moving early is very important in order to make a good recovery.

So now you know, some of the common myths about back pain.  Interesting isn’t it!  Now, spread the word………

Otherwise known as GTPS, can be one of the causes of pain on the outside of the hip.  GTPS involves the tendons and bursae (small fluid filled sacs) which surround an area of bone on the outside of the hip known as the greater trochanter.

Symptoms include pain lying on that side, pain on the outside of the hip which gets worse with prolonged use and pain climbing stairs.

Risk Factors:

1. Crossing your legs!
2. Training error- too much too soon, leaves tendons vulnerable to injury (tendinopathy.)
3. Repetitive Training
4. Tight ITB (iliotibial band)
5. Poor core stability
6. Standing on one leg for prolonged Periods

Treatment will start with your physiotherapist taking a  detailed history followed by physical examination and a biomechanical evaluation.  Your treatment plan  is likely to include some modification of your current exercise regime and an exercise programme.  It will be tailored to your current function, with consideration given to contributing factors identified during examination and your goals

The achilles tendon at the back of the ankle is one of the  the more commonly known tendons in humans, it connects the calf muscle to the heel bone.  Tendons connect muscles to bones.  Pain and dysfunction in a tendon is known as tendinopathy (previously known as tendonitis.) So, how do tendons become injured? Every tendon has a certain capacity to bear load and when this capacity is exceeded, the tendon can become injured and painful.  This capacity varies from tendon to tendon and between individuals.  There has been some very exciting research in this field over the last number of years, and it is known that under the microscope painful tendons look different to normal tendon.  A type of protein, known as collagen, which forms part of the structure of tendons becomes altered and disorganised, changing the micro architecture of the tendon.  We now know that complete rest is detrimental to the tendon and surrounding muscle and does not aid long term recovery.   Research strongly supports the use of a gradual strengthening programme, over passive treatments (painkillers, electrotherapy, injection) in the rehabilitation of tendon injuries.  A good rehabilitation programme reduces pain and improves the tendon’s capacity to bear load again, allowing you to return to your activity.  Take home messages:

• If you suddenly increase your activity, so that a tendon is taking more load than it’s capacity, is is more likely to become injured.
• Complete rest is detrimental to a tendon in the long term.  Reducing the load (but not complete rest) initially is advisable (for example, perhaps walking instead of running.)  Use it or loose it!
• Don’t have an injection into the tendon without trying a good strengthening programme first.

Poor squatting technique can adversely load the body, leading to injury e.g. spine, hip and knee.  It is useful to use a mirror from the side and then the front in order to check the technique of your squat.  With good squatting technique, you should certainly feel your muscles working but no feeling of strain or ache.   Things to watch for:

• Looking from the front: the centre of your knee cap, should line up over your middle toe, no knock knees!
• Looking from the side, your knees should not move forward in front of the ankle joints, the knee should be directly above the ankle joint
• Looking from the side, your lower back should stay in neutral (gentle hollow), and the spine should neither bend nor arch as you squat
• As you squat, lift your arms up to counterbalance, and bring them down again as you return to standing.  This will help to stop you from falling over!

This weekend will see almost 20,000 people take to the streets of Dublin to participate in the annual Dublin City Marathon. If this inspires you to think about taking up running, there are some helpful tips you should know to reduce your risk of developing a musculoskeletal injury.

In April, Louise took part in RCSI’s public lecture series (RCSIMyHealth) and explored the topic of how to prevent injuries as a recreational runner, as part of an evening of lectures on the topic of Active Lifestyles – are they Helpful or Harmful? No surprise to summarise the evening’s discussion that an active lifestyle carries with it significant health benefits, including adding years to your life. Participation in sport of course does carry some risk of developing a musculoskeletal injury but research evidence is building on how best to identify who is at risk of such injuries, and more importantly, how to go about preventing these injuries.

Louise Keating’s 20 minute lecture summarises this evidence and should be of help to the novice runner or even seasoned marathon runner.

Good luck to those of you taking part in the Marathon on Sunday!

Whiplash Definition

Whiplash (or Whiplash Associated Disorder) occurs when your head and neck is suddenly jolted backwards and forwards (or forwards then backwards) in a whip-like movement, or is suddenly forcibly rotated which may occur in a rear-end or side impact car accident. This may cause, neck muscles, ligaments and joints of the neck to stretch more than normal (sprain) and may result in pain. We frequently use the analogy of the sprained ankle to describe what happens in the neck. The nature of injury and the severity of symptoms vary between different people. A relatively minor accident may cause a big impact to an individual whereas for others there may be no symptoms. The recovery time is also variable from one individual to another.

Common Symptoms

• The main symptoms are pain and stiffness in the neck. It may take several hours after the accident for symptoms to appear. The pain and stiffness often become worse on the day after the accident. You may also feel pain or stiffness in the shoulders or down the arms. There may be pain and stiffness in the upper and lower part of the back.
• Headache is a common symptom.
• Dizziness, giddiness, light-headedness, unsteadiness and a feeling of off balance has been reported in 75% of whiplash patients.
• Blurred vision, pain in the jaw or pain on swallowing, and unusual sensations of the facial skin may occur for a short while, but soon go.
• Some people feel tired and irritable for a few days and find it difficult to concentrate.
• Some people may feel distressed after the motor vehicle collision and these feelings usually settle with time and recovery.

Recovery

Many people recover within a few days or weeks. For 20-25% of patients it may take several months to experience substantial improvement in symptoms. Ongoing symptoms may vary in their intensity during the recovery period.

Investigations

There is no definitive test for whiplash. X-Ray, CT, MRI do not demonstrate hard objective evidence of damage following whiplash injury. Neck (cervical spine) x-rays may be taken to rule out injuries such as bone fractures or dislocations.

Self-Management

The Australian Whiplash Injury Recovery – a Self Help Guide is an excellent resource for patients recovering from whiplash giving plenty of practical advice, exercises to optimise recovery. Stay active and do as many of your normal activities as possible. Some more vigorous activities that place undue stresses on your neck may need to be avoided in the early stages of recovery. Plan gradual increases in activity and exercise levels so that you can successfully return to full participation in your regular activities, hobbies or sports. Continue or resume working perhaps in a reduced capacity at first. It may be necessary to change some work routines for a while. Talk to your employer and colleagues so that you can plan your workload effectively. Don’t be afraid to ask for help from family, friends and colleagues. A good posture will help and minimise stress on your neck, change position regularly during the day.

Physiotherapy

If things are not settling we can advise you how best to manage your symptoms. We assess joint movement, neck muscle strength, neck tenderness and sensitivity. Our treatment approach for whiplash injury is evidence based, meaning it is based upon published research that demonstrates their effectiveness in whiplash injury. Hands on treatment including mobilisation and manipulation combined with exercise including neck strengthening, proprioceptive (balance) and oculomotor (eye movement) exercises have been shown to reduce pain and improve ability to perform everyday activities. Taping may also be part of treatment.

Medication

Painkillers are often helpful and may be recommended by your doctor. Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day. Anti-inflammatory painkillers may be used alone or at the same time as paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with stomach ulcers, asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers. A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. A muscle relaxant such as diazepam is occasionally prescribed for a few days if your neck muscles become very tense and make the pain worse.

If you have any additional questions about Whiplash or to make an appointment, please call 797-9545.

Elaine Maughan MISCP, MSc