P.R.I.C.E. Principle Sports Injury latest 2023

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Hamstring Injury

The hamstrings are a thigh muscle group located in the posterior part of the thigh (back of the upper leg) and are a common site of injury and persistent pain in athletes. Typical areas that are preferentially injured are higher in the thigh near the buttock and towards the outer side of the leg. The hamstring muscles have not been given common names and retain their Latin names: biceps femoris; semi-tendinous and semi-membranous. The biceps femoris is most often injured from these three muscles.

A severity classification is applied to hamstring injuries to aid in diagnosis and treatment. A grade 1 injury will involve damaged muscle fibers but relatively mild strain. A grade 2 injury will involve moderate muscle strain with assessable loss of muscle power and a grade 3 injury involves a complete muscle tear or tear of the musculotendinous unit. Injuries are most common at the tendon-muscle junction in the upper areas of the muscle, although the tendon-muscle junction of the biceps femoris occurs for much of its length. Injuries to the tendons themselves are rare unless there is already a definite pathology.

The ischial tuberosity (the bones we sit on or the “buttock bones”) is where most hamstring tendons originate. An avulsion fracture can occur at this stage where a sudden large range of motion occurs without warning and tears the tendon from the bone connection, a condition most commonly seen in people who water ski. Young people have a greater number of these injuries as they are more active in sport and participate in risky activities such as contact sports, outdoor sports, sprinting, rugby and football.

The hamstrings begin at the ischial tuberosity of the buttock, run down the back of the thigh, and insert into various places on the tibia or fibula. When these muscles contract and lengthen at the same time (eccentric contraction), as in track events and rugby, the risk of injury can be high. Direct muscle blows can lead to tissue bruising while water skiers are more prone to avulsion injuries when falling because they experience rapid hip flexion with straight knees. The onset of hamstring strain is usually sudden and often when the person is moving rapidly, with audible popping in the muscle often reported.

Pain is immediately felt in the back of the thigh and the injury often occurs at the start of activity (not yet warmed up) or at the end of activity where fatigue may be a factor. General movements and functional activities such as climbing stairs can be painful provided the injury is not too severe. There may be little to see in the back of the thigh in these patients, but testing the ability to bend the knee against resistance can cause a painful response. If one of the hamstring muscles is torn, it may contract into a ball during the test and the examiner will notice the reduced strength.

It is believed that an increased risk of suffering a hamstring injury occurs if the force ratios of the quadriceps and hamstrings are incorrect, the person is tired, there is poor warm-up or limitation of flexibility. A history of hamstring injury is a significant risk of having a recurring strain. The approach to injury treatment is dictated by the severity of the muscle and tendon damage and a physical therapist will quickly progress a person with mild strain to strength training from a range of motion, while more serious injuries may even require surgery.

The primary goals of physiotherapy for a moderate level injury would be to limit the degree of local swelling and reduce pain and inflammation from soft tissue damage. Physios use PRICE principles in the following cases: Protection of damaged tissue to prevent further damaging stresses from being applied; Rest from normal activities and sports to allow the healing process to continue; Ice in 20-minute bursts to control inflammation and pain; Compression on the damaged area with elastic bands; Elevation of the piece is not straightforward due to its location and the fact that the patient wishes to keep their knee bent.

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