Strains Of The Hamstring And Groin Essay, Research Paper

STRAINS OF THE HAMSTRING AND GROIN

I. ACUTE HAMSTRING STRAIN

An acute hamstring ?pull? is a common and frustrating injury occurring particularly in sprinters. It can be related to some of the following factors:

1. Lack of flexibility of the hamstring group.

2. Imbalance in the ratio of strength and power between the hamstrings and the quadriceps. In sprinters the quadriceps are usually stronger than the hamstrings, while in long distance runners the ratio of quadriceps to hamstring strength may be a closer 1:1.

3. Inequality of strength of the left versus the right hamstring group.

4. The fact that the biceps muscle receives two nerve supplies, one to the short head and one to the long head. This theoretically results in an inappropriate contraction of the one head while the other is relaxing.

5. A poor running style, particularly leaning backward when decelerating at the end of a sprint or when attempting to lengthen the stride.

SIGNS AND SYMPTOMS:

With an acute strain the athlete is immediately aware of the condition. Occasionally it feels as if something has ?popped? in the back of the thigh. In severe cases the athlete will describe an intense tearing sensation, with pain from the ischial tuberosity down to the back of the knee. There is usually generalized pain, but tenderness is localized to the area of the actual disruption. Swelling can occur fairly rapidly and obscure the defect of a severe tear. Passive straight-leg raising is limited, and there is inability to fully contract the hamstring against resistance. After a few days, considerable ecchymosis might be noted in the back of the thigh, which will gradually descend to behind the knee.

TREATMENT:

Immediate treatment is with ice and compression, using a cold, wet elastic wrap. The athlete should gently stretch the hamstrings while icing, to help prevent the loss of flexibility that otherwise would occur. Should spasm of the hamstrings prevent stretching, a TENS may be useful. An anti-inflammatory drug and analgesics are given as necessary. If the athlete cannot walk normally, crutches should be used.

A few days after the initial bleeding has subsided, ice therapy can be augmented with isometric contractions of the hamstrings, TENS, ultrasound, gentle frictional massage, and gentle controlled hamstring stretching.

Once hamstring setting exercises are painless, the athlete may be progressed onto an isokinetic apparatus. Then, both the hamstring and the quadriceps groups should be progressively developed. Stretching should be emphasized. When satisfactory strength, power, and flexibility have been achieved, the athlete may begin to jog. A useful exercise is running backwards. Straight ahead running should be gradually increased, but no sprinting should be allowed until the criteria for return to full participation have been fulfilled. (Table 1.1)

II. SLOW ONSET HAMSTRING STRAIN

With this type of strain, which occurs particularly in the long distance runner, progressive tightness and discomfort are noted in the uppermost third of the posterior aspect of the leg. Localized tenderness may or may not be present. Hamstring flexibility is limited, weakness is usually apparent, and asymmetry in the heights of the posterior superior iliac spines is sometimes present, suggesting the association of lower-back joint dysfunction or other lumbar spine pathology. Tenderness is sometimes localized to the ischial tuberosity, suggesting either microtrauma of the hamstring attachment or ischial bursitis.

TREATMENT:

Progressive stretching of the hamstrings, together with various therapy modalities such as ultra sound, muscle stimulation, TENS, ice massage, cross-frictional massage, and stretching with ice massage, may all effect an improvement. Mobilization of the lower back may be indicated. An intensive muscle-balancing and muscle-strengthening program for the hamstring, gluteal, adductor, and quadriceps muscle groups should then be undertaken. A cortisone injection may be indicated in cases of ischial bursitis.

Criteria for return to participation after an acute strain of the hamstring group. Table 1.1

1. There should be at least equal flexibility of the hamstrings bilaterally (preferably more than was present before the injury) 2. There should be equal bilateral strength, power, and endurance of the hamstring group. 3. There should be a satisfactory ratio of quadriceps-to-hamstrings strength, power, and endurance. Hamstring rehabilitation should continue for some time after the athlete has returned to participation.

III. GROIN MUSCLE STRAIN

A strain of one of the groin muscles-the sartorius, part of the rectus femoris, one of the adductors, or the iliopsoai-tends to be a slow healing condition. The athlete complains of discomfort localized in the groin area, particularly when greater speed and a higher knee lift are attempted. Tenderness is usually localized to the muscle involved. For instance, placing the muscle under stress, isometric resistance, or forced hip flexion reproduces the pain.

TREATMENT:

After the initial icing, gentle prolonged stretching of the involved muscle should be instituted, together with a strengthening program for all the groin muscles. These exercises are isometric at first. Once performed painlessly, the athlete progresses to high speed isokinetic workouts.

Tapping/wrapping the upper thigh to hold the hip in slight flexion, which prevents extension, often provides symptomatic relief and may help the athlete to continue participating. Compression shorts are readily available and are popular with many athletes. Ultrasound and, in particular, TENS are accessory means that may help the athlete return to participation. Corticosteriod injections are sometimes used in resistant cases.

Criteria for return to participation after a Groin Strain. Table 1.2

1. Pain free range of motion with flexibility. 2. There should be equal bilateral strength, power, and endurance of the groin. Groin wrap and rehabilitation should continue for some time after the athlete has returned to participation.