Hamstring Strain Injury

It seems that this NFL season hamstring stains have become a frequent injury, which has sideline many of your elite athletes. Could these hamstring strains been avoidable? Are hamstring strains the result of improper training? Or, Are hamstring strains not a hamstring strain, but the result of lumbar spinal neural tension? I would like to discuss those above questions through hamstring strain clinical testing, treatment approaches and differential diagnosis related to neural tension dysfunction.

Dr. James Cyriax reported that a muscular strain will be painful upon contraction and stretch motion. The painful stretch and contraction concepts has continually involved into best practice clinical testing. The research by Reiman et al. “Diagnostic Accuracy of Clinical Tests for Assessment of Hamstring Injury: A Systematic Review” JOSPT, April 2013 compared variety of reported hamstring stretches and hamstring contraction testing, which showed validity of the contraction and stretch principle of Cyriax for hamstring injury.

When treating a hamstring injury, it is very important that you identify the time frame of the injury. In other words, you have established whether the injury is acute or chronic. The treatment approach is different for an acute and chronic muscular injury. You will treat an acute hamstring strain with the traditional focus of; patient education, pain management, edema control, protection of the injury, area and muscle spasm /guarding relief. If the injury is approximately greater than 21 days (reported Kisner and Colby, Therapeutic Exercises), hamstring injury is in its chronic stage. Therefore, treatment focus should be focus on using eccentric exercises. In “Eccentric Muscle Action: Implications for Injury Prevention and Rehabilitation” by Pull et al. stated that eccentric exercises increases the number of sarcomeres in series and increases the optimum torque angle. As a result, eccentric exercises are crucial within the rehabilitation and strength and conditioning program of the hamstring.

Lastly, lumbar spinal neural tension has to be ruled out. Upon passive stretching (Straight leg raise (SLR) passive or active, standing trunk flexion), neural tension can present itself as posterior leg pain. Many of times this symptom is Dx as a hamstring strain. We have two key tests that can be used to differentiate between neural tension dysfunction and hamstring strain. First, hamstring contraction at the knee will not be painful if the cause of pain is neural tension. Second, Brian Mulligan’s SLR distraction technique produces a lumbar segmental gapping effect as you bring the leg into greater hip flexion. If the cause of pain is due to hamstring strain, this motion will be painful. If the cause of the pain is due to neural tension, the Mulligan approach will allow for greater neural mobility, which will allow the leg to continue through full range motion without pain.

Hamstring strains can be avoidable and time away from the sport due to hamstring strain injury can decrease if we train and rehab using eccentric exercises.




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