Hamstring injuries aren't just for QBs
Philadelphia quarterback Michael Vick injured his hamstring muscle in early October, and after three weeks of rest, he tried to return to lead the Eagles against the Giants on Oct. 28. Unfortunately, he wasn't ready to return and was reinjured.
I have a confession to make: I am an Eagles fan, God help me. As such, I am painfully aware of the inability of Mr. Vick to perform in the Eagles' high-speed offense without a healthy hamstring.
Time to answer a few commonly asked questions: What is the hamstring? How is it injured? What is the best treatment?
A hamstring strain is a tear of the muscle fibers of the hamstring - a group of three muscles in the back of the thigh that run from the back of the hip (lower pelvis), crossing the back of the knee and attaching to the knee bone (tibia).
The hamstring muscles work to extend the hip and bend the knee during running and walking. They are very active when an athlete changes direction, especially forward and backward or decelerating.
This injury, like other muscle strains, varies in intensity. Severe hamstring strain occurs when many muscle fibers are torn. The athlete may experience a sudden, severe pain in the back of the thigh and occasionally report a popping sensation. Pain, swelling and black-and-blue skin from tissue damage and bleeding is often reported. Pain increases when you try to bend the knee. In very severe cases, the bony attachment can be pulled so strongly that a small fracture can occur. Healing time can be as short as a few days or as long as weeks or even months.
Causes of strain
The most common causes of hamstring strain are:
-âOveruse: Every time the knee is bent, the hamstring muscles must contract. If there is inadequate time for rest between workouts or competition, the muscles may be fatigued and become vulnerable to injury. Also, overuse of the same muscles without rest may make them irritated and inflamed.
-âInadequate warm-up: A warm muscle stretches like a piece of gum warmed up in your mouth. When you pull the warm gum, it stretches. But if you drink an ice-cold drink with gum in your mouth and then stretch the gum, it will tear instead of stretch. A good warm-up will prevent tearing and prepare the nervous system for sudden movements and changes in direction.
-âSudden movement: Quick sprints, sudden changes in direction and quick turns with an unexpected force or slip.
-âPoor body mechanics: This is especially problematic when moving or lifting a heavy load away from your center of gravity.
-âForceful contact or loss of traction: This happens when a leg is forced away from the body by an outside force - like a tackle in football - or a slip on grass or ice.
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 your 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.
There are many conservative options. Your family physician or orthopedic surgeon will help you decide which choices are best.
-âAnti-inflammatory medications such as aspirin, acetaminophen or ibuprofen to reduce pain and swelling.
-âOrthopedic physical therapy such as heat, cold, ultrasound, electrical stimulation, joint mobilization, massage, range-of-motion exercises, strengthening exercises and supportive compression strapping. Once you're pain-free, a preventive training program is essential to prevent reinjury.
-âActivity modifications. If it isn't the week of the district tournament, rest and avoid running or stretching/stressing of the thigh muscles.
-âSupportive devices such as thigh wraps or sleeves and compression shorts (like those worn under basketball shorts) can provide compression and relief.
Recent studies have determined that a training program specifically designed to prevent hamstring injuries is effective, especially for the competitive athlete. This program includes high-intensity training (such as interval sprints); simulating the demands of your particular sport; weight training for power, strength, speed and endurance; exercising all muscle groups of the lower body, not just the quads and hams; proper warm-up; stretching; agility drills; and proper cool-down, with ice on the affected area.
PAUL J. MACKAREY, P.T., D.H.Sc., O.C.S., is a doctor in health sciences specializing in orthopedic and sports physical therapy. He is in private practice and is an associate professor of clinical medicine at Commonwealth Medical College. His column appears every Monday. Email: firstname.lastname@example.org.