THIGH INJURY, HAMSTRING |
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General Information
DEFINITION--An injury to a hamstring tendon. The hamstrings connect the muscles of the thigh to the back and side of the knee. These tendons can be felt behind the knee on either side. They feel like tough rope. Hamstring tendons, muscles and bone comprise units that stabilize the knee and allow its motion. The injury, usually a strain, occurs at the weakest part of a unit. Hamstring strains are of 3 types:
Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers of the muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Hamstring tendons and associated muscles.
Bones in the pelvis and knee joints.
Soft tissue surrounding the injury, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
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SIGNS & SYMPTOMS
Pain when moving or stretching the leg.
Muscle spasm of the injured muscles.
Swelling over the injury.
Weakened leg (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the hamstring tendon or muscles (visible with X-rays).
Inflammation of the sheath covering the hamstring tendon.
CAUSES
Prolonged overuse of muscle-tendon units in the leg.
Single violent injury or force applied to the muscle-tendon unit in the leg.
RISK INCREASES WITH
Contact sports.
Running, jumping and quick-start sports.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Obesity.
Poor nutrition.
Previous pelvic or knee injury.
Poor muscle conditioning.
HOW TO PREVENT
Build your strength with a long-term conditioning program.
Warm up adequately before practice or competition.
Use proper protective equipment, such as knee pads and thigh pads, during participation in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care.
Application of tape, plaster splints or a cast (sometimes) if a muscle ruptures or the muscle-tendon-bone attachment loosens.
Self-care during rehabilitation.
Physical therapy (moderate and severe injury).
Surgery (severe injury).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the pelvis, femur and knee to rule out fractures.
POSSIBLE COMPLICATIONS
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic knee following repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
Continue using an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured area. Use for 20 minutes at a time.
After 24 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Wrap the injured leg with an elasticized bandage between ice or heat treatments.
Massage gently and often to provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Non-prescription medicines such as aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger medicine for pain, if needed.
Injection of a long-acting local anesthetic to reduce pain.
Injection of a corticosteroid, such as triamcinolone, to reduce inflammation.
ACTIVITY
For a moderate or severe injury, use crutches for at least 72 hours.
Resume your normal activities gradually.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe hamstring injury, or a mild injury persists longer than 10 days.
Pain or swelling worsens despite treatment.
Either of the following occurs with a cast or splints:
Pain, numbness or coldness below the injury.
Dusky, blue or gray toenails.
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