Cheatography
https://cheatography.com
Presentation, management etc
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Causes of hamstring strains
- See Upper leg muscle cheat sheet for anatomy |
- Strain caused by excessive load during eccentric contraction/extreme stretch |
- Bicep femoris most commonly involved |
- Sports that involve sprinting and jumping most likely to sprain hamstrings (eccentrically) - terminal swing phase just before foot contact |
- Stretching injuries involve water skiiing, martial arts and dancing |
- Most vulnerable when function rapidly changes from eccentric deceleration of the forward swinging tibia to concentric extension of the hip joint |
- Muscle fatigue - insufficient warm up, hx of prior injury, hamstring inflexibility/weakness |
- Quads strength overpowers capacity of the hamstring to eccentrically decelerate forward progression of the tibia during terminal swing phase |
- FAI - limits hip ROM |
- Hypertonicity of the quads, iliopsoas, inadequate control of lumbopelvic muscles , poor running mechanics |
- More common with age |
- Black people most affected |
- Males more affected |
Classification
Grade I: Strain without significant fibre tearing |
Grade II: Partial muscle tearing |
Grade III: Complete muscle/tendon rupture |
Presentation
- Most occur during activity |
- Tearing feeling + significant pain |
- Pain in lower buttock and posterior thigh when straightening leg |
- Bruising, swelling present |
- Tenderness over the injury |
- PROM - may produce pain with passive hip flexion and knee extension |
- RROM - pain reproduced with hip extension/knee flexion |
- Braggards to differentiate between hamstring injury and lx radiculopathy |
- SI /lumbar restrictions |
- Neurological exam unremarkable - IF +ve NEURO FINDINGS, CONSIDER OTHER DIAGNOSIS |
Imaging
- Often unnecessary unless avulsion f# /other bony pathology is suspected (Ischial tuberosity) |
- Only MRI if severe and surgical intervention is needed |
DDx
- Contusion |
- F# |
- Neoplasm |
- Hip Pathology |
- Posterior Compartment Syndrome |
- Adductor strain |
- Ischial Bursitis |
- Herpes Zoster |
- Piriformis Syndrome |
- Lx referral |
- Consider Lx radiculopathy if +ve neuro findings, without trauma or pain extending below knee |
Management
- Difficult as healing is delayed with persistant syndromes and moderate re-injury rates |
- Proximity of the injury to the ischial tuberosity correlates with recovery (more proximal = longer) |
- Phase I: RICE, Compression bandage, cryotherapy, immobilisation/crutches for severe injury - avoid sustained knee flexion when using crutches |
- SMT/EMT of Lx, SI, LL |
Progress to Phase II when patient can walk withiout pain and moderately tolerates resisted knee flexion |
- Phase II: Increase running to 50% of maximum and avoid sprinting , stationary cycling/swimming , stretching of psoas, hamstring, adductors, quads and lx |
- Nerve mobilisation |
Progress to Phase III when pt is able to perform pain-free resisted knee flexion and can run at 50% speed without pain |
- Phase III Gradually increase jogging from 50% to full sprinting, resolve gait abnormalities and orthotices, should not return to sport unless full knee ROM, adequate hamstring to quads ratio and pain free has been achieved |
- Advice on proper warm up/cool down |
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