Tag Archives: hamstring injuries

03Sep/12

Another hamstring injury, but how serious is it?

The hamstring injury is one of football’s blights, affecting so many of our best known players. The latest is Andy Carroll who sustained the injury yesterday in his first game at West Ham – read here. The extent of the injury will be clearer following a scan. Hopefully this will be a minor insult that will be fully resolved with a rapid, yet safe return to play.

A study published this year in the BMJ looked at the use of the MRI scan as a prognostic tool for lay-off after hamstring injuries in professional footballers and the association between the MRI findings and injury circumstances. It was found that: ‘70% per cent of hamstring injuries seen in professional football are of radiological grade 0 or 1, meaning no signs of fibre disruption on MRI, but still cause the majority of absence days’. This is an interesting point as it demonstrates that significant time out of football for hamstring problems is not underpinned by serious tissue damage. We know that pain is not an accurate indicator of tissue damage and certainly I have seen many patients who experience repeated injury, yet there is no clinical evidence for an inflammatory response, the early stage of healing.

The seriousness of the injury can be measured by the impact it has upon the player’s ability to perform. This would include the time it takes to return to the field. It appears from the aforementioned study that the tissue basis for the injury does not explain the extent of the lay-off. What other factors could play a role?

The circumstances around an injury include the state of the tissues and mind in the lead up to the incident. Nothing happens in isolation. There is a background to any injury, even if it is sustained during a tackle, sprint or other seemingly unique event. The background includes general fitness, tissue health, stress, emotional state, hydration, fatigue and a previous experience of injury, particularly if it is in the same body region.

A new or recurring injury – what to do?

Therefore, when assessing a new injury, pain or recurrence, it is vital to consider these factors to establish early on the potential risks for longevity of the condition. A rapid diagnosis, reassurance and a plan certainly help. The player needs to know what has happened, what can be done and what they will need to do to get back to the field of play. This is the same for any level of participation. The immediate way in which the inury is managed and thought about by the player can have an impact upon the recovery. For example, if the injury is ridden with fear and concern, often unhelpful choices are made with regards to self-treatment. Knowledge allows for adjustment and effective management to move forwards through the healing process proactively towards the more functional stages of recovery without unneccesary anxiety.

Pain without an obvious injury or damage

Pain can often exists without any significant damage to the tissues, or any at all in some cases. A problem can present as a hamstring pull, it feels like a hamstring pull, yet there is no sign of an actual injury. Equally, a player could rupture muscle fibres and not feel the pain immediately. In most cases the pain is largely co-existent with the injury, but as we have seen, there does not have to be a huge tear. The message is that we should not use pain as the sole guide to the severity of the injury, however we must seek to treat the pain in the best way we can to reduce the risk of pathological behaviours developing-that would prolong revovery. In a less acute situation when there are no clear signs of injury, often there is sensitivity to movement in the sciatic nerve that has become excited through the mechanism or irritated by inflammatory molecules. This can be highlighted with the slump test. The sciatic nerve supplies the hamstring muscles and when sensitive can manifest pain in any of the tissues in which it innervates.

Summary

The seriousness of an injury is very individual with a hamstring injury potentially affecting the career and income of the professional player versus the inconvenience and disappointment of an amateur, part-time player, although with no-less suffering. How much damage has been sustained will also vary and cannot be assessed purely on the basis of the amount of pain. Many factors influence how an individual responds and copes with an injury, and certainly fortifying these mechanisms is key in the early stages with rapid diagnosis, reassurance and treatment.

If you are suffering recurring hamstring injuries, call us now on 07518 445493 to learn what you can do to tackle the problem and return to playing football

08May/12
Motta hamstring injury Euro 2012 final | Hamstring injuries | Football injuries

The hamstring | a common recurring problem

The unfortunate Thiago Motta of Italy suffered what appeared to be a hamstring injury just minutes after coming onto the pitch last night. The Euro 2012 finalists were already under severe pressure from the dominant Spanish team when he was stretchered off the field clutching the back of his thigh. The Brazilian-Italian footballer was expressing his and his nation’s agony as they eventually lost 4-0.

Hamstring injuries are common in football. Often seen as the player pulling up having been sprinting, he clutches the back of his thigh, then hopping or hitting the floor. The amount of pain can vary as in any injury as pain is not an accurate indicator of the amount of actual damage.

The hamstring group is made of three muscles situated on the back of the thigh: biceps femoris on the outside, and semimembranosus and semitendinosis on the inside. They run from the pelvis to the lower leg, bending the knee but also slowing the knee down as it straightens. It is often in this latter phase that the ‘pull’ occurs.

When the muscle is pulled it can be difficult to walk. There can be bruising and swelling in the thigh, although sometimes this is deep in the leg and therefore not immediately visible. With rupture of the muscle fibres, the blood and fluid may track down the leg, causing bruising and swelling to appear lower than the injury.

With an acute injury, ‘PRICE’ is the management strategy of choice where P is protection, R is rest, I is ice, C is compression and E is elevation. In the early stages of an injury and the healing process there is pain, redness, swelling and heat. These are all manifestations of the inflammation that starts healing. Despite the unpleasantness, the signs and symptoms are the body’s responses to injury and are normal. Seeking the advice of a health professional is advisable so that you can fully understand the problem and what you must do to facilitate the most effective recovery.

When we have recovered from the acuteness of a hamstring injury, an individualised training programme must be designed, explained and implemented by a trainer or physiotherapist. This should be followed, progressed and completed to reduce the risk of future problems in the same area. The exercises and drills become increasingly functional, rehearsing the types of movements and skills needed to perform. This routine is practiced so that the player is ready physically and mentally for the demands of the game.

It is not uncommon for a twinge or similar pain to be felt in the back of the thigh sometime after the original injury. Of course there can be a re-injury where actual muscle fibres or tissue can be damaged. However, there can equally be cases whereby it feels like the original injury but there is no actual damage. In this situation, the brain has recognised the pattern of movement, determines a potential threat and responds with a pain in the back of the thigh, more as a warning shot. This means that there is still an underlying sensitivity that may have been felt as a persisting tightness (‘my hamstrings are always tight’, I often hear) or some discomfort with running or sitting with pressure on the muscles. This low level sensitivity and tightness requires a different treatment and training approach. To determine the difference, you should see a physiotherapist or other healthcare professional who can assess your situation and advise you on a specific course of action.

If you have a recurring hamtrsing injury or pain in the back of your thigh that is stopping you return to full play, call us now: T 07518 445493

27May/11

Persisting & recurring sports injuries: Specialist Clinics in London

Do you have a recurring sports injury? Do you continue to experience pain when engaging in exercise? Are you struggling to return to play after an injury or an operation?

This is one of the reasons why Specialist Pain Physio Clinics were set up in London and Surrey. The blight of on-going problems and pain after an injury or pain that has just crept up on you over time. In these situations, the tissue-based model of care does not suffice. In persisting states of pain, there are changes throughout the nervous system and other body systems at play to influence the processing of pain. Our movement changes, our thoughts about movement and exercise change and the pain changes with time. All of these changes require addressing and that is what we do.

Why does it persist?

There are some good reasons that we know of including continued change in movement, on-going guarding and protection, altered processing of sensation and psychosocial factors such as fear of movement, anxiety, negative emotions and beliefs. Addressing these and other issues is fundamental in handing back control, providing relief and moving forwards towards resumption of activities and sports.

What do we do?

Like Sherlock Holmes we look for the clues to your on-going experience and then design a treatment programme to target these mechanisms. We consider the type of pain(s) you are experiencing, the role of influential body systems, your lifestyle factors, your expectations and beliefs, the goals of the programme and other pertinent aspects of the experience. From here we use a range of strategies and therapies to facilitate your active participation in progressing towards your goals. Some of these therapies include mobilising muscles and joints if that is an issue (to guide normal movement and create normal sensation), specific exercises to restore control of movement with enhancements to create the best possible outcome, self-care strategies for day to day living and very modern approaches that facilitate learning and training in the brain (e.g. Motor imagery, sensory discrimination).

Overall we aim to create the right circumstances for your body, brain and mind to resolve the physical, psychological and social issues around persisting pain and injury.

So, if you are struggling with a persisting injury and/or pain, whatever your level of participation or sporting choice, get in touch and we can help you to achieve your goals.

T 07815 445493