Re: Hamstring injury

[Guest guest]

Hi Joe

Joe, as your Dr discussed, one of the possible causes of recuurent hamstrings

tears in children relates to the disparate growth rates of the skeletal and

soft tissue structures during puberty. Often skeletal growth rates

significantly exceeds that of the soft tissues, placing the hamstrings under

considerable tension. The result is that the hamstrings are maintained in a

permanently loaded and stretched position and become tight, fatigued and

weak.

There are a number of other causes that may predispose one to hamstring

lesions such as referal of pain from the lumbar spine, meniscal problems at

the knee and biomechanical problems at the foot to name a few.. Lets

discuss some more likely causes considering your sons age and level of

activity.

Postural variations such as increased lumbar lordosis and concurrent

anterior pelvic tilting moves the origin of the hamstrring muscles (ischial

tuberosities) further away from the distal attachments of the hamstring

groups. This will result in an increase in the resting muscle tension. The

hamstring will not only be functionally tighter but will be more inclined to

early fatigue. Such postural abnormalities require correction of muscle

imbalances around the pelvis using stretching and strenghthening strategies.

Poor running style may also lead to recurrent hamstring tears. The

hamstring work at significantly higher speeds with a large eccentric

component in running sports. A poorly coordinated running style which

places a large workload on the hamstrings may again provoke early fatigue

and injury. Finally abnormal quadriceps power due to excessive quadriceps

muscle hypertrophy may produce an abnormal force in the hamstrings,

particularly when there is a loss of coordination due to fatigue (commmonly

seen in athletes who mix cycling and endurance running).

What can you do? Correction of muscle imbalances requires exercises to

improve posture, strength, endurance, coordination, proprioception and

flexibility. As a general rule muscle tightness should be adressed before

strenghtening. Strengthening should involve functional retraining of the

hamstrings in an eccentric muscle function.

As you can see it can become quite complicated. The cause of the hamstring

tears whether it related to a growth spurt or pelvis dysfunction needs to be

adressed to ensure these tears dont become recurrent.

CAUTION The sciatic nerve travels very close to the hamstring origin and may

be involved with the hamstring tear. It is quite possible that the buttock

pain (piriformis symptoms) may be originating from sciatic nerve irriation

near the tear itself. This needs to be assessed and treated to prevent

tethering of the sciatic nerve which can cause unnecessary neural problems

for your son down the track.

My advice for your son is to seek a musculoskeletal specialist who can

assess any predisposing factors to hamstring injuries such as pelvic, knee

and foot biomechanics and muscle imbalances. There are a variety of

techniques avialable to therapist to corect pelvic dysfunction and or muscle

imbalances which are beyond this email.

PS It interesting to note that muscle strength in adolescence does not

significanlty increase to adult levels until approximatley 1 year after peak

height velocity is reached and of course we must also remember that children

< 15yrs are not little versions of adults. They respond to exercise

differently because of differences in their physiology and biochemistry.

Regards

BRENDAN DIPLOCK

B.Physio

[Guest guest]

I think I may be able to help with your sons hamstring

problem. I am colliegiate football player and compete

as decathalete in track and field, so I have had some

" hammy " problems in the past that I have been able to fix.

First don't stretch first in your workouts, jog a

few laps to warm-up, then, instead of stretching, do a

dynamic warm-up, i.e. high knees, butt kicks, walking

lunge, side walking and most important backwards run,

leaning forward really kicking the legs backwards. All

these done for about 30 meters and then you may try to

stretch out the hamstring.

In the weightroom you could

try the glute/ham machine for about 3-4 sets of 8 reps

with bodyweight a couple of times a week. Do not do

these though until the pain is gone in the hamstrings

as to not reinjure the area but rather strengthen the

hamstrings. You can look at www.allsport.com for video

clips of the dynamic flexibility drills.

Frisch

--------------

Joe E. Littleton<jelittleton@...> wrote:

> My son has recently been having trouble with

> hamstring pulls, having pulled

> his left ham at the insertion point, resulting also

> in an irritation of the

> piriformis, a few weeks ago and then last week

> pulled his right ham at the

> belly of the muscle. He is 13 and has grown over 6 "

> in the last year. The

> doctor says that because of his growth spurt he has

> developed a muscle

> imbalance and must work to strengthen the hamstrings

> so that he will not

> continue to suffer the problems.

>

> We have a 20lb ortho boot with 1lb adjustments, plus

> a fully equipped gym

> complete with dumbbells, Olympic weights, power

> racks, knee machine

> (isokinetic push/pull), Isokinetic power rack, and

> various and sundry other

> workout equipment. I have been making him ride a

> schwinn airdyne for three

> minutes in the morning then doing a thorough stretch

> of hamstring and quad

> and ride 30 minutes after school and thoroughly

> stretch. Every other day, I

> have him do 5 sets of 15 in the knee extension and

> the hamstring curl.

>

> Does anyone have any further suggestions to

> facilitate recovery and balance

> of the hamstring. He is a competitive soccer player

> and is going to start

> running track this year.

>

> Any help would be appreciated.

>

> Joe Littleton

> Director, Phoenix Engineering Inc.

> Houston, TX

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Joe,

I suggest you get his lumbar spine assessed. It sounds as though there are

significant neural tension problems here. In growth spurts it has been

suggested that bone grows in length before the muscles and nerves have time

to adapt, and over time these structures accomodate to increased length

(though I wish to avoid the word " growth " when describing an adaptive

lengthening of muscles as the cells do not proliferate, but I'm not sure

about nerves? - Mel??.

In the early stages this creates quite a deal of tension in the neural

system. The hamstrings are tight to protect this system, and often lumbar

spine problems can perpetuate the situation. I bet he has limited hip

range, and a sore L5-S1. I would be looking at closed chain work that will

incorporate his gluts, and proximal and distal stability eg. squats, lunges

(which require considerable hamstring control but also may lengthen at the

same time). Neural mobilisation and hip stretches may help also. I don't

think just strengthening his hams will help your lad - sorry. Especially

for soccer, this requires good proximal and distal stability (as Mel suggests

frequently).

Regards,

Epsley

PHYSIOTHERAPIST

Northside Sports Injury Centre

Brisbane, Australia.

-----------------------

Joe E. Littleton wrote:

<My son has recently been having trouble with hamstring pulls, having pulled

his left ham at the insertion point, resulting also in an irritation of the

piriformis, a few weeks ago and then last week pulled his right ham at the

belly of the muscle. He is 13 and has grown over 6 " in the last year. The

doctor says that because of his growth spurt he has developed a muscle

imbalance and must work to strengthen the hamstrings so that he will not

continue to suffer the problems. .....>

[Guest guest]

DC,

Since you are in Silverton, I would refer

to Dx Ultrasound for imaging with Goeser, MD, DC. Other objective

measures are strength, Doormat Sign, SLR. Torso Flexion ROM and strength.

KT Taping is very helpful in the region,

compression shorts, rehab exercises, Graston Technique.

Ted

Ted Forcum,

DC, DACBSP

ACA Sports Council, President

'08 US Olympic

Sports Medicine Team Member

Back

In Motion Sports Injuries Clinic, LLC

11385 SW Scholls Ferry Road

Beaverton, Oregon 97008

503.524.9040

www.bimsportsinjuries.com

The information contained in this

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From:

[mailto: ] On Behalf Of cote@...

Sent: Tuesday, December 22, 2009

2:40 PM

Subject:

Hamstring injury

I have a healthy 30 yo male that injured himself by

walking on top of a

pile of X-mas trees and his leg sinked and got stuck while moving rapidly.

The torque applied to the leg created a twisting motion strong enough to

give him a good lumbar sprain and a Hamstring strain. I have been treating

for about ten days and the lumbars are feeling very well, but his

hamstring is still terrible. Tx has included, ultra sound, EMS,

massage,

trigger point and chiro. I am not sure what else to do to speed up his

recovery and how to put a objective evaluation of the extent of the

strain. Should I order an MRI? Any suggestion is welcomed.

Thanks and Joyeux Noel a tous!!!

Cote

Silverton

[Guest guest]

DC,

Since you are in Silverton, I would refer

to Dx Ultrasound for imaging with Goeser, MD, DC. Other objective

measures are strength, Doormat Sign, SLR. Torso Flexion ROM and strength.

KT Taping is very helpful in the region,

compression shorts, rehab exercises, Graston Technique.

Ted

Ted Forcum,

DC, DACBSP

ACA Sports Council, President

'08 US Olympic

Sports Medicine Team Member

Back

In Motion Sports Injuries Clinic, LLC

11385 SW Scholls Ferry Road

Beaverton, Oregon 97008

503.524.9040

www.bimsportsinjuries.com

The information contained in this

electronic message may contain protected health information confidential under

applicable law, and is intended only for the use of the individual or entity

named above. If the recipient of this message is not the intended

recipient, you are hereby notified that any dissemination, copy or disclosure

of this communication is strictly prohibited. If you have received this

communication in error, please notify Back In Motion Sports Injuries Clinic,

LLC at 11385 SW Scholls Ferry Road,

Beaverton, OR-97008.

and purge the communication immediately without making any copy or

distribution.

From:

[mailto: ] On Behalf Of cote@...

Sent: Tuesday, December 22, 2009

2:40 PM

Subject:

Hamstring injury

I have a healthy 30 yo male that injured himself by

walking on top of a

pile of X-mas trees and his leg sinked and got stuck while moving rapidly.

The torque applied to the leg created a twisting motion strong enough to

give him a good lumbar sprain and a Hamstring strain. I have been treating

for about ten days and the lumbars are feeling very well, but his

hamstring is still terrible. Tx has included, ultra sound, EMS,

massage,

trigger point and chiro. I am not sure what else to do to speed up his

recovery and how to put a objective evaluation of the extent of the

strain. Should I order an MRI? Any suggestion is welcomed.

Thanks and Joyeux Noel a tous!!!

Cote

Silverton

[Guest guest]

,

this may be a late reply and you've already found solution. However, I'd suggest cold laser and/or micro-current stim on the hamstring. You didn't mention if you palpated a tear. Is there any bunching of the muscle, palpable or visible?

Minga Guerrero DC

[Guest guest]

,

this may be a late reply and you've already found solution. However, I'd suggest cold laser and/or micro-current stim on the hamstring. You didn't mention if you palpated a tear. Is there any bunching of the muscle, palpable or visible?

Minga Guerrero DC