Are you Hamstrung?

John Steffensen, 29 years old, born in Perth, Australia, specialises in 200m and 400m. His personal bests are 20.79 and 44.73 respectively. He won the gold medal in 400m at the Commonwealth Games in Melbourne, 2006. At the Beijing Olympics 2008, John Steffensen pulled out of the race due to ongoing hamstring injuries.

Hamstring injuries

The 400 metres requires athletes to sprint with rapid acceleration off the start line and to maintain the explosive speed for the whole duration of the race, which can put tremendous strain on the hamstrings. Recent statistical studies in Australia on injury types and injury frequencies have shown that 25% of hamstring injuries will recur in the first four weeks.

The most common cause of hamstring injuries is rapid acceleration and deceleration. The muscle is subjected to the greatest amount of eccentric force. This happens when the muscle is contracting eccentrically to decelerate during the swinging leg prior to foot strike, and the rapid concentric contraction required at foot strike into pull through of hip extension.

Besides the true strain or tear of the hamstrings, there is another group of posterior thigh pain that we call ‘neural hamstring’ problems. It means the pain experienced is due to other factors such as referred pain from the back, the hip, myofascial trigger points or the disruption of the nervous system. The pain tends to be more acute ‘cramping’ or ‘spasm’. This type of pain may appear to have minor strain and is often the most frustrating and difficult to manage.

Neutral Hamstring

Neutral hamstring problem can be detected by performing tests such as Straight-Leg-Raise, Passive-Knee-Extension and Slump Test.

Straight-Leg-Raise test is performed by passively raising the leg with the knee extended. The test will put the muscle, nervous system and fascia on stretch. This can be added with pulling the ankle towards the ceiling.

Passive-Knee-Extension is performed with the hip at 90 degrees, the knee is passively straightened up until resistance is felt. The benefit of this test is that the pelvis is held fixed throughout the test and it places an emphasis on the functional way the hamstring works in running ( i.e. knee extension while hip in flexion).

Slump Test involves sitting on a plinth, hands behind the back, the patient actively extend the knee, pulling the toes toward the ceiling, head bends forward on chest and then the trunk. Pain thus felt in the back of the thigh can be eased by lifting the head up or pointing the foot down.

The back also plays a significant part on hamstring pain. Poor mobility between the joints in the back and poor coordination of the back and pelvis can place unnecessary stress on the thigh muscles. Specific back pathologies can refer pain into the back of thigh or interfere with the function of the sciatic nerve, which runs along the hamstring muscles.

Physiotherapy Intervention

Besides the routine soft tissue techniques of treating a hamstring strain, proper abdominal and pelvic control is an essential component in providing a solid base from which the thigh muscles can function. Good activation of the core system will reduce stress on the spine, thus minimise unwanted transfer of stress to the thigh muscles.

In PhysiCo, all our physios are well trained in diagnosing and differentiating the true hamstring tear from the ‘neutral hamstring’. It is only by accurate diagnosis that the problem can be treated and dealt with properly, thus enable you to carry on with your sporting pursuits. Please do not hesitate to contact us for an appointment.

Written by Ben Lee, sports physiotherapist at PhysiCo. Hyde Park Medical Centre, 175 Liverpool Street, Sydney. NSW 2000. Tel: (02) 9267 3775