Hamstring strain can survive a challenge for athletes and clinicians because of their high incidence, slow healing and the symptoms. These lesions are common in sports that involve sprinting – such as football, athletics, rugby and football, and to limit even in sports with ballistic movements, such as Martial Arts.
Impact and risk factors:
The average number of days lost due to a hamstring strain generally in the range 8-25 days, depending on the location and severity of the injury. Unfortunately, there is a high risk of re-injury during the first two weeks after sports participation resumed. The authors suggest that this is often by inadequate rehabilitation program, a premature return to sports, or a combination of both.
The age of the person and a history of hamstring strain has as risk factors for injuries that are not modifiable were identified. modifiable risk factors include muscle weakness, fatigue, lack of flexibility and an imbalance of strength (hamstring quadriceps or disadvantages eccentric vs. concentric), and coordination deficits of the trunk and pelvic floor muscles.
The objectives of the clinical examination are discussed here:
1st To describe the diagnostic investigation of lesions due to the acute hamstring emphasis on tests and measures that have predictive value;
2nd A comprehensive guide to rehabilitation on the basis of existing evidence recovery time and the risk of re-injury and minimize
3rd To recommend future directions for research on mechanisms of injury and recovery, to develop better prevention and rehabilitation more individualized.
Clinical Summary:
History
• Mechanism of injury: high speed runs, the most common Achilles tendon injury specific. Sudden eccentric load (as when one follows through after kicking a football or martial arts for example) is also a common mechanism.
• Due to the high recurrence rate patients report a previous injury. In addition, injuries in a “familiar” at or near a city occur earlier injury.
• Most patients with an audible “pop” at the time of the accident, that is associated with immediate pain, often involving the proximal tendon. They are often not in a position to the activity because of pain (1 continue)
• Patients may experience difficulty in walking or running, or pain during the session if the injury to more proximal.
Place of injury:
• Injuries involving intramuscular tendon or fascia and the adjacent muscle (eg biceps femoris during training at high speed) require usually a shorter period of rehabilitation than those involving the proximal free tendon (eg semimembranosus tendon strain and kicking dance classes).
• The injuries from the partial or complete ruptures often the result of extreme flexion of the hip and energetic and often require surgery with a long rehabilitation.
• It is important to note that the actual duration of rehabilitation was to show how predictable from combinations of clinical tests based on measures of severity of injury sustained by an MRI.
• As the wounds would move more proximal to the ischial tuberosity and / or involves increasing the length and diameter – extends the duration of treatment and rehabilitation.
• There is no connection between the original evaluation and the ability to assess the risk of recurrence seems the injury. The gifts, the violations as serious based on physical findings or MR imaging results were not a higher rate of re-injury.
Review:
• The main objective of the review, after a careful examination should be to identify the exact strain of the Achilles tendon and to assess the resulting dysfunction
• Strength evaluation of the thigh muscles is applied by the manual resistance setting on the knees and hips is recommended. It is important to note that provocation of pain during strength testing is also appropriate to conclude that the weakness and bilateral comparison should be made for each measurement. It is important that, because the muscle with variable length, which occurs in various amounts of hip and knee flexion. Therefore, the positions of the many tests carried out to stabilize the isometric force and provocation of pain (eg 15 and 90 ° in the hip resistance at 0 ° extension of the method).
• Range of motion in the acute phase is often limited because of the pain and can not be an accurate assessment of the flexibility of the muscles. Hamstring length was typical to flex the hip, 80 degrees while lifting the right leg passive knee extension at 20 ° to the test of knee extension force.
• palpation of the site to determine the point of maximum pain (compared to the buttock), is associated with the recovery phase. The more proximal to the point of maximum pain shows more time to the level before the accident, (2) to return. It is also necessary to identify specific region (provocation of pain) and the presence / absence of an obvious defect in the muscle-tendon unit.
• neural tension has implications for pain in the posterior thigh and is evaluated by a test case, force. A positive result indicates a contribution more proximally and is often caused by people who suffered hamstring recurrent injuries (by residual inflammation and scarring) have associated. It should include the participation of neurons in the absence of a mechanism of injury.
• Image Processing: Recent MRI studies of Class I and II acute hamstring strain indicated that anomalies (eg, edema) may help in the presence and severity of injuries and an estimated time of recovery confirm, but are not in a position to risk of people hurt again predict. MRI is superior to ultrasound than for the deeper muscles to avoid injuries of the past, because the remaining scars measured, increased sensitivity to the size of the injury and to identify subtle edema.
Prognosis and rehabilitation:
• Several factors must be taken into account are likely to contribute to the high rate of re-injury in the posterior thigh muscles:
(1) the continued weakness of the muscle injured
(2) extensibility reduced unit musculotendon because of remaining scar tissue and
(3) adaptive changes in biomechanics and motor patterns of sporting movements following the first violation.
• Research continues to show that evaluate the risk of recurrence of injury by strategies that rehabilitation exercises, neuromuscular control and eccentric strength training, objective measures for the recovery of muscles, tendons can be combined to minimize and ready to return to sport.
• eccentric strength training is appropriate because of its effect on reconstruction of the damaged tissue and muscle-tendon reset the duration of voltage to a more appropriate – scar tissue is stiffer than the contractile tissue that replaces and modifies the mechanics of muscle contraction.
• neuromuscular control of the region lumbopelvic is also necessary for optimal function of the hamstrings during normal sporting activities – so clinicians are encouraged to assess and prescribe exercise basic measure of stability and improve muscle coordination.
• Another factor to consider is that early use of neuromuscular mobilization of the remaining adverse effects of scar tissue formed boundaries early in the process of transformation. Early mobilization has been shown to the penetration of collagen fiber orientation and muscle regeneration through the scar tissue and promote recapillarization to the injured area.
• If the voltage of the neuron is found in the review – nerve “dental floss” or mobilization techniques could be used.
• Evidence of additional measures, such as electrotherapy and massage therapy are to be supported at this point is inconclusive.
Clinical Applications and conclusions:
It is important to remember that help the location of injuries in the hamstring group can predict the duration of treatment and rehabilitation. More specifically, about the injuries to the sciatic tuberosity and the size of the affected area, most rehabilitation. Due to the high incidence of injuries that support the knee tendon various sports and activities of the commentators, the development of better methods to prevent injuries. There is some evidence to improve flexibility and strength to beat the thigh muscles to be useful, but unfortunately there has been no conclusive results suggest a reduction of violations of these strategies.
That is, the integration of the eccentric hamstring exercises routine training found to significantly reduce the incidence of hamstring injuries. Previous literature suggests that if there is an imbalance (> 20% deficit from side to side) between concentric and eccentric hamstring strength of the quadriceps during isokinetic tests there is an increase of 4-fold compared risk of hamstring injuries. to compensate for insufficient capacity of eccentric hamstrings to concentric contraction of the quadriceps during the swing phase terminal or walk / run will be the result of the increased risk of injury (3). There is also evidence that eccentric training may lead to changes in the development of maximal force at longer muscle lead more. As always, clinicians should carefully implementing a program of eccentric training because of the delayed onset of muscle pain, patient compliance can have. progressive load and intensity is therefore recommended.
Another important aspect of exercises for the rehabilitation of injuries is a neuromuscular control (eg, knee high walking quickly over the execution of the exercises, running the Pre-Fall Drill and explosive starts), the target of the lower extremities and lumbopelvic region and are from the authors as highlighted in Achilles tendon injury prevention programs. These could be used in addition to the basic stability of the other joint exercises (planks, bridges Glute etc..) See below for guidelines for the rehabilitation of the author described in this article.
Rehabilitation Guidelines:
The report provides detailed guidelines for the systematic renovation of the Grade I and II muscle strain based current best available evidence. The first phase covers the protection, ice, NSAID and therapeutic exercises. Progression to Phase II occurs when:
1st Patient is in a normal, pain-free way;
2nd Feature very low speed running without pain, and
3rd Running without pain disadvantages submaximal isometric contraction (50-70%) of resistance in the prone knee flexion (90 °) test manual resistance.
Phase II is similar to guidelines for the use of Phase I by focusing on the full range of motion, ice after practice, discontinuation of NSAID therapy and exercises focusing on neuromuscular control, agility drills and stabilization of the trunk. The use of anaerobic training and athletic abilities are rush initiated carefully, so that the extension of the posterior thigh muscles and a large eccentric work. The progression criteria are
(1) Full-Power 5.5 MMT without pain during a one-repetition maximum effort isometric MMT supine position with the knee flexed to 90 degrees
(2) front and rear running speed up to 50% without pain.
Phase III provides a full range of motion unrestricted, icing after exercise and therapeutic exercises. The emphasis is on flexibility, progressive exercises designed for sport and the eccentricity and the rapid change in the attitude. The criterion of return to sport is difficult and requires further investigation. The guidelines stress resistance evaluation, mobility and functional abilities, without pain or stiffness. functional capacity should now be at full strength and speed in the vicinity.
