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Study Guide
Instructions: Answer the following questions in 2-3 sentences each.
- Describe the location and function of the hamstring muscles.
- Explain the two main causes of hamstring strain.
- Why are the hamstrings particularly vulnerable to strain injuries?
- List five factors that can increase the likelihood of a hamstring strain.
- Describe the typical symptoms of a hamstring strain in the acute phase.
- How might chronic hamstring tightness affect posture?
- What steps should be taken during manual therapy treatment of a hamstring strain in the acute phase?
- Explain the rationale for stretching and strengthening the non-injured hamstring group during the acute phase of a hamstring strain on the opposite side.
- What are the goals of manual therapy treatment during the chronic stage of a hamstring strain?
- Describe the self-care measures a patient can take during the acute and chronic phases of a hamstring strain.
Short Answer Key
- The hamstring muscles are located on the posterior thigh and consist of the biceps femoris, semitendinosus, and semimembranosus. They primarily function to extend the hip and flex the knee.
- Hamstring strains can occur due to excessive stretching of the muscle fibers or forceful contractions that exceed the muscle’s capacity.
- The hamstrings are susceptible to strain because they are biarticular muscles, crossing both the hip and knee joints. This means they are subject to tension forces from both ends, making them more prone to injury.
- Factors increasing hamstring strain risk include: inadequate warm-up, muscle tightness/inflexibility, fatigue, compression, previous hamstring injury, muscle imbalances (stronger quads than hamstrings), and sacroiliac joint dysfunction.
- Acute hamstring strain symptoms typically include sharp pain at the site of injury, tenderness to palpation, swelling, and possible bruising (ecchymosis).
- Tight hamstrings can pull the pelvis into a posterior tilt, leading to a rounded lower back posture and potentially causing pain and dysfunction in the lumbar spine.
- Acute phase manual therapy focuses on reducing inflammation using RICE (rest, ice, compression, elevation) and gentle, distal-to-proximal soft tissue mobilization. Proactive treatment for the low back and contralateral lower extremity may also be necessary to address compensatory issues.
- Stretching and strengthening the non-injured hamstring can provide a neural cross-over effect, offering some benefit to the injured side. This can help maintain some muscle function and potentially speed up the rehabilitation process.
- Chronic phase manual therapy aims to decrease hamstring hypertonicity, promote healthy scar formation, and address any lingering tightness, trigger points, or fascial adhesions. Techniques may include moist heat, soft tissue manipulation, stretching, and joint mobilization.
- Acute phase self-care involves RICE. During the chronic phase, patients should use moist heat, perform regular stretching, and gradually reintroduce activity, ensuring thorough warm-ups and cool-downs.
Essay Questions
- Discuss the biomechanics of hamstring strain, explaining how movements during activities like running can lead to injury.
- Compare and contrast the signs, symptoms, and treatment approaches for acute versus chronic hamstring strains.
- Explain the concept of muscle imbalances and their contribution to hamstring strain risk. Discuss specific strategies for addressing these imbalances.
- Describe the role of manual therapy in the rehabilitation of hamstring strain, highlighting specific techniques and their benefits at different stages of healing.
- A patient presents with posterior thigh pain. Outline a comprehensive assessment strategy to differentiate between hamstring strain and other potential causes, such as sciatica.à
Glossary of Key Terms
Hamstring Strain
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A tear in one or more of the three hamstring muscles (semitendinosus, semimembranosus, and biceps femoris), located on the back of the thigh. This injury typically occurs due to overstretching or forceful contraction of these muscles. The biceps femoris is the most commonly strained hamstring muscle.
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Acute Phase
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The initial stage of injury, usually lasting a few days to a week, characterized by: * Inflammation: The body’s natural response to tissue damage, involving increased blood flow, redness, heat, swelling, and pain. * Pain: Often sharp and intense in the initial stages, particularly with movement or touch. * Swelling: Accumulation of fluid in the injured area, contributing to a feeling of tightness and restricted movement. * Limited Range of Motion: Difficulty moving the affected leg due to pain and swelling
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Chronic Phase
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The later stage of healing, starting after the initial inflammation subsides. This phase can last for weeks or even months, depending on the severity of the strain and individual healing factors. The focus during this phase shifts to restoring mobility, flexibility, and strength
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RICE
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Acronym for Rest, Ice, Compression, Elevation: a standard first-aid protocol for acute musculoskeletal injuries like hamstring strains. * Rest: Protecting the injured area from further stress and allowing it to heal. * Ice: Applying cold therapy to reduce inflammation and numb pain. * Compression: Wrapping the injured area to limit swelling. * Elevation: Raising the injured leg above heart level to minimize fluid build-up
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Soft Tissue Manipulation
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Hands-on techniques, often referred to as massage therapy, used by trained practitioners to address muscle and fascial restrictions. These techniques aim to: * Release Muscle Tension: Reduce tightness and spasm in the muscles. * Improve Circulation: Increase blood flow to the injured area to promote healing and remove waste products. * Break Down Adhesions: Restore normal gliding between tissues and reduce stiffness
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Stretching
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Therapeutic movements designed to lengthen muscles and improve flexibility. This is an important component of both preventing and rehabilitating hamstring strains, but should be done carefully, particularly in the acute phase, to avoid further injury.
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Strengthening
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Specific exercises aimed at increasing muscle strength and endurance. This is important for supporting the joint, improving functional movement, and reducing the risk of re-injury in the chronic phase of hamstring strain rehabilitation
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Joint Mobilization
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Manual therapy techniques applied directly to joints to restore their normal mechanics. This can involve gentle gliding or traction forces applied by a trained practitioner to address stiffness, reduce pain, and improve range of motion. Hip joint mobilization is often incorporated in the chronic phase of hamstring strain treatment to address restrictions that may have developed due to altered movement patterns during healing
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Neural Cross-Over
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A phenomenon where stimulation or training applied to one side of the body can produce a response or improvement in the corresponding muscles on the opposite side. This concept is utilized in hamstring strain rehabilitation by stretching and strengthening the uninjured leg to potentially benefit the injured side, particularly in the acute phase when direct work on the injured side may be limited
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Antalgic Gait
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An altered walking pattern where a person limps or favors one leg to minimize pain or discomfort. This is commonly observed in individuals with acute hamstring strains, as placing weight on the injured leg can exacerbate pain. Prolonged antalgic gait can lead to compensatory muscle imbalances and other problems in the low back and uninjured leg, highlighting the importance of addressing these potential issues during treatment
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Myofascial Trigger Points
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Hypersensitive knots or nodules that can form within muscles and their surrounding fascia. These trigger points can cause local pain, referred pain (pain felt in a different area than the trigger point itself), and restricted movement. Trigger point release techniques, such as sustained pressure or deep stroking massage, are often incorporated into soft tissue manipulation to address these points and restore normal muscle function
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Fascial Adhesions
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Restrictions or abnormal cross-links within the fascia, a thin connective tissue that surrounds and supports muscles and other structures throughout the body. These adhesions can develop due to injury, inflammation, or immobility, leading to tightness, decreased mobility, and paid. Manual therapy techniques, particularly those that target fascial release, aim to break down these adhesions and restore normal tissue gliding
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