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Top 5 Factors Causing Hamstring Strains

Source: Pixabay

Source: Pixabay

 “What’s he got?” the coach shouts with frustration as I approached with my exam findings of the injured football player.

Before I could even start with my reply, he barked back with double the volume and triple the disgust; “It’s a damn hammy, isn’t it?!”

That conversation, if you want to call it one, took place more often than I want to admit over the past 20 years as Head Athletic Trainer/Physical Therapist with the Jacksonville Jaguars.  Strained hamstrings have a way of adding to the stress level of everyone as the player, the coaches and the athletic trainers continue to search for the mystery cause and illusive solution.

Training Camp Strained Hamstrings

This year’s NFL Training Camps are producing more pulled hamstrings than anyone expected.  Reading over the NFL injury reports this weekend, only a week into a long season, it’s hard to find any teams without at least a couple of players not practicing because of a strained hamstrings.

What the Hell are the Hamstrings?

That’s not a typo.  It’s supposed to be plural because there are three (3) muscles that make up the hamstrings located on the backside of the thigh.  All three muscles originate on the lower back of the pelvis and extend below the knee behind the upper calf muscle.  Two of those hamstring muscles pass the knee on the inner or medial side while the third “hammy” inserts on the outer or lateral upper shin above the lateral calf muscle belly.

Simplifying the Function of the Hammies:

(in order of their importance for a football player)

  • Decelerate or slow down the extension (straightening) motion of the knee while running.
  • Assist in extending the hip.
  • Bending the knee.
  • Assist in rotating the shin in relationship with the femur or thigh bone while changing direction.

Terminology Check

Strain (medical) = Tweak (optimistic player) = Pull (pessimistic player) = Tear (bar guy)

They all simply mean that some of the muscle fibers within any of the three hamstring muscles has been torn.  More fibers torn means more bleeding, more pain, more weakness, more loss of function and more downtime.

Factors Contributing to NFL Hamstring Strains

  1. Fatigue – Weaker muscles are vulnerable muscles.  Have you noticed most NFL players with hamstring strains are the players in the skilled, speed positions?  The wide receivers, defensive backs and running backs typically head the list of positions who suffer most of the pulled hamstrings.  They are running and changing directions fast on every play.   When their muscles fatigue the important role of the hamstring is magnified, increasing the potential for fiber failure.
  2. Dehydration – Muscle dehydration is grossly overlooked in relationship with muscle strains.  Simply stated; a dehydrated muscle becomes less effective when forced to contract and relax quickly.  During high speeds and/or high volume activities the “drying up” of a muscle can quickly lead to a strain.
  3. Muscle Imbalance – Strong muscles tend to be tight muscles.  Weak muscles tend to be longer muscles.  When the strong or primary muscles, such as the hamstrings, are doing most of the work the less important muscles, such as the hip rotators or lower Abs, often become too weak.  This imbalance, much like a shimmy in your car, becomes worse high speeds.
  4. Poor Warm-up – Sweating on the outside doesn’t mean your muscles on the inside are prepared to contract/relax at full throttle.  A player who’s been standing around for 10 minute and is suddenly thrown in for a special teams play or a high-intensity drills is immediately at risk for a hamstring injury.
  5. Body Compensation – NFL players move very fast.  When the work load on hamstrings is high, other muscle such as the calves, groin and “glutes” (butt muscle) need to help more.  When other muscles above or below the hammies don’t do their job, the long hamstring muscles pay the price.

Strained hamstrings will tests the patience of the player, the athletic trainer and the coach.   Addressing these factors starting on Day #1 can help keep the players on the field and to help you avoid being the bearer of bad news.

 

TBD

Biceps Femoris Tendonitis: The Forgotten Hamstring

The truth is….athletes “pull” muscles. That is something everyone is at risk for with an active lifestyle. Biceps femoris tendonitis is typically an injury resulting from overuse or over stretching of the biceps femoris tendons of the most lateral hamstring on the back of the thigh.

The two most common locations for pain with this injury are at the ischial tuberosity, just below the buttock, or along the palpable tendon near the outside of the knee 2-4 inches above the joint. In other words, at the tendons at the top of the muscle or the longer tendon just below the muscle.

These are the locations of the tendons responsible for connecting the biceps femoris muscle to your pelvis and shin bones. Repeated injuries involving the muscle itself can create a chronic inflammation of the tendons and their enclosed sheath.  This is commonly referred to as a form of tendonopathy.

Tendonopathy is a general term used to describe a combination of ailments. It is often associated with repeated micro tearing and inflammation of a tendon and it’s surrounding sheath. Athletes of all ages and sports are prone to tendonopathies of all three (3) hamstring muscles.

The biceps femoris is one of those hamstring muscles.  It is located at the posterior thigh and moves down the back-outside of the upper leg where it inserts just below the lateral knee. This muscle assists in flexion or bending of the knee, extension of the hip and some rotation of hip movement while the knee is in a bent position.

Avoiding the complicated science behind the reasoning, the biceps femoris is very important for acceleration and deceleration with all running and jumping activities. Injuries involving any of the hamstring tendons or muscle bellies are painful and can easily take up to 4-6 weeks to properly heal.

Signs & Symptoms of Biceps Femoris Tendonitis

  1. Pain or tenderness just under the buttock or at the back-outside corner of the knee with motion.
  2. Palpable swelling and tenderness just under the buttock or at the outside of the knee.
  3. Increased pain with active or resistive flexion (bending) of the knee.
  4. Inability to perform simple exercises without pain anywhere along the length of the lateral hamstring. These activities include running, stair climbing, forward bending with the knees straight while reaching for your toes, pulling the knees towards the chest and backward walking.
  5. It is not unusual to feel a “squeaking” within the distal tendon sheath with slow active knee bending.
  6. Pain with lateral or external rotation of the foot and shin while sitting with the knee bent.

Professional Treatment for Biceps Femoris Tendonitis

  1. Immediately stop activity and apply compression to the area.
  2. Avoid all hamstring stretches for at least 4 days. (Trust me on this one…I’ve learned this valuable tip the hard way!)
  3. Apply ice packs to the lateral knee and/or back of the thigh for 15 minutes every hour.
  4. During and after every ice treatment, apply compression to the involved tendon and the hamstring muscles in that region of the hip/thigh/knee.
  5. When resting, elevate the affected lower limb to minimize swelling.
  6. Avoid prolonged sitting.
  7. Three days after you are able to walk pain free, initiate an easy stretching and non-running exercises plan.
  8. After three days of pain-free stretching and functional athletics, progress as tolerable with strengthening and running activities.  The two key variables at this point to avoiding a setback are Progression & Common Sense

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Are you certain of the diagnosis of biceps femoris tendonitis and do you have any other concerns with my injury?
  2. Are other hamstring muscles, nerves or tendons damaged?
  3. How long can I expect for this injury to properly heal?
  4. Do you suggest that I visit a physical therapist for a comprehensive rehabilitation program?

Elite Sports Medicine Tips from Mike Ryan

  • Check your strength – It would be beneficial to you to consult a physical therapist during your down time. Getting a professional option on your lower extremity strengthen might shed some light on why you got injured in the first place.
  • Stretch it out – Promise yourself that when you recover from this injury, you will spend 5-10 minutes stretching every day.
  • Ice – Regular application of ice on the biceps femoris muscle belly and the involved tendon will help control the inflammation.
  • Take your time – When returning to your sport, take your time. Stretch properly and gradually build up the intensity of your activities.
  • Pay attention – After returning to your workouts, monitor the hamstring signs and symptoms.  If it gets cranky, return to rest, ice aggressively, STOP stretching and try again in two days.