HAMSTRING INJURIES

By Sarah Brook, Physiotherapist at our Manning practice.

5 key points on proximal hamstring injuries:

1. The Hamstring muscle group consist of 4 main muscles: the Long and the Short Head of the Bicep Femoris, the Semitendinosus and the Semimembranosus. Only the Long Head of the Bicep Femoris, the Semitendinosus and the Semimembranosus cross both the hip and the knee joint. (Beltran, Ghazikhanian, Padron, Beltran, 2012).
2. There are 2 main classifications of hamstring injuries: Type 1 caused by rapid acceleration injuries, most commonly while the hamstrings are contracting whilst being lengthened (eccentric muscle contraction), and Type 2 injuries caused by rapid excessive lengthening, eg., when falling into the splits. (Askling, 2011).
3. Proximal hamstring injuries most commonly involve either the junction between the tendon and the bone, or the myotendinous junction (tissue between the muscle and tendon). (Beltran, Ghazikhanian, Padron, Beltran, 2012, (Vila Pouca, Parente, Natal Jorge, Ashton-Miller, 2021).
4. Injuries will occur at the area of least resistance. In children, adolescents, and older adults, this is the junction between the tendon and the bone, and in young adults this is the myotendinous junction. (Beltran, Ghazikhanian, Padron, Beltran, 2012, (Vila Pouca, Parente, Natal Jorge, Ashton-Miller, 2021). 
5. For certain hamstring tears, a holistic tendon-based rehabilitation program has been demonstrated to manage these injuries successfully and help facilitate a full return to sport. (Looney, Day, Comfort, Donaldson, Cohen, 2023).

References:

1. Askling C., Types of hamstring injuries in sports. British Journal of Sports
Medicine 2011;45:e2.

2. Vila Pouca, M. C. P., Parente, M. P. L., Jorge, R. M. N., & Ashton-Miller, J. A. (2021). Injuries in
Muscle-Tendon-Bone Units: A Systematic Review Considering the Role of Passive Tissue Fatigue. Orthopaedic journal of sports medicine, 9(8), 23259671211020731.

3. Beltran, L., Ghazikhanian, V., Padron, M., & Beltran, J. (2012). The proximal hamstring muscle-
tendon-bone unit: a review of the normal anatomy, biomechanics, and pathophysiology. European journal of radiology, 81(12), 3772–3779. https://doi.org/10.1016/j.ejrad.2011.03.099

4. Looney, A. M., Day, H. K., Comfort, S. M., Donaldson, S. T., & Cohen, S. B.
(2023). Proximal Hamstring Ruptures: Treatment, Rehabilitation, and Return to Play. Current reviews in musculoskeletal medicine, 16(3), 103–113. https://doi.org/10.1007/s12178-023-09821-7