Hamstring injury
Chronic hamstring pain

Hamstring injuries often develop acutely. This means that the pain occurs in one go during a sudden increase in power or speed. If this is not the case and the symptoms developed gradually, this is referred to as a non-acute hamstring injury. This can become a chronic injury.

More information about the acute form can be found in the article about the acute hamstring injury. We will discuss the non-acute hamstring injury below.

Description of the condition

The 'hamstrings' is a collective term for a group of 3 muscles that are located at the rear of the thigh. These are the 'semimembranosus', the 'semitendinosus' and the 'biceps femoris'. Their functions include the flexing of the knee and extending of the hip. In a hamstring injury, one or more of these hamstring muscles are affected.

Prolonged strain of the hamstrings can result in over-exertion. Repeated tensile and tractive forces on the muscle fibres can result in small tears in the muscle. These muscles are particularly susceptible to this if the training is not built up properly, or if a warm-up is omitted.

Damage to muscles usually occurs at the weakest point in the muscle. This is the part where the tendon tissue flows into the muscle tissue. In the image, this is the transition from white (tendon tissue) to red (muscle tissue).

Cause and origin

A chronic hamstring injury involves pain that gradually becomes worse. The symptoms usually develop as a result of repetitive walking movements, as when running. This injury is common in sports such as the marathons and the triathlons.

Signs & symptoms

The symptoms are less pronounced than for the acute hamstring injury. There is a nagging pain around the buttock and at the rear of the thigh. Sometimes the pain extends towards the rear of the knee. The exact location of the symptoms is often hard to pinpoint. The following symptoms can be present:

• Pain when flexing the knee against resistance.
  
• The pain is felt during or after running.
  
• Stretching of the hamstrings can be painful.
  
• Cramping sensation along the rear of the thigh.
  
• Loss of strength.
  
• As the hamstrings attach to the sitting bones, the symptoms can also be experienced whilst sitting as this places pressure on the damaged structures.

Diagnosis

The non-acute hamstring injury is more difficult to diagnose than the acute form. Following the physical examination, the physiotherapist can offer you advice and set up a treatment plan if necessary.

Treatment

The use of eccentric strength training is becoming an important part in the treatment of hamstring injuries. This means that training takes place in such a way that the muscle is lengthened instead of shortened during strength exercises. There are many indications that this has a positive effect on the recovery and the structure of the muscle and tendon tissues.

Exercises

If you have a hamstring injury it is important to train the hamstrings correctly. Take a look here at the online exercise programme with exercises for hamstring injuries.

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your area.

References
Heiderscheit, B.C., Sherry, M.A., Silder, A., Chumanov, E.S. & Thelen, D.G. (2010). Hamstring strain injuries: recommendations for diagnosis, rehabilitation and injury prevention. J Orthop Sports Phys Ther. 2010 Feb;40(2):67-81.
Hibbert, O., Cheong, K., Grant, A., Beers, A. & Moizumi, T. (2008). A systematic review of the effectiveness of eccentric strength training in the prevention of hamstring muscle strains in otherwise healthy individuals. N Am J Sports Phys Ther. 2008 May;3(2):67-81.
Petersen, J. & Hölmich, P. (2005). Evidence based prevention of hamstring injuries in sport. Br J Sports Med. 2005;39:319-323.