Over the last few issues of The Islander I have been exploring anterior knee issues and am now going to take a look at the back of the knee starting with the Hamstrings which are also known as Biceps Femoris, Semitendinosus and |Semimebranosus.

The hamstring muscles attach to the pelvis (underneath the Gluteal bottom muscles) at the ischial tuberosity which is the knobbly part of the pelvis which we sit on.

They are long fusiform (sausage shaped) muscles passing all the way down the back of the thigh to the tibia. Their function is to work the knee in opposition to the Quadraceps, providing knee flexion and some hip extension (in conjunction with the Gluteal muscles).

Symptoms of a Hamstring Strain

Symptoms include a sudden onset of pain in the back of the thigh usually during exercise with pain on walking and straightening the leg. There is pain on palpation and bruising may also occur if the muscle fibres have been torn. Tears can also be caused by not warming up sufficiently prior to exercise and also from a sudden uncontrolled stretch such as slipping on a wet or icy surface.

There are 3 grades of Hamstring tear. While physical examination is usually all that is required for diagnosis, MRI or Ultrasound scans may also be used to confirm the extent of the damage.

Grade 1 . The muscles will feel tight with only a little pain on walking but running will be difficult. There may be some swelling and local tenderness on palpation.

Grade 2 . There will be difficulty walking and some limping may occur. Running will be painful to impossible. There will be some swelling and any stretching of the leg or resisted knee flexion will be painful.

Grade 3 . This is a more severe injury as there will be tearing of the muscle fibres which may be felt as an indentation in the muscle. There will be bruising from the bleeding of the torn fibres and a considerable loss of functional ability.

Treatment

In the case of a minor strain, the Hamstrings will heal within a few days leaving behind a feeling of stiffness. Self treatment should include regular ice over the strain and gentle stretching.

Grade 2 and 3 will be in need of medical attention, firstly to identify which grade of injury and secondly to promote recovery.

The Physiotherapist will first use ice, ultrasound and choose a method of protecting the injury from further damage such as strapping or elastic support. Crutches or a walking stick may be required to help rest the leg and all activity should be avoided during the initial stages of healing. The length of time the walking aids will be required depends on the extent of the injury. Massage, passive and active stretching will be introduced and strengthening exercises towards the end of the treatment. There are right and wrong ways of stretching the Hamstring as there are 3 muscles involved, and your Physio will show you how best to achieve this.

It is cannot be stressed enough that seeking medical advice is most important in this injury. As the tear in the muscle tissue heals, fibrous scar tissue is laid down within the muscle bulk which can be the cause of recurrent injury seriously affecting your future enjoyment of exercise and sport. Physiotherapy treatment aids the conversion of this scar tissue back to elastic and contractile muscle tissue. The Physiotherapist will also check your gait in walking and running to ensure against a future pelvic tilt or low back pain problems.

Surgery for a Grade 3 tear is rare but necessary in the event of a full rupture. MRI scan will be used for diagnosis and the recovery time is significantly longer. A full rupture is most likely to occur in the case of recurrent and poorly treated previous injury.