Hamstring strain : Movement impairment

We have written assesment skill and treatment part of hamstring strain. Now we make you think even more deeply for hamstring strain.

Generally, we treat hamstring strain with hamstring retraining. But, if hamstring strain has occurred due to overuse or repetitive stress of hamstring the treatment should be retraining of gluteus maximus, quadriceps, and hip lateral rotators.

The hamstring muscles are more dominant than the quadriceps muscles for the action of knee extension. In walking or running, once the foot is fixed by contact with the ground, the hip extension action of the hamstring muscles contributes to the extension of the knee. Hip extension to assist in knee extension is commonly used by the patient who has weakness of the quadriceps muscles as a result of poliomyelitis. To reinforce the knee extension action, the patient often flexes the trunk slightly to use gravity to further contribute to the knee extension movement. A similar movement pattern is seen in the runner who uses the hamstring muscles for knee extension control. He or she demonstrates a pattern of bringing the knee backward to the body rather than bringing the body up to the knee as when climbing stairs or when standing from a sitting position. So in patient with such pattern of movements, quadriceps are weak and hamstring are overactive that will susceptible for overuse injury.

Secondly, Another possibility for hamstring strain is the insufficient participation of the gluteus maximus muscle to generate the tension necessary for hip extension.

A third example of strain, specifically strain of the biceps femoris muscle, occurs when the biceps femoris muscle is insufficiently assisted by the intrinsic hip lateral rotators-the gemelli, obturators, piriformis, and quadratus femoris muscles-in producing lateral hip rotation.

Following alterations are found in patients with hyperactive hamstrings and its underactive synergists.

Movement impairments [restrict]

PRONE POSITION. During active hip extension the motion of the femur is almost complete before there is an obvious change in the contour of the gluteus maximus muscle.

SITTING POSITION. When the patient is in a sitting position and performs active knee extension, there is,simultaneous hip extension.

STANDING POSITION : When stepping up a step or rising out of a chair, the knee appears to be moving back toward the body rather than the body moving toward the knee that stays in a relatively fixed position. When returning from a forward bending position, the primary motions are the hips swaying forward and the ankles moving into dorsiflexion. When the patient is standing on the affected leg, the hip medially rotates and often the knee hyperextends.

You should check for this below misalignment

• Swayback posture
• Postural hip extension
• Medial hip rotation
• Knee hyperextension.

In Summary,

Hamstring strain occurs as a result of overuse, which is caused by the insufficient participation of the three synergistic groups of the hamstring muscle actions-gluteus maximus, intrinsic hip lateral rotator, and quadriceps muscles. Manual muscle testing of these synergists, as well as observation of movement patterns, is used to support the hypothesis of altered recruitment patterns.

TREATMENT

Treatment should be emphasis on strengthening weak synergists first. After proper restoration of strength and postural alignments, emphasis on hamstring strengthening can be instituted. Immediate strengthening of hamstring will create more  dominance of hamstring (which is already overworking).

Quadruped exercises.

Rocking backward improves the flexibility of the gluteus maximus and piriformis muscles if either is short or stiff.

Side-lying exercises

Hip abduction is performed with slight lateral rotation of the hip, if the POSTERIOR GLUTEUS MAXIMUS is weak.

CORRECTING POSTURAL HABITS AND MOVEMENT PA’ITERNS. Correct posture is neutral position of the hip and knee and avoids hip extension and knee hyperextension. When in the sitting position, “unconscious” contraction of the hamstring muscles must be avoided. When walking, the gluteus maximus muscle should contract at heel strike. When returning from forward bending, the gluteus maximus muscles are used and the forward hip swaying motion is avoided.

Reference

Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention  J Orthop Sports Phys Ther 2010;40(2):67–81.

Altered muscle activation following hamstring injuries Gisela Sole1, Stephan Milosavljevic1, Helen Nicholson2, S John Sullivan BJSM 2010

Prone hip extension with lower abdominal hollowing improves the relative timing of gluteus maximus activation in relation to biceps femoris  Manual therapy  February 2016

The activity pattern of lumbopelvic muscles during prone hip extension with and without hamstring strain Int J Sports Phys Ther. 2014 May

Diagnosis and movemtnt impairment : Shirely sharhman

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