Millions of people in the world participate in sports each day, but there are potential injury risks that the involvement in sport brings. During our annual high school competition, an athlete from my high school got a hamstring strain while participating in the finals of intercampus basketball competition. It was a challenging and frustrating injury for him because it healed slowly and gave a lot of problems to the medics. Because of the nature of the injury, our athlete underwent proper rehabilitation because as it was a precaution from his doctors against it recurring.
The injury damaged his hamstrings which are tendons or strong bands of tissues located at the back of the thighs attached to the bone by thigh muscles. They are composed of three muscles that run along the back of the thigh starting from the hip to near the knee which include biceps femoris, semimembranosus and semitendinosus. The semitendinosus starts at the ischial tuberosity and inserts at the pes anserine while the semimembranosus originates from the ischial tuberosity and inserts at the posterior medial tibia. The biceps femoris is two-headed. The long head stems from the ischial tuberosity, and a short head begins at the postero-lateral femur. The insertion point of the biceps femoris is at the head of the fibula.
While these muscles are not utilized while walking or standing, they are crucial during activities that require the bending of the knee such as running. The athlete got the hamstring injury because he overstretched his muscles beyond the limit. While playing, the athlete was constantly in explosive and sudden movements that overstretched his hamstring because there was an imbalance between the quadriceps and the hamstring muscles. The inadequate flexibility and strength imbalance in the group of the hamstring muscle also exasperated the injury in the athletes hamstring.
Moreover, while the athlete was playing, he experienced an active lengthening of the muscle fibers during an eccentric contraction. This is because the athletes contraction speed increased the contraction force as he straightened his leg to move forward. The hamstring muscles were not only lengthened but also loaded with the weight of the body and the force required to forward movement, hence the knee was extended while the hip flexed during swing phase causing the hamstring strain where the hamstring tendon was torn from the bone. The injury was severe because there were small bone fragments that were ripped away when the muscles pulled away from the point of attachment.
Fig. 2 AAOS, severe hamstring injury where the tendon has been torn from the bone; aaos.org, July 2015.
The athlete suffered a severe hamstring tear because immediately after the strain, he threw the ball away and went straight down on his back clutching his thigh and with his mouth open which showed he was in severe pain. He then rolled several times on the ground with his hand still clenched on his thigh, and after a while, he supported his body with the other hand on the ground. He could neither bend his leg or straighten it because of the intense pain on his thigh. There was a large lump of muscle tissue which swelled in his thigh because he had raptured his muscles. This lump was accompanied by a sudden sharp pain and a formation of a bruise as there was bleeding within the tissues. The medics straightened his leg by flexing the leg forward and back, but it was painful. He was supported by physicians to stand, but despite the support, he could neither move nor use his injured leg and was put on a stretcher and driven out of the field for proper diagnosis and medication. After few days, there was a discoloration on the back of the leg which showed how severe the injury was. He was not able to play for the next couple of weeks because he underwent treatment in various phases.
After the injury, the medics gave him immediate treatment in the field by stretching his leg and application of ice, local heat and use of heat retainer at the back of the thigh until the pain subsided. At the treatment room, the athlete underwent PRICE principle (Rubin 526). The athlete was protected by subjecting him to rest, put on ice, compression of the injured hamstring, elevation, and was later referred to a specialist for further treatment. During rest, the athlete took a break from the field and was advised to use crutches to avoid subjecting a lot of weight on the injured leg. He was also put on cold packs several times a day that lasted over 20 minutes as well as compression of the thigh by being made to wear an elastic bandage which compressed the damaged muscles to prevent swelling and loss of blood. Furthermore, the athlete had to be in an elevated position while resting by reclining and putting his injured leg on a level higher than his heart to prevent any further swelling. Finally, the athlete was warned against alcohol, running or any activity that put the injured leg on any form of strain.
After the immediate treatment, the medical staff and athletic trainers were under pressure to make sure the player received specialized medication. Despite the availability of clinicians who diagnosed the injury, the athlete underwent advanced radiological evaluation in a specialized hospital for sports injuries. The doctors in this facility used Magnetic Resonance Imaging (MRI) which offered a more detailed analysis of the injury. It provided details of the location of the strain, the cross-sectional area of the injured thigh, the extent of the tear, and allowed the radiologist to grade the injury (Cohen et al. 424). All the details were crucial because it aided in the decision of the treatment type and predicted the possible return to activity.
The MRI results showed a hamstring avulsion where the tendon was torn away from the point of insertion into the bone, and the tendon pulled away bone fragments during the strain. Moreover, the athlete suffered haemorrhage and complete disruption of the musculotendinous junction. These details helped in the determination of the retraction extent and a subsequent surgical plan.
Surgery was eventually performed to repair the tendon avulsion. The surgeon used the MRI report as an aid in the restructuring the pulled muscles back to its original position. This was done by pulling the hamstring back to its place and removal of scarred tissue. The tendons were reattached to the bone by use of staples and large stitches. The tears within the muscles was also sewed together with stitches. After the surgery, the athlete was required to keep weight off the injured leg to protect the repairs done on the tendon. He was given crutches, and a brace meant to hold his hamstring in a relaxed position. These aids lasted several months because of the extent of the injury.
After the surgery, the player underwent rehabilitation for the athlete to return to the game. A physiotherapy program started after the swelling and the pain had settled down. Specific exercises were performed to help in the restoration of strength and motion (Schmitt 335). Hamstring stretching was done by subjecting the injured leg to gentle stretches to make it flexible. As the process continued, more dynamic stretches were introduced which targeted the muscles in different ways that enhance healing. Stretching exercises which gradually increased the load on the muscles of the athlete were also performed when he was free from pain. Other basic static exercises which increased the resistance of the muscles were done by a specialized physiotherapist and progressed into more demanding and specific activities as the muscle strengthened.
AAOS. Severe Hamstring Injury where the Tendon has been Torn from the Bone. Aaos.org, July 2015, orthoinfo.aaos.org/topic.cfm?topic=a00408.
AAOS. Normal Hamstring Anatomy. Aaos.org, July 2015, orthoinfo.aaos.org/ topic.cfm?topic=a00408.
Cohen, Steven B., et al. "Hamstring Injuries in Professional Football Players: Magnetic Resonance Imaging Correlation with Return to Play." Sports Health 3.5 (2011): 423-430.
Rubin, David A. "Imaging Diagnosis and Prognostication of Hamstring Injuries." American Journal of Roentgenology 199.3 (2012): 525-533.
Schmitt, Brandon, Tyler Tim, and Malachy McHugh. "Hamstring Injury Rehabilitation and Prevention of Re-injury using Lengthened State Eccentric Training: A New Concept." International journal of sports physical therapy 7.3 (2012): 333.
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