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technique MYOFASCIAL TECHNIQUES Working with Hamstring Injuries By Til Luchau What word first comes to mind when you hear hamstrings? If you said "tight," 1 "sore," "pulled," or "injured," you have plenty of company—these are the words most frequently used with hamstrings in Google searches. It doesn't take a psychoanalyst to interpret those free-association results—many people associate hamstrings with pain, stiffness, and injury. Hamstrings work hard. They are major stabilizers of the body's biggest segmental relationships, such as pelvic tilt, trunk angle, and hip position. They are also prime movers in some of the body's most powerful actions, such as running, stepping, jumping, and bending (Image 1). As such, they are prone to straining or tearing injuries (Image 2), most often as a result of sudden acceleration or lunging motions that are common in running and ball sports. The most common sites for hamstring injuries are at their musculotendinous junctions (usually mid-thigh, where tendons blend with muscle fibers) and at the hamstrings' proximal end (where tendons insert on the ischium). The hamstrings are comprised of the semimembranosus, semitendinosus, and biceps femoris muscles. The short head of the adductor magnus, which also flexes the knee, is sometimes considered a hamstring as well. The biceps femoris is the most lateral of these muscles and is the most frequently injured of this group. Hamstring injuries, even if relatively minor, take time to recover, since these structures are constantly in use in any upright activity. In addition, because hamstring strains usually result from activity, they occur most often in active people—who sometimes have difficulty not being active. This might be why reinjury of partially recovered strains or tears is quite common. About one-third of recovering athletes reinjure their hamstrings, most often within the first 14 days after returning to play.1 Depending on severity and other factors, recovery times of four to six weeks are not uncommon, and in cases of reinjury, much longer periods are 114 massage & bodywork january/february 2014 2 The hamstrings are powerful structures that are involved in running, striding, and jumping. The biceps femoris (Image 1) is most commonly injured. Image 2: Coronal section MRI of a torn hamstring tendon (red arrows). Bleed-out into surrounding tissues is also visible. Image 1 courtesy Primal Pictures, used by permission. Image 2 courtesy of http://en.wikipedia.org/ wiki/File:Hamstring_tear_STIR_cor_annotatios.jpg.
