THE HAMSTRING CONNECTION

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THE HAMSTRING CONNECTION

• Exploring the relationship between the hamstrings
  and the pelvis, spine, knee, ankle and foot

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Football

• Nobody in football should be called a genius. A
  genius is a guy like Norman Einstein.
• Commentator and former American Football player
  Joe Theismann - 1996

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Hamstring Functional Demands

• The hamstrings are required to-
• Support body weight
• Aid locomotion
• Provide supplementary forces to other movements.
• Effectively they need to
• - Transmit and dissipate forces

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Hamstring Functional Demands

• Failure to transmit or dissipate forces leads to
  tissue stress and possible failure.

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RESEARCH INTO HAMSTRING PRESENTATIONS

• To date we know-
• Hamstring injuries are the most prevalent injury
  in sport.
• Strongly associated with sports involving rapid
  acceleration and maximum speed running.
• Risk factors include lack of warm up, decreased
  flexibility and fatigue.

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RESEARCH INTO HAMSTRING PRESENTATIONS

• Only proven risk factor is previous injury.
• MRI studies suggest 19 of those presenting with
  hamstring symptoms do not have any tissue damage,
  suggesting altered functional mechanics or pain
  referral.
• Other studies suggest strong relationship with
  the lumbar spine.

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RESEARCH INTO HAMSTRING PRESENTATIONS

• Up to 33 of those who sustain a hamstring injury
  will have a further episode of similar symptoms
  within months of a return to sport does this
  suggest underlying biomechanical issues for that
  individual as this figure is twice as high as for
  other musculo-tendinous injuries.

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RESEARCH INTO HAMSTRING PRESENTATIONS

• There is a strong relationship between previous
  back pain and future hamstring injury
  congenital anomaly, altered mechanics or altered
  neural input? Can all these pdf be amenable to
  osteopathic intervention?
• Significant lumbar lordosis has been found
  retrospectively in athletes with hamstring
  symptoms cause or effect?

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Basketball

• Shelby Metcalf, basketball coach at Texas AM,
  recounting what he told a player who received
  four Fs and one D at college
• Son, looks to me like youre spending too much
  time on one subject.

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Hamstring Function

• They can be regarded as an integratory area
  with-
• Fascial links to the pelvis, lumbar spine and
  lower leg.
• Functional links via locomotion and posture to
  the lumbar spine, pelvis, hip, knee and foot.
• Neurological links with the lumbar spine.

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Hamstring Anatomy

• Biceps femoris
• Origin Long head ischeal tuberosity
• Short head linea aspera,
  lateral supracondylar ridge of the femur
• Insertion Fibular head
• Nerve Supply L5, S1,2

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Hamstring Anatomy

• Semitendinosis
• Origin Ischeal tuberosity
• Insertion Upper medial shaft of tibia
• Nerve Supply L5,S1,S

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Hamstring Anatomy

• Semimembranosis
• Origin Ischeal tuberosity
• Insertion Medial condyle of tibia
• Nerve Supply L5, S1,2

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Hamstring Anatomy

• Adductor magnus (hamstring portion)
• Origin Ischeal tuberosity
• Insertion Adductor tubercle of femur
• Nerve Supply L2,3,4

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Anatomical Relationships

• Hamstring origin has shared fibres with
  sacro-tuberous ligament and hence
  thoraco-lumbar-fascia
• Semimembranosis blends with medial capsule of
  knee
• Biceps femoris has intimate relationship with
  fibula position

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Functional Relationships

• The hamstring group has many functional
• relationships, especially with-
• Thoraco-lumbar fascia
• Lumbar spine
• Quadriceps function
• Knee function
• Fibula function
• Foot mechanics

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Boxing

• Lou Duva, trainer on the Spartan training regime
  of heavyweight Andrew Golota
• Hes a guy who gets up at six oclock in the
  morning regardless of what time it is.

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European Football

• When the seagull follows the trawler, it is
  because they think sardines will be thrown into
  the sea.
• I am searching for abstract ways of expressing
  reality, abstract forms that will enlighten my
  own mystery.
• Eric Cantona

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Case Study 1 - Mike

• 24 year old rugby player presents with deep
  hamstring pain 2/3 of the way down the lateral
  aspect of the hamstrings of 2 weeks duration
  following a heavy tackle causing instant
  hamstring pain.
• Diagnosis, management and treatment?

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Mike - Case considerations

• Assessment of hamstring injury -
• Spinal health
• Hip health and flexibility
• Knee and lower leg function
• Hamstring function reproducible pain
• Location of injury muscle or myotendon
• Severity and chronicity of injury

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Treatment and Management

• Why is he not getting better?
• How can I help Mike get better quicker?
• How can I help prevent re-injury?
• How can Mike help?
• What exercises can Mike do to help in the long
  term?

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Case Study 2 Mikes mate - Tim

• Tim is a 22 year old rugby player, very highly
  regarded player who presents with his fourth
  episode of hamstring symptoms this season. He has
  left sided deep tenderness similar to Mike, but
  palpation shows more scar tissue.
• He is good at warming up and down and stretching
  and feels very depressed.
• Diagnosis, treatment and management

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Tims Torment

• Assessment of Tim shows very poor spinal/hip
  flexibility and Tim says it is years since he
  could touch his toes.
• Palpation of the hamstring group reveals several
  areas of scar tissue mainly in the biceps
  femoris.
• Why might this model sportsman be suffering?

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American Football

• Bill Peterson, Florida State Coach
• You guys line up alphabetically by height and
  you others, pair up in groups of three and then
  line up in a circle.

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Cast Study 3 Mikes big brother - Andy

• Andy is 28 years old and presents with hamstring
  symptoms very like Mikes. He cant believe it as
  he has recently cut back on his training and
  playing as he has recently taken a more senior
  role at work in the accountancy firm and got
  engaged.
• Diagnosis, treatment and management

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Andys agony

• Andy is really worried, he wants to play in a
  lower squad but feels that if he cant play then
  he will get unfit and fat very quickly and the
  wedding is quite soon.
• Examination reveals that he too has limited
  flexibility before the symptoms come on, but Andy
  says this loss of flexibility has only happened
  since the hamstring injury his physio has
  helped a little but only for a short time after
  each treatment can you do any better.he does
  mention he notices it first thing in the morning
  too.

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Referral Patterns - disc problems

• Mild NRI may cause paraesthesia.
• Dermatomal referral typically affects inner
  hamstrings if from L5, lateral hamstring from S1
  and central hamstrings from S2.
• Myotomal referral from L5 can affect the gluteus
  medius, hamstrings and peronei from S1/2 the
  buttock, thigh, calf and peronei

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Referral patterns disc problems

• L5 involvement often cause weakness and cramping
  in gluteus medius, biceps femoris and foot drop
• S1 involvement often causes weakness/cramping in
  the buttock and hamstrings generally

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Case Study 4 Mikes aunt - Ann

• Ann is a 50 year old half marathon runner who
  presents with left lateral deep hamstring ache
  just above the knee joint.
• It seems to have come on over the last few months
  as she has increased her training her new age
  group this year has inspired her to enter four
  half marathons.

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Anns admission

• Ann explains that she is addicted to running
  since achieving weight loss of 2 stone over the
  last year ( she went from 11 stone to 9 stone
  she is 54) and is terrified of putting the
  weight back on. Her doctor has not been able to
  help though she had been very helpful when she
  sprained her left ankle several times last year.

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Case Study 5 Mikes aunts sister Polly

• Polly is a 52 year old recreational skier who
  comes to see you with medial knee pain following
  a valgus injury to the knee several months ago.
  She wants to book her next skiing holiday and
  expects you to get her symptom free.

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Motor sport

• Alan Kulwicki, stock car racing, on racing
  Staurday nights as opposed to Sunday afternoons
• Its basically just the same, only darker.

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Case Study 6 - Mikes grandad, Joe

• Joe is a 69 year old retired builder who wants to
  run a marathon in eight months for a cancer
  charity following the death of his wife. He has
  done no exercise for the last two years while he
  cared for his wife. He comes to you for advice
  and help with his low back pain and tight
  hamstrings which started when he started walking
  two miles a day three weeks ago. He is rather
  overweight and reports mild high blood pressure
  that is currently unmedicated.

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Basketball

• Chuck Nevitt, North Carolina State basketball
  player, explaining his nervousness at a practice
  session
• My sisters expecting a baby, and I dont know
  if Im going to be an uncle or an aunt.

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References

• Human Movement edited by Marion Trew, Tony
  Everett
• Gait Analysis an introduction by Michael W.
  Whittle
• Muscles, Nerves and Movement by Barbara
  Tyldesley, June Grieve
• Sport Stretches by Michael J. Alter
• ISBN 0 88011 827 7

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References

• Successful management of Hamstring Injuries in
  Australian Rules footballers
• Wayne T Hoskins and Henry P Pollard
• Chiropractic and Osteopathy 2005134