Hamstring injuries

1. “Problems cannot be solved by the same
level of thinking that created them” A.E.
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2. Hamstrings
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3. Most common injury in
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4. Hamstring – Incidence & Severity
• Approximately 6 players/squad/season
• Miss approximately 3 matches or weeks of
play
Woods et al., 2004 – Hoskins et al., 2005
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5. Risk factors
• Previous hamstring injury  >2x risk
• Age
• ACL injury (altered proprioceptive feedback)
• Reduced flexibility ???
• Low hamstring strength ???
• Strength deficits or imbalances ???
 Isokinetic testing – specificity? Engebretsen et al., 2010
Arnason et al., 2004
Tsuda et al., 2001
Verrall et al., 2001
Christensen et al., 2000Mathieu Gram

6. Mathieu Gram

7. Clinical reasoning
+ Psychosocial
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8. Anatomical links
TibFib joint
SI Joint
m. Romboidei
ACL
Tsuda et al., 2001
Beltran et al., 2003
Hoskins et al., 2005
m. Popliteus
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9. Strong framework?
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10. Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
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11. Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
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12. Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
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13. Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
SIJ
Lx
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14. Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
“Problems cannot be solved by the same
level of thinking that created them” A.E.
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15. Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
TibFib Joint
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16. Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
TibFib Joint
SI Joint
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17. Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
TibFib Joint
SI Joint
Lx
Woods et al., 2004
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18. Muscular
When evaluating hamstring pain,
Evaluate:
- Framework  Lumbar-Pelvic dysfunction?
- Tension  Trigger Points?
- Strength
- Length
Vogt et al., 2003
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19. Muscular
When evaluating hamstring pain,
Evaluate:
- Framework  Lumbar-Pelvic dysfunction?
- Tension  Trigger Points?
- Strength
- Length
Vogt et al., 2003
Gluteus Maximus
vs
Hamstrings
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20. Neural
When evaluating hamstring pain,
Evaluate neurodynamics:
Piriformis syndrome
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21. “Problems cannot be solved by the same
level of thinking that created them” A.E.
Treatment of hamstring injuries should also
be directed at non-local hamstring factors.
Hoskins & Pollard, 2005
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