Chronic Proximal Hamstring Pain in a Runner
Hamstring injuries which are among the most common soft tissue injuries in athletes usually result from non-contact injuries that present in 2 forms: sudden onset with immediate incapacitating pain, and slow insidious onset with muscle tightness, both of which suggest that the underlying presence of increased muscle tension within the hamstring may precipitate the condition. This in turn can contribute to the high rate of recurrence and chronicity of the problem.
Correction of the underlying causes of hamstring injuries has been approached in a variety of ways. A popular soft tissue technique that has gained recent notoriety is Active Release Technique or ART. This technique was developed by Dr. Michael Leahy who proposed a mechanism to explain the increased tension that can develop within muscle tissue. He called this mechanism the "cumulative injury cycle". In this cycle, repetitive micro-injury in tight muscles leads to an increased friction and tension within the muscle tissue and surrounding structures. This tension leads to either decreased circulation to the tissue in what is termed the "chronic cycle", or it leads to the "inflammation cycle" whereby a tear or crush injury ensues, followed by inflammation. Both of these cycles lead to the same result: an accumulation of adhesion's and fibrosis within the tissue. This in turn further increases the tightness of the tissue, in our case, the hamstring muscle, and sets the stage for an injury to occur.
It is the goal of ART to remove these adhesion's, thereby decreasing tissue tension, and thus stopping the cumulative injury cycle. ART involves the practitioner contacting the dysfunctional soft tissue, taking muscles through a range of motion starting in a shortened state and ending in a fully lengthened out position. This serves to break-up the scar tissue and adhesion and lengthen out the shortened muscle tissue. The effectiveness of this therapy has been described in a variety of case reports and is utilized by many practitioners for the treatment of a variety of conditions involving soft tissue dysfunction. However, as with any treatment method, effectiveness is subject to proper diagnosis as well as to anatomical and biomechanical considerations.
A case study:
A thirty eight year old competitive tri-athlete presented complaining of chronic proximal hamstring pain and tightness in the right leg. She described the pain as constant and exacerbated by running. A diagnosis of acute tendonopathy of the proximal hamstring was given. After a course of therapy using the RICE (rest, ice, compression, elevation) principle of acute injury management that served to greatly decrease the pain intensity, a residual subjective feeling of discomfort/pain and tightness remained that she felt greatly decreased her running performance. The patient then sought out Active Release Technique (ART) for her complaint. The practitioner diagnosed the condition at this point as a chronic proximal hamstring tendonopathy and managed the injury using Active Release Technique, manipulation and stretching. Areas addressed included not only the hamstring, but also other affected muscles and soft tissues including the plantar fascia, achilles tendon, gastrocnemius (calf muscle), erector spinae (low back muscles), sacrotuberous ligament and long dorsal ligaments (pelvic ligaments). The patient reported a subjective decrease of 60-70% in pain intensity and tightness after only two treatments. By the fifth visit the pain was only felt during testing of the end range of motion. At this point the patient was able to return to running. By the eighth visit the end range of motion testing was unremarkable. With continued treatment including stretching and strengthening protocols, the patient made a full recovery.
Additionally, a biomechanical foot assessment with review of shoes used for running +/- orthotic prescription is more often than not necessary, with a view to improving leg alignment during the running cycle.
|Tags: Lower body|