Articles

Hamstring Strains

What is a Hamstring Strain?

The muscles on the back of the thigh are called the hamstring muscles. They can be injured following excessive tension through them. This is a common condition known as a ‘Hamstring Strain’. Early intervention is desirable to ensure that rehabilitation is provided at the correct stages of muscle healing. Home exercises are a vital part in ensuring a good repair to the injured area and assist in returning the individual back to full activities as soon as possible.

The muscles on the back of your thigh are known as the hamstring muscles. These muscles attach to the pelvic bone and insert just below back of the knee. The hamstring muscles are responsible for bending the knee and extending the leg backwards. They also help lower the trunk forwards and backwards from a standing position. They are particularly active during running (especially making a quick sprint) jumping, walking and also help control the leg when kicking.

A hamstring strain describes a condition whereby tearing has occurred in some or all of the hamstring muscles. It a relatively common condition especially in sports injuries where many types of athletes are affected including: sprinters, hurdlers and football players.

What is the cause of a Hamstring Strain?

When the tension through the hamstring muscles is excessive such as too much repetition, high force or overstretching, one or more of the hamstring muscles can tear. Sometimes the tear can be at the attachment point of the muscle at the pelvis or more commonly in the muscle itself. It is more likely to occur in sportsman if there is insufficient warm up and stretching of the muscles before activity and / or at the start of the sporting season if they are not sufficiently prepared and conditioned for this level of exertion.

We use a grading system in an attempt to describe the extent of the injury :

Grade 1: a small number of muscle fibres are torn resulting in some pain but allowing full function.
Grade 2: a significant number of muscle fibres are torn with moderate loss of function. Grade 3: all muscle fibres are ruptured resulting in major loss of function.

The majority of groin strains seen in clinics are grade 2.

What are the symptoms of a Hamstring Strain?

Pain can be felt just below the buttock on a bony prominence called the ischial tuberosity. This is where the muscle attaches to the pelvis. More commonly pain can be felt halfway down the back of the thigh – this is where the main bulk of the hamstring muscles are. Difficulty may be felt going up stairs, sit to stand movement, running and in more severe cases walking. There is also likely to be a sensation of tightness and cramping in the back of the thigh. The severity of symptoms is likely to relate to the severity of the injury and so the grading system can help describe what the most likely symptoms will be :

Grade I Hamstring Strain: Mild discomfort, often no disability. Usually does not limit activity.

Grade II Hamstring Strain: Moderate discomfort, can limit ability to perform activities such as running and jumping. May have moderate swelling and bruising associated.

Grade III Hamstring Strain: Severe injury that can cause pain with walking. Often patients complain of muscle spasm, swelling, and significant bruising.

What is the treatment for a Hamstring Strain?

Immediate Treatment (the first 48-72 hours)

Most mild to moderate sprains and strains can be treated at home using a self-care technique called RICE therapy, and by avoiding HARM

Using RICE therapy
RICE stands for rest, ice, compression and elevation. Advice relating to each of these areas is out- lined below.
Rest – It is important to rest following the injury to keep the amount of inflammation around the in- jury site to a minimum. Allow pain to guide your level of activity; this means that activities which cause symptoms should be avoided. You can do activities that don’t aggravate your injury. Resting inadequately may prolong your recovery. If your injury is severe enough your clinician may recom- mend that you use crutches.
Ice – Apply ice wrapped in a damp towel to the injured area for 15 to 20 minutes every two to three hours during the day. Do not leave the ice on while you are asleep, and do not allow the ice to touch your skin directly because it could cause a cold burn.
Compression – compress or bandage the injured area to limit any swelling and movement that could damage it further. You can use a crepe bandage, a simple elastic bandage, or an elasticated tubular bandage. It should be wrapped snugly around the affected area but it should not be too tight. Re- move the bandage before you go to sleep.
Elevation – If there is obvious swelling in the thigh keep the injured area raised and supported on a pillow to help reduce the swelling. If your leg is injured, avoid having long periods of time where your leg is not raised. In practice this is rarely an issue in hamstring strains.

Avoiding HARM

For the first 72 hours after a sprain or muscle strain you should avoid HARM. This means that you should avoid:
Heat – such as hot baths, saunas or heat packs (applying a controlled amount of heat to affected joints)

Alcohol – drinking alcohol will increase bleeding and swelling and decrease healing Running – or any other form of exercise that could cause more damage
Massage – which may increase bleeding and swelling

The Rehabilitation Stage (after 48-72 hours)

In the first 2-3 weeks after an injury the body lays down scar tissue over the injury site. The secret of a good repair will be to apply some gentle stress in the form of gradual and progressive stretches through the hamstring muscle over this recovery period. This will help shape a well aligned, uniform repair across the injured muscle and avoids the injury returning. By contrast, if this gentle stress is not applied then scar tissue is laid down haphazardly around the injury site and causes ‘knotting’ within the muscle. This poor repair is susceptible to prolonging the pain and / or can predispose the individual to recurrence.

Exercise

As mentioned above this will be the most important aspect of your management. Gradual and progressive stretching in the early stages may lead on to strengthening the hamstring muscles and perhaps the core abdominal muscles and pelvic muscles. In the latter stages of recovery your clinician may advise on a warm up routine and offer more inventive exercises which may be specific to the sport or activity that you are involved in.

Other forms of treatment

Your Osteopath may recommend heat treatment after the inflammatory stage to increase blood supply and improve the rate of healing. This and soft tissue massage may help loosen tight muscles particularly in preparation for activity. Ultrasound is also used by some clinicians as this is thought to speed up the healing process.

How long will my symptoms last?

Minor hamstring strains (Grade 1) usually resolve within 3 weeks whilst moderate (Grade 2) injuries need a little bit longer (about 4 to 6 weeks). In the case of a complete rupture – which is rare, the muscle may have to be repaired surgically and the rehabilitation afterwards will take at least 3 months.

In terms of returning back to sporting activity your Osteopath will want you to have full, pain free muscle flexibility and strength. You will need to have demonstrated in training a gradual and progressive return to all aspects of the physical demands of your sport and show that you have regained full fitness. Only then will your Osteopath be confident to return you back to full competitive sporting activity.

The individual exercise program that you have received must be performed correctly, at the appropriate stage of healing and with the prescribed frequency. Stretching exercises in particular are very important in ensuring a strong repair of the hamstring muscle by influencing the matrix of the scar tissue that is laid down. Failure to do this may result in a poor repair that can prolong the injury and predispose you to the injury recurring. Your Osteopath will be relying on your input to achieve a successful outcome.

Cranial Osteopathy For Babies

Is your baby distressed and crying non-stop but the doctor can’t find a problem? It may be time to give Cranial Osteopathy a shot

Babies can be subject to enormous forces when they are born, twisting and turning as they squeeze their way out to the outside world. This can mean a lot of stress and pressure, particularly on baby’s head. This pressure can be relieved with the healing effects of cranial osteopathy, which can be a great non-invasive treatment for little ones.

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Here are some pictures of June Jowitt recently treating a baby using Cranial Osteopathy.

 

 

 

What is Cranial Osteopathy?    

Many babies arrive having had slight compression from the pressure on their head during assisted or natural birth. Whatever the cause, your Osteopath aims to relieve these pressures and tensions that are found in the cranium. They do this in a very gentle, skilled way. There is no pushing or pulling but rather the osteopath feels for tension in the tissues and then holds the tissue in a way that the body wants it to go until it releases. This allows the body to calm itself and become more relaxed.

By using gentle manipulation on a baby or toddler’s head and spine, Osteopaths can make them more comfortable. Cranial treatment is particularly effective on newborns and young babies, as their skull bones are not yet fused. Cranial treatment essentially seeks to correct any damage or slight alterations caused during childbirth, especially if it was an assisted delivery, or particularly fast.

Your Osteopath will check baby’s neck, shoulder, jaw, diaphragm, rib cage and spine. Don’t be afraid to ask the osteopath what she is doing throughout each treatment.

What problems does Cranial Osteopathy help with?   

Cranial osteopathy can relieve a number of problems for your baby, such as feeding troubles or unsettled and griping symptoms. Whilst no-one really knows what causes colicky symptoms, Osteopaths recognise what may be contributing to the problem. Many osteopaths believe that the vagus nerve which exits from the base of the skull and supplies the stomach and the upper part of the intestines, can be irritated or compressed. It is particularly vulnerable to distortion during the birth process and, if irritated, can make the stomach more sensitive, contributing to the colicky symptoms. It is thought that the over-sensitivity of the gut is one way in which the brain responds to stress. This in turn affects the sympathetic nervous system which aids in the control of many of the body’s internal organs. After experiencing the shock of birth, it isn’t really very surprising that this can cause their nervous system to overreact!

Cranial osteopathy can also be excellent in helping with flat head syndrome. This refers to a lack of symmetry in head shape, particularly common after assisted delivery. Only rarely are flat heads in infants due to fusing of the head “joins”. Usually the “joins” are not fused and early asymmetry can lead to flattening and a preference for lying with the head in one position. The back of the head can flatten on one side or both – a condition named “deformational plagiocephaly”. This can often cause feeding issues. It is important to ensure that there is adequate mobility in the neck to allow full rotation both ways.

To avoid or reduce head flattening;

  • encourage regular turning of the neck when baby is on their back by getting her to look both ways.You can use bright objects or things that “jangle” to get your babies attention. For example, a toy or even a bunch of keys!
  • If you put your baby down on her side, remember to alternate sides. (If baby sleeps on her back, observe head movement and check that one side is not favoured over the other).
  • Some supervised time on their tummies while they are awake also helps reduce a tendency to flattening of one side of the head.

Cranial osteopathy is not the only remedy for restless babies, but it can help ease the trauma of birth and sooth an unsettled baby. It is worth considering cranial osteopathy if your baby is suffering from Colic, irritability, restlessness, feeding difficulties or a misshapen head.

Overview of Flexiseq

What is Flexiseq?

Flexiseq is a gel product that contains small particles called Sequessomes and contains no active drug.  This product has gained attention over the last year in the media. It is claimed to relieve pain associated with Osteoarthritis (OA) and by helping lubricate the joints and is especially effective for people suffering with knee OA.

How does it work?

The manufacture’s claim that the Sequessome vesicles move into the joint and create a lubricating layer that protects the damaged surface from friction and further wear and tear. Here is a video created by the company that makes Flexiseq to explain how it works.

From their scientific studies they have published, we do not yet understand how Flexiseq works or whether it is more effective than a completely inactive gel rubbed onto the knee. Hopefully in the future further studies will be conducted to learn more.

Overview of Flexiseq

It has been proven that Flexiseq can provide good initial pain relief. As there is absence of any active drugs, it is great as people who are unable to take conventional medication due to the effect on their stomach, heart, kidneys etc. Nowadays people are living longer, therefore the likelihood of suffering with OA increases. There is a real need for products that can help with OA but without the side effects of anti-inflammatory medication.  Flexiseq is proven to be very safe and cause only minor side effects such as mild skin irritation. It is a little more expensive than some other products, £16.49 from our local Lloyds Pharmacy for a 50g tube. There are many methods of relieving OA, but flexiseq could help you day to day.

Please read our information page about Osteoarthritis to learn more about the condition and how osteopathy can help.

Here is a link of a basic overview of the research for Flexiseq done by Arthritis Research UK.

http://www.arthritisresearchuk.org/arthritis-information/complementary-and-alternative-medicines/cam-report/complementary-medicines-for-osteoarthritis/flexiseq/flexiseq-trials.aspx.