Proximal Hamstring Tendinopathy-Part 1
Proximal hamstring tendinopathy (a.k.a. tendinosis) is an uncommon overuse injury most commonly observed in long distance runners and sprinters.
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Anatomy and Biomechanics of the Hamstrings
The hamstrings consist of 3 muscles: semitendinosis, semimembranosis and biceps femoris (short and long head). All 3 muscles (except biceps femoris short head) originate from the ischial tuberosity and separate from on another 5-10 cm distal to their attachment. The hamstrings function in movement of both the knee and hip. The main functions of the hamstrings include: hip extension and knee flexion. However, the hamstrings also weakly adduct the hip, the long head of the biceps femoris aids in external rotation of the thigh and leg whereas the more medial semimembranosus and semitendinosus muscles assist with internal rotation of the thigh and leg.
The function of the hamstrings during running is critical. First, the hamstrings provide dynamic stabilization to the weight-bearing knee in running by eccentrically contracting (contract while lengthening) to decelerate forward momentum of leg swing at ~30° short of full knee extension. Second, the hamstrings eccentrically lengthen at foot strike to facilitate hip extension, thus further stabilizing the leg for weight bearing. Third, the hamstrings assist the gastrocnemius in extending the knee during the takeoff phase of the running cycle.
Clinical Presentation
Most commonly tendinosis occurs in the semimembranosis tendon. Patients typically present with a history of distance running or jumping. Pain is experienced in the lower gluteal region, sometimes radiating along the hamstring muscle into the posterior thigh and/or popliteal fossa. Pain is often experienced while performing acceleration or speed activities such as running or jumping or while sitting for prolonged time. Upon physical examination, patients may experience tenderness over the ischial tuberosity. Active stretching of the posterior thigh will recreate pain at the ischial tuberosity. Generally, no strength deficiencies are noted in hip flexion or extension. Supine bridging can assess for weakness and pain within the hamstrings.
Surgical and MRI findings have reported that adhesions of the sciatic nerve and proximal hamstring tendons can result in compression of the sciatic nerve. Due to these adhesions, the sciatic nerve may become taut and impinged during forward swing of running and therefore complicate symptoms of hamstring tendinopathy. Patients may complain of buttock or thigh pain with radicular symptoms that may be confused with low back and/or hip pathology or Piriformis syndrome.
Visit On The Mark-it Physiotherapy and Sports Injury Clinic (www.markitphysio.com) to book an appointment with chiropractor Dr. Erika Bell for treatment of sports related injuries.
Dr. Erika Bell, BKin (Hon)-Liberty Village Chiropractor
Doctor of Chiropractic
Active Release Technique Provider
Contemporary Medical Acupuncture Provider
What is Chiropractic?
Chiropractic is a non-invasive, hands-on health care discipline that focuses on the neuromusculoskeletal system. Chiropractors use a manual approach to provide diagnosis, treatment and preventive care for issues relating to the spine, pelvis, extremities, nervous system, muscles and joints.
Chiropractors use a combination of treatments, all of which are predicated on the specific needs of the individual patient. After taking a complete history and diagnosing a patient, a chiropractor can develop and carry out a comprehensive treatment plan which may include chiropractic manipulations of muscles and joints, therapeutic modalities (IFC, Ultrasound), soft tissue therapy (A.R.T ®), rehabilitation and lifestyle advice.
Check out our chiropractors located in liberty village/kingwest. Can help with your sports injury and road to recovery
Liberty Village Chiropractor
What massage aims to achieve
Sports massage, like many other types, needs a thorough understanding of anatomy, physiology, muscular and skeletal systems. This is paramount in sports massage as dealing with top class athletes. Regular massage will prevent the wear and tear of intensive training, letting the athlete ease sore muscles, recover from aches and pains as well as targeting muscle imbalances and specific areas of weakness.
The benefits of sports massage
When applied skillfully massage is the best way of releasing muscle tension. It can restore balance to the musculo-skeletal system and if received regularly prevents injuries which can keep athletes out of action for months, and in severe cases, years.
Massage seeks to relieve the tension which builds up in joints, ligaments, tendons and muscles.
Muscle imbalances are also treated through sports massage. These often develop and go undiagnosed until they creep up causing serious pain and often injury. These often occur through incorrect posture, poor form or from intensive activity. A skilled sports massage therapist will be able to detect this quickly before the problem becomes too severe and thus save an athlete from damaging time off through injury.
Check out our massage therapists in liberty village and get back to sport safer and faster.
For more information about massage and massage therapists go to the Regsitered Massage Therapists’ Association of Ontario www.omta.com
This past weekend I finally received the email I have been waiting for. The chance to work with our country’s elite athletes on the international stage. I am honoured, proud and excited to say that I will be accompanying Canada’s national figure skating team as the team phyisotherapist for the 2012 ISU Four Continents Figure Skating Championship.
The 2012 Four Continents Figure Skating Championships 2011–2012 season: Skaters will compete in the disciplines of men’s singles, ladies singles, pair skating, and ice dancing for the title of Four Continents Champion. The four continents of the event’s name refer to the Americas, Asia, Africa, and Oceania, which are four of the continents represented in the Olympic rings, omitting Europe.
The competition has been assigned to be held from February 7–12, 2012, in Colorado Springs, Colorado, United States.
For related news check out
www.skatecanada.ca
www.isu.org
In the next few months university begins and so does varsity sports. Athletes will be arriving in Toronto from all over the province and the nation to compete at university of Toronto for their respective sports. Check out http://www.universityoftorontohotels.com for your hotel accommodations. You will find Toronto hotels located near the university of Toronto. If you sustain a sports injury the sports physiotherapists, chiropractors and massage therapists of Toronto physiotherapy-On the Mark.It Physiotherapy & Sports Injury clinic are here to get you fit to play so you can return to the pitch, rink or field as soon as possible. www.markitphysio.com
This presentation is an educational tool for elite and non-elite athletes who may encounter a concussion during their sporting career. The information provided was obtained from the sport concussion assessment tool (SCAT2) and the Consnesus statement on concussion in sport from the 3rd international conference on concussion in sport, held in Zurch November 2008. I am hoping this tool can benefit athltetes, coaches and trainers to better undrestand and recognize the signs and symptoms of concussion and to comply with the most recent recommendations from the world’s experts on concussion in sport. This will only ensure the safest possible return to play and allow the athlete to compete at his/her highest levels for years to come.
This year I have the honour of working with the Under 20 Ontario Women’s Rugby club. In my first act as the team’s sport physiotherapist I have created this pretty medical questionnaire. A full understanding of an atheletes past medical history can help prevent future injuries and improve the liklihood of success on the pitch. Below I have included the medical forms. I encourage all who work with a team to look at these forms, print them and use them. Your athletes will only benefit from the knowledge you gain.
Rugby medical form page 1 2011
Rugby medical form page 2 2011
Call it reflection time but my time at the rink allows me take stock of where I have been and imagine where I will eventually go. This event has brought me full circle, literally face to face with the first few crucial steps of my career. I am currently writing this piece surrounded by 2 sports medicine physicians and a sports physiotherapist who started their journey of being the future pioneers of their respective professions exactly the same time and place I started my first job. Our past defines where we end up.
The time allows me to learn about my profession and how we have developed as health practitioners to experts in rehabilitative/urgent care to the elite athletes of the world. It allows me to pay homage to the pioneers of the past with their countless hours of volunteering, team management, planning, treating and travel. You have created the system for the younger physiotherapist to develop and grow. Its because of you that we are as strong as we are in the field of sports physiotherapy. I marvel at your greatness
Finally, how does a guy like me end up working a figure skating event like this. Well, my old bosses used to be the chief medical officer and chief therapist for this event many years ago. They brought me along as a lonely volunteer and taught me all about what it takes to provide superior care and coverage at a national sporting event. They helped me grow into a physiotherapist who is passionate for the sports he covers. To give 110% and then some. To put into the sport the same passion and effort in a five day period that one of these athletes puts in everyday of their lives. Thank you to my personal figure skating pioneers.
