Common Sports Injuries - Treating the Hamstrings

Posted by Judith Winer on Jun 01, 2020

Hamstrings - Trigger Point Anatomy

Ultimately, the hamstrings are trying to be gluteal muscles, while the lumbar muscles are trying to be hamstrings

The hamstrings eccentrically contract during gait in order to decelerate extension of the knee joint and hip flexion, while also playing a very important role in pelvic stability.

The hamstring muscles decelerate internal rotation on heel-strike

The hamstrings disappear under the gluteus maximus and provide force closure of the sacroiliac joint through the coupled action of the force provided by the contralateral latissimus dorsi.

This force is transmitted through the sacrotuberous ligament and further up to the thoracolumbar fascia.

Hamstring trigger points are often mistaken for Sciatic Pain

Typically, pain from trigger points is referred up toward the gluteal muscles, with some residual pain spreading down just below and behind the knee into the medial gaster of the gastrocnemius.

This pain can often be mistaken for sciatic pain. Weak inhibited gluteal muscles, including the gluteus medius, can lead to myofascial trigger points forming in the hamstrings and lumbar erector muscles, including the quadratus lumborum.

Ultimately, the hamstrings are trying to be gluteal muscles, while the lumbar muscles are trying to be hamstrings.

Hamstrings Muscles

Trigger Point therapy for injury avoidance

It's easy for one or more of the hamstrings to get overloaded and just about anyone who plays sport regularly, from professionals to weekend warriors, should benefit from therapy in this area to help avoid what can become painful and long term injuries.

We generally take a look at the hamstrings on just about every client who plays a sport regularly that involves running, jumping and turning ..... even when there are no symptoms.

Fortunately, identifying and treating trigger points in the hamstrings is pretty straightforward although bear in mind that trigger points in large muscles will often require additional pressure.

Anatomy

The hamstrings consist of three muscles. From medial to lateral they are the semimembranosus, semitendinosus, and biceps femoris.

Origin

Ischial tuberosity (sitting bone). Biceps femoris also originates from back of femur.

Insertion

Semimembranosus: back of medial condyle of tibia (upper side part of tibia).

Semitendinosus: upper medial surface of shaft of tibia.

Biceps femoris: lateral side of head of bula. Lateral condyle of tibia.

Action

Flex knee joint. Extend hip joint. Semimembranosus and semitendinosus also medially rotate (turn in) lower leg when knee is flexed.

Biceps femoris laterally rotates (turns out) lower leg when knee is flexed.
Antagonists: quadriceps.

Nerve

Branches of sciatic nerve, L4, 5, S1, 2, 3.

Basic Functional Movement

During running, the hamstrings slow down the leg at the end of its forward swing and prevent the trunk from flexing at the hip joint.

Biceps Femoris Trigger Points

Biceps Femoris - Typical Referred Pain Pattern

Semimembranosus/ Semitendinosus - Typical Referred Pain Pattern

Trigger Point Referred Pain Patterns

Semimembranosus and semitendinosus: strong 10 cm zone of pain, inferior gluteal fold, with diffuse pain posteromedial legs to Achilles tendon area.

Biceps femoris: diffuse pain posteromedial legs, with strong 10 cm zone posterior to knee joint.

Indications

Posterior thigh pain sitting/walking (worse at night), tenderness in back of legs may cause limping, pain worse on sitting, post back surgery, hamstring pain cycling/soccer/ basketball/tennis/football.

Causes

Prolonged driving, improper sitting/ work chair that digs into back of thighs, hip surgery, sitting cross- legged, hip/knee/ankle injury/ fracture, leg casts, high-heeled shoes, PSLE, sacroiliac joint dysfunction, improper stretching before/after sport.

Differential Diagnosis

Sciatica. Radiculopathy. Muscle tears. Osteitis. Bursitic osteoarthritis of knee. Knee joint dysfunction. Tenosynovitis.

Connections

Piriformis, popliteus, gluteal muscles, obturator internus, vastus lateralis, plantaris, gastrocnemius, thoracolumbar paraspinal muscles.

Self Help

Trigger points in hamstrings often occur from improper stretching before and after sports. It is very important to get the stretching techniques down pat. Balls and foam rollers can be very good for relieving pain and stiffness when you are at home.

Trigger Point Treatment Techniques

Spray and Stretch	YES
Deep Stroking Massage	YES
Compression	YES
Muscle Energy Techniques	YES
Positional Release	YES
Dry Needling	YES
Wet Needling	YES

Links

Find a Trigger Point Professional in your area

More Articles About Hip Injuries and Treatment

Online Hip Course - Stuart Hinds

Dry Needling for Trigger Points

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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.