Chronic Hamstring Injuries Caused By Nerve Impingement
A hamstring injury is one of the most common problems facing professional footballers
- accounting for almost 40% of all Premiership injuries in the 2004/05 season.This type of injury is sometimes referred to as a "pulled hamstring" and the likes of Arsenal skipper Cesc Fabregas has recently been a victim, meaning a spell on the sidelines during a vital time in the Premiership title race.
The term "pulled muscle" comes from the description of how the injury takes place. Since the muscle works over the hip and knee joint, the muscle is susceptible to injury due to being stretched beyond its limit and the muscle tissue being torn.
Depending on its severity, a hamstring pull is classified as a first, second or third degree strain:
a first degree strain is damage to a few muscle fibres,
a second degree strain is damage to a more extensive number of muscle fibres,
a third degree strain is a complete rupture of the muscle itself.
But recent studies have found a relationship between lower back problems and hamstring injuries, particularly in older athletes. It is often the underlying cause in those patients who suffer from recurrent "hamstring" problems.
Even a subtle entrapment of a particular nerve in the lower back (L5 nerve) is believed to lead to an increased risk in hamstring symptoms.
The compression on the nerve can be caused by a prolapsed disc, more commonly known as a slipped disc, or by a structure called the "lumbosacral ligament".
Although a trapped nerve is believed to increase the chances of an actual physical strain in the hamstrings, remarkably a trapped nerve can sometimes mimic a hamstring problem without any physical signs of a muscle strain!
Management
Those of us who lead active lives will be familiar with the RICE protocol - Rest, Ice, Compression and Elevation - which is often used for muscle strains. The ice is aimed at reducing the bleeding and damage within the hamstring muscle tissue and should be applied for 15 minutes every hour (never apply ice direct to the skin). Resting may be the common sense approach, but it is one that is often ignored. Unfortunately, it doesn't take much to turn a one hamstring strain into a grade two, or a grade two hamstring strain into a grade three. As a general rule, grade one Hamstring strains should be rested from sporting activity for about 3 weeks and grade two injuries for about 4 to 6 weeks. In the case of a complete rupture, the hamstring muscle will have to be repaired surgically and the rehabilitation afterwards will take about 3 months. But the management of hamstring injuries, whereby the lower back is involved, differs from the typical RICE protocol.
The way to deal with this would be to see a specialist who can examine the low back. If the low back would be involved, than traction and specific vertebral mobilisation techniques can be used to free up the nerve. In addition, anti-inflammatories should be taken - something which wouldn't be advisable when dealing with a traditional muscle strain. Neural mobilisation (stretching the nerve) is something that can also be considered, as long as it doesn't increase the symptoms.
After the initial pain has subsided, core strength and core stability can be introduced to improve muscle function across the trunk and pelvis and reduce the risk of hamstring injuries.
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