Muh Ikhwan Zein

Hamstring Anatomy
No Name Origin Insertion Action
1 Biceps Femoris (Long Head) Ischial Tuberosity Lateral Condyle of • External Knee
the Tibia, Head of Rotation
Fibula • Hip extension
• Knee flexion
Biceps Femoris (Short Head) Linea Aspera on the Lateral Condyle of • Knee Flexion
posterior surface of the the Tibia, Head of • External Knee
femur Fibula Rotation

2 Semimembranosus Ischial Tuberosity Medial condyle of • Hip extension.

proximal the tibia • internal knee rotation
• Knee Flexion
3 Semitendinosus Ischial Tuberosity Pes anserine medial • Hip extension.
tibia • internal knee rotation
• Knee Flexion

4 Innervation Sciatic Nerves

Early Re-injuries – Within 2 months
Early Re-injuries – Within 2 months
 Early Re-injuries – Within 2 months
100

90
Cumulative proportion %

80

70
Re-injury:
Same location, same muscle
60 Same muscle
50
Other muscle

40

30

20

10

0
0 50 100 150 200 250 300 350

Days between initial injury and re-injury

Wangensteen A, Tol JL, Witvrouw E, Van Linschoten R, Almusa E, Hamilton B, Bahr. Hamstring re-
injuries occur at the same location and early after return to sport – a descriptive study of MRI-
confirmed re-injuries. Am J Sports Med. 2016
 Injury mechanism of the sprinting type injury

• Occurs at the terminal (late) swing phase

• Bi-articular HS reaching max hip flexion & knee extension angle
• Shift from ECC to CON contraction at max activity of HSM
• Speed related increases in muscle force and negative work
• E absorption> E accumulation. If Not : risk of muscle strain
 Clinical Diagnosis
• history of an acute onset of posterior thigh pain, on physical
examination the triad of localized pain on
1. Palpation
2. Stretching
3. contraction of the hamstring muscle

Askling, C., Saartok, T. & Thorstensson, A. Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. Br. J. Sports Med. 40, 40–44 (2006).
Askling, C. M., Tengvar, M., Saartok, T. & Thorstensson, A. Acute first-time hamstring strains during high-speed running: A longitudinal study including clinical and magnetic
resonance imaging findings. Am. J. Sports Med. 35, 197–206 (2007).
History and Inspection
• Acute posterior
thigh pain
• Mechanism of
Injury
• Hematoma (+)
• Abnormal gait
Examination
• Palpation → Pain in localized area
Range of Motion (ROM) Examination
1. Standing Trunk Flexion
2. Straight Leg Raise (SLR) test
3. Passive Knee Extension Test (PKET)
4. Active Knee Extension Test (AKET)
5. Slump test
ROM Examination
1. Standing Trunk Flexion
Rrom Examination
2. Straight Leg Raise (SLR) Test
ROM Examination
3. Passive Knee Extension Test (PKET)

1 2
 ROM Examination
4. Active Knee Extension Test (AKET)

1 2
ROM Examination
5. Slump Test
Strength testing
• Isometric Knee Flexion Strength test
ACUTE HAMSTRING STRAIN

P • PROTECTION

• REST
R

I • ICE

C • COMPRESSION

E • ELEVATION
 Rest vs Early Mobilization?
• Early mobilization induces increased, rapid and organized growth of
capillaries to injured area
• IGF-1 : increased after 10 min of exercise
• → Satellites (stem) cell activation
• More rapid return of strength with mobilising

Jarvinen et al (2013), Shefer et al (2012), Maculuso et al (2012), Mourkiotti et al (2005)

• Rest vs Optimal Loading
• Early active mobilization program
• Under PAIN level (VAS < 2)
Inflamation phase

Fibroblastic
Regeneration &
Repair phase

Maturation &
Remodeling
phase
Intervention Strategies Used in Sports Injury
Prevention Studies

Vriend et al, Sports Med 2017; 47

23 5
66 RCTs Controlled interrupted
Trial time series

22
155 studies prospectiv
e cohort
39 pre-
post test
design
studies

Athlete Regulation Equipment Environment

n =85 (55%) n = 14 (9%) n = 33 (21%) n = 18 (12%)
Intervention Strategies to Prevent Injury

Athlete Rules and Regulation Equipment Context (environment)

1.Improving physical 1.New or modified 1.Tape 1.Coaching education

fitness (Strength, rules of sport
Balance, agility) 2.Brace 2.Referee education
2.New law
2.Technique correction 3.Footwear 3.Changing safety
(e.g. falling, landing, 3.Strict enforcement of culture
etc) rules/penalizing 4.Protective gear
4.Policy change
4.Mandatory of Health
3.Psychological/cogniti Screening
ve skills

4.Education:
• Increase risk
• awareness
• Information on injury
• preventive behavior