Hamstring Injuries

By Jake Veigel MD

If you've been following the U.S. Men's National Soccer Team at the World Cup, you know how big a deal hamstring injuries can be. Here's what you need to know, from sports medicine expert Jake Veigel, MD, at the Intermountain Memorial Clinic and Sports Medicine Specialty Group.

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The United States Men’s National team was victorious in their first match of the 2014 World Cup on Monday.  But the victory came with a price as starting striker, Jozy Altidore, suffered a hamstring injury and will not play in Sundays match against Portugal.  It is still uncertain if Altidore will be back for later matches should Team USA advance.  While hamstring injuries are very common in sports, especially sprinting sports like soccer, they unfortunately can shut you down.   Even very minor injuries will keep you from performing your best until they are healed.

The hamstring muscles are a group muscles that sit right behind the thigh.  As the muscles travel down the back of the thigh they diverge.  One called the biceps femoris attaches to the fibula (the smaller bone in the leg on the outside part) and the other two called the semitendinosus and semimembranosus attach to the Tibia or shin bone.  These muscles work together to straighten the hip joint and bend the knee joint. 

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A hamstring strain is an injury to one of these muscles or to one of the tendons of these muscles.  An injury can be very high and even so severe that the tendon pulls off the bone.  The injury can also be in the muscle belly or even lower near the knee.

When you injure your hamstring you feel sudden pain at the sight of their injury, as was evident when Altidore suffered his injury, immediately pulling up and grabbing at the back of his leg. You may feel a pop when it occurs and the pain and weakness of the muscle makes it very difficult to continue playing.

The big question for the UTMNT is if Jozy can recover in time to play in their final match of group play against Germany on June 26h.  Treatment for hamstring injuries involves rest, ice and stretches in the short term.   Anti-inflammatory drugs can help with the pain.  Images like an ultrasound or MRI are often helpful in assessing the severity and location of the injury, which intern can help with treatment.  Often, the closer the injury is to the hip, the longer the recovery may take.  Recovery time is variable and can be as short as one week (so there is a chance Altidore could return) but is often more near 4-6 weeks. 

Sometimes injections in or near the injured area are performed in attempt to get an athlete back in play; however, going back to play too soon can increase the risk of reoccurring injuries in the future.  I like to perform a test called the Askling H test prior to return to full activity.  If that test is completely pain free then you are ready to play.

As you participate in sports or activities, hamstring strengthening exercises are thought to be the best way to prevent hamstring injuries, most importantly eccentric strengthening exercises.  An eccentric exercise is one when the muscle is contracting while elongating.  Two examples are illustrated below.

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From:  Petersen. Preventive effect of eccentric training on acute hamstring injuries in men's soccer a cluster randomized controlled trial AJSM 2011

And if you are alone you can do them on a stability ball

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When dealing with injuries, the future health of the athlete should always be a top priority.  We wish Jozy a quick recovery and will be cheering on Team USA throughout the rest of the World Cup.