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In This Issue...
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Driving Impaired: The Costs & Consequences
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Health
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Hamstring Muscle Pulls and Tendonitis
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Hamstring Muscle Pulls and Tendonitis
By Barbara MacFarlane, MD
Lifesport & Wellness Center
Hamstring injuries occur just as easily in the old as the young, and occur as often with the inactive as the active person. The injury can happen equally in normal daily activity or with high competitive activity.
The most common cause of the tendon inflammation is overuse.
It is repetitive stress placed on the muscle and tendon that causes the overuse. Active sports such as those that involve running, kicking, jumping or any quick starting or stopping motion are the main culprits with the tendonitis and hamstring muscle pull.
Inactive People Face Additional Risks
For the inactive, when they suddenly undertake an activity, it makes them subject to the problems of tendonitis. Any other factors such as overpronation of the foot, strength differences between the two legs, lack of any activity and obesity only further increase the risk of the tendonitis and hamstring muscle pull.
Hamstring tendonitis often goes through an insidious onset and then progressively gets worse.
The hamstring muscle runs down the back of your thigh; there are tendons both at the top and the bottom.
The top tendon attaches to your "sitting" bone and the bottom tendons run on both the inner and outer part of your knee from the back of the knee towards the front of your lower leg just below your knee.
You can get tendonitis in either the top or bottom tendons or even both areas at the same time. Once the tendonitis develops, it becomes more painful with overexerting or after exercise, or even just with sitting for prolonged periods of time.
Initially there is often just decreased mobility and stiffness after exercise, which then progresses to occur even at rest. Once the hamstring tendonitis or muscle pull begins to have symptoms at rest, the hamstring muscle itself begins to weaken and it becomes difficult to walk without a limp. Swelling can be present around the tendon.
Hamstring Causes Lower Back Pain
Hamstring problems often cause low back problems as well. With tightness in the hamstring, it can promote tilting of the pelvis and low back muscle tightness. Sometimes the first symptom that the patient experiences is low back pain rather than hamstring muscle or tendon pain. Attending to the hamstring problem is the way to deal with this type of low back pain.
The Stages of Healing
The stages of tendonitis pain are similar for any type of tendonitis. Hamstring tendonitis is no different.
The stages are as follows:
1) Minor twinges that occur early in an activity or workout and then resolve as the muscle and tendons warm up and become more flexible (often lasts the first 3 months),
2) Pain that lasts longer into the activity or workout and returns after the exercise (usually month 3-6), and
3) Pain that is constant (usually after 6 months).
Recovery Takes Time
With the pain progressing over a period of six months, it is often an equally long course to return to a symptom-free state. Any very abrupt increase in activity can shorten the six-month course of obtaining the tendonitis to as short as a few days, but the treatmenttime to resolve the tendonitis in not equally reduced.
Recovering from tendonitis requires time and patience, which often are the very things people do not have a lot of.
Hot/cold compression wraps are very useful in the treatment of hamstring tendonitis. Initially the cold and the compression help minimize the amount inflammation and pain that occur in the tendon and the muscle. Less inflammation will cause less tightening of the muscle and less pain as well.
Later, after the acute stage, the hot compression can draw blood to the area and cause healing of the tendon and muscle.
Warm Up Essential
An injured muscle/tendon always decreases in strength after being injured. Because of this decrease, the hamstring muscle needs both endurance and static strength improvement during the rehabilitation phase of recovery.
A good warm-up allows the muscle to be more flexible. With this flexibility it is easier to train strength. An active person always needs to remember to return to activity stronger than prior to the injury.
The need to progress slowly to allow recovery to be full and efficient is best guided through formal physical therapy.
This is often taken as an insult by the patient to find out that they need therapy. However, the therapist can guide the patient through the prolonged process.
Always knowing where you are on the continuum of getting better is a great motivator for anyone, and the therapist can provide this feedback and guide the patient with the right increments of challenge to the healing muscle and tendon.
Patience with the healing process is very important with hamstring tendonitis. Expect the process of healing to take at least as long as the process of acquiring the symptoms. Seek professional therapy and understand that getting stronger is the ticket to returning to the same activity, or any running or jumping activity.
Once you get symptom free, enjoy the benefits and keep healthy and fit.
by Barbara J. MacFarlane, MD
Lifesport Medicine
and Wellness Center
www.lifesportmedicine.com 
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