yogatherapy-117
Treatment for Diabetes Millitus through Yoga
November 19, 2016

Hamstring

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The hamstring is a group of three muscles, the semitendinosus, the semimembranosus, and the biceps femoris. They are located at the back of the thigh and is responsible for knee flexion and hip extension.

The origin of the muscle  if at the base of the pelvic bone (ischium) and a small part also runs over the hip joint, the insertions attached to the fibula and tibia.

Although this is a very large muscle, it is also very thin and long and therefore prone to injury. 

The hamstring can strain easily during running, jumping, equating, climbing up or down stairs the muscle can also tear easily and many people would hear and feel a significant "pop" as it happens. 

|The Quadraceps are the balancing group of muscles at the front of the thighs, together with the hamstrings they stabalise the knee. When the Quadraceps are tight it can pull the pelvis forward causing the hamstring to strain or tear.

The hamstrings are also supported by the glutes. Weak or tight glutes can easily overwork the hamstrings and cause injury.

An imbalance between the three hamstrings can also contribute to injury.

Inadequate warming up and stretching before exercising could lead to injury as well.

Athritis of the back, hips or knees can also limit the movement and flexibility of the hamstrings that can cause injury.

Hamstring tears can happen along any of the tendons of the muscle anatomy, but the most common occur in the middle.

An injury to the hamstring cause numerous symptoms like inflammation, swelling, heat,  pain, tenderness, muscles spasms, and bruising.

 

There are three types of injuries:

  • A grade 1 strain describes fibers that are stretched but not torn. A pulling sensation and ache at the back of the thigh may be felt and pain will increase gradually. The pain may be nonspecific and accompanied by tenderness.
  • A grade 2 strain occurs if there is a partial tear of some of the muscle or tendon fibers. A sharp pain and poppng sensation will be experienced during the specific moment of injury and the pain will be felt at the back of the thigh or more acutely at the bottom of the buttocks. There may also be heat and swelling present due to inflammation.
  • A grade 3 strain describes the rare situation where there is complete tear or rupture of the muscle or tendon. This injury results in a loud pop, acute pain, swelling, and bruising. 
 
Assessing the injury before offering treatment or rehabilitation exercises are important to understand the degree of the injury.  touching the area to feel heat, swelling or asses the level of tenderness is done first. In grade 2 or 3 injuries one might be able to feel (like scar tissue) exactly where the tear occur alongside the muscle. A range of movements testing the motions of the back, hips and knees may be done with our without resistance to reveal pain that cannot be felt by initial touching of the hamstring. 

Most patients do not need X-rays or MRI scans, unless there are concerns that the pain is due to fractures and/or pinched nerves like Sciatica that can mimic the signs of hamstring injury. 
MRI's can be helpful to plan the rehabilitation and recovery of athletes to get them back in the game as soon as possible. 

Injuries of the hamstrings are initially treated by the "RICE" concept.

 
1. Rest - motions as simple as walking will be painful and must be avoided with other weight baring movements. Crutches may be given to severe cases to keep the leg in rest. 

2. Ice - Ice the area frequently for 15-20minutes. After inflammation has subsided the icing - heating alternating can be helpful.

3. Compression - wraps and types from the knee to the hip joints or at the knee/ hip joint, to support athletes to start training again without overworking the muscles.

4. Elevation - Lifting the leg higher than the heart will help fluids cause by inflammation to drain.
Anti-inflammatories may be prescribed for 5 - 14 days to relieve such symptoms and pain. 

In grade 1 injuries the Rice technique will be adequate and the muscle will repair itself within a couple of weeks.
  Grade 2 injuries will need rehabilitation exercises and later stretches to help the muscle heal and regain it's strength and flexibility. The process may take between 3-9 months.

Grade 3 tears in the hamstring or avultion fragments have to be operated on and a series of rehabilitation exercises will have to be given and may take up to a year to recover. 


Yoga Sequence to help patient recover from a hamstring injury consist mainly of stretching and strengthening exercises. It is important to start working with the client after initial physiotherapy rehab and recovery is complete.

The client can start the yoga sequence from week 1 depending on the severity of the injury and the range of motion and ability thereof without pain. 

Physical therapy for hamstring injuries:

  • Week 1
    RICE technique. The key is to get the swelling down and the injury free of inflammation. Therapist/ Physio can apply passive range of motion.
  • Week 2-4
    Start active range of motions with the focus on strengthening the muscle. Isometric exercises without any pain. Keep icing and compressing the injury. Start cardio exercises like swimming. Regular massaging techniques to remove scar tissue.
  • Week 2-12
    Isotonic exercises start apply weight and more effort. Start stretching the muscle. Ver mild stretching can be added with no pain.
  • Week 6 - month 6
    Polymetric exercises, stretching the muscle followed by contraction of the muscle. Also exercises like running and stopping, jumping, running stairs etc may be added.
1. Start stretching by laying on the back and pull the knee towards the chest. Now bring the foot in line with the knee and pull into the chest, like a half pigeon. 
We are starting to stretch the hamstrings and the glutes too. Tight glutes can lessen the range of movement in the hamstrings. Hold pose for 2 minutes.

2. Place the legs so that the heels touch the buttocks and lift into a bridge posture. Perform 20 repetitions in slow controlled movements.  Then do it once more and hold the posture for 1 minute - 2 minutes. 
3. Lay on the back and place a block under the sacrum, one leg in half pigeon and the other leg in a 90 degree angle. Pull the legs closer and lengthen the second leg. If the patient has hyperextended knees keep the knee bent. This way we stretch the hamstrings and glutes. Can also try double pigeon here while lying down on the back. Hold for 2 minutes.
4. Now place a block underneath the ankles and lay flat on the back. Lift the hips (a version of bridge pose) with straight legs.  Perform 20 repetitions in slow controlled movements.  Then do it once more and hold the posture for 1 minute - 2 minutes.
5. Lay down on the back again, bend the knee into the chest and now slowly start lengthening the leg into a 90 degree angle. A belt can be used for support. Compressing the origin or insertion of the muscle by binding it with a belt or bandage tightly can also help. When this feels comfortable, pull the straight leg closer to the chest. Also lengthen the leg out to the side then pull the leg over and lengthen it to the opposite side, supine twist. 
6. Hug both legs into the chest and rest the hamstrings for 1 minute. 
7. Roll over and rest in makrasana, or keep arms in locust, or half cobra, now lift the leg upwards. Keep the leg straight. Perform 20 repetitions in slow controlled movements.  Then do it once more and hold the posture for 1 minute - 2 minutes. 
8. Push up into downward dog, taking turns to bend and stretch each leg with inhalation and exhalation, continue for 1 minute.
9. Standing up keep the legs wide and bend forward, keep a straight back. Try not to hunch by using blocks or the wall for support. Do deepen the stretch place block under the balls of the feet. Monkey breathing can be performed here to warm up the muscles, with or without pulses downwards. Move body over to the right legs and pull the abdomen close to the thigh (repeat on other side) If the hamstrings are still very tight then bend on the inhale and stretch on the exhale. Always tilt the pelvis and lengthen the spine. Hold this stretch for 1 minute.
10. Chair pose 2 x 30 seconds held each time. Can also be done against the wall for support. 
11.   Keep one leg on wall or chair and bend forward. Do not hunch and pull the abdomen towards the thigh. A strap can be used for support.
12. Hold on to the wall and lift the leg up backwards, keep the leg straight.  Do 20-30 repetitions and then hold the leg up for 1 minute.
13. Then swing the leg backwards and forwards releasing tension increasing the movement, while holding onto the wall with one hand. By placing a block underneath the standing leg the height increase to create more space for movement. 
14. Try to stretch the hamstring by bending over straight legs, feet together.
15. Now step into horse pose and stretch the quads, as tight quads can also prevent full range of movements of the hamstrings. Hold for 30 seconds. Then place the elbows on the floor and stretch through the hamstring and hold for 30 seconds.
16. Press up into Warrior 1. Perform 20 pulses and then hold the posture for 1 minute.
17. Now straighten both legs and bend over the front leg. Blocks can be used as support. Keep the back straight; no hunching. Hold the posture for 1 minute.
18. Step back into downward dog. Inhale and with the exhale lift one leg into the air. Keep the leg straight. Hold posture for 1 minute.
19. Come onto four legged posture and with an inhale lift the leg up into the air with a flexed foot, exhale and curl leg into chest. Repeat 20 - 30 times. 
20. Rest in child's pose for 1 minute.
21. Sit with one leg stretched out in front in half butterfly, stretch over the leg with a straight back. A belt can be used to prevent hunching. Progress and keep both legs in front hip with apart. If the hamstrings are very tight bend the legs and catch the toes (or use a belt) now inhale and with the exhalation start lowering the legs and stretching the back, tilting the pelvis. Keep each stretch for 30 seconds - 2 minutes.
22. Now lie down and hug the legs into the chest for 30 seconds. 
23. Rest in savasana for 2 minutes.
Keep in mind that if the hamstring feels tight, pulling, burning or like locking in any stretch it is best to keep moving it. For instance, inhale and bend the legs a little then slowly stretch the muscles by exhaling and lengthening the legs slowly. This action can be repeated a number of times until the stretch feels painless. 
another method to help a muscle stretch is to bind it using special bandages or even a yoga strap/belt. When you feel a strong limitation preventing the muscle to stretch bind the muscle either at the origin (buttocks), insertion (behind the knee) or in a spiral from the knee to the buttocks. This will keep the muscle in tact and prevent the weak part to over stretch. 

The hamstrings are easily injured and takes a long time to repair fully. If this injury happens to you, friend, or client work at a steady pace and don't rush the recovery thereof, because this is a very important muscle that we use in our daily activities like sitting, standing up, walking, climbing stairs. It is important to recover fully.

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