Hamstring Syndrome

with Rehab

ExitCare ImageHamstring syndrome is a rare condition that causes pain and sometimes loss of feeling in the back of the thigh, often to the bottom of the foot. Hamstring syndrome is caused by pressure on the sciatic nerve in the hip, by a fibrous tissue that extends between two of the hamstring muscles on the backside of the thigh. The sciatic nerve may also be compressed between the muscles and bones of the pelvis. The hamstring is a collection of three muscles located on the backside of the thigh, that are responsible for straightening the hip and bending the knee. The hamstring muscles are important for walking, running, and jumping. The sciatic nerve usually passes near these muscles, and the pelvis runs under these muscles, in the thigh.

SYMPTOMS

  • Tingling, numbness, or burning in the back of the thigh to the back of the knee, and sometimes to the bottom of the foot.

  • Tenderness in the buttock.

  • Pain and discomfort (burning or dull ache) in the hip or groin, mid-buttock area, the back of the thigh, and sometimes to the knee.

  • Heaviness or fatigue in the leg.

  • Pain that worsens when sitting, running fast, kicking, or trying to stretch the hamstring muscles.

  • Pain that is less strong when laying flat on the back.

CAUSES

Hamstring syndrome is caused by pressure on the sciatic nerve in the hip, by either a fibrous tissue or bone.

RISK INCREASES WITH:

  • Sports that require jumping, sprinting, hurdling, or sitting.

  • Kicking sports (like soccer and football kickers).

  • Recurring hamstring muscle strains.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper exercise technique.

PROGNOSIS

If treated properly, hamstring syndrome usually goes away in 2 to 6 weeks. Occasionally, hamstring syndrome goes away on its own. Rarely, surgery is necessary.

RELATED COMPLICATIONS

  • Permanent numbness in the affected knee, leg, and foot.

  • Persistent pain in the knee, leg, and foot.

  • Increasing weakness of the leg.

  • Disability and inability to compete in sports.

TREATMENT

Treatment first involves resting from activities that aggravate your symptoms. The use of anti-inflammatory medications will help reduce pain and inflammation. Strengthening and stretching exercises are important for reducing the severity of symptoms. These exercises may be completed at home or with a therapist. Corticosteroid injections may be given to help reduce inflammation and reduce pain. If non-surgical treatment is unsuccessful, then surgery may be needed, to free the compressed nerve.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be recommended. However, these injections should only be used for serious cases, as they can only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM)AND STRETCHING EXERCISES - Hamstring Syndrome

These exercises may help you when beginning to rehabilitate your injury. Nerves can be easily irritated by excessive or incorrect movements. Only increase your repetitions with your caregiver's permission.Contact your caregiver if your symptoms get worse while doing any of the prescribed exercises. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH - Hamstrings, Standing

  • Stand or sit, and extend your right / left leg, placing your foot on a chair or foot stool.

  • Keep a slight arch in your low back and your hips straight forward.

  • Lead with your chest and lean forward at the waist, until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.)

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Hamstrings, Supine

  • Lie on your back. Loop a belt or towel over the ball of your right / left foot.

  • Straighten your right / left knee, and slowly pull on the belt to raise your leg. Do not allow the right / left knee to bend. Keep your opposite leg flat on the floor.

  • Raise the leg until you feel a gentle stretch behind your right / left knee or thigh. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Hamstrings, Doorway

  • Lie on your back with your right / left leg extended and resting on the wall, and the opposite leg flat on the ground through the door. Initially, position your bottom farther away from the wall.

  • Keep your right / left knee straight. If you feel a stretch behind your knee or thigh, hold this position for __________ seconds.

  • If you do not feel a stretch, scoot your bottom closer to the door and hold __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Hamstrings/Adductors, V-Sit

  • Sit on the floor with your legs extended in a large "V," keeping your knees straight.

  • With your head and chest upright, bend at your waist reaching for your left foot to stretch your right thigh muscles.

  • You should feel a stretch in your right inner thigh. Hold for __________ seconds.

  • Return to the upright position to relax your leg muscles.

  • Continuing to keep your chest upright, bend straight forward at your waist to stretch your hamstrings.

  • You should feel a stretch behind both of your thighs and knees. Hold for __________ seconds.

  • Return to the upright position to relax your leg muscles.

  • With your head and chest upright, bend at your waist reaching for your right foot to stretch your left thigh muscles.

  • You should feel a stretch in your left inner thigh. Hold for __________ seconds.

  • Return to the upright position to relax your leg muscles.

Repeat __________ times. Complete this exercise __________ times per day.

MOBILIZATION EXERCISES - Hamstring Syndrome

Mobilization exercises help trapped nerves to glide freely. When nerves have extra pressure on them, or when they get anchored down by surrounding tissues, they can cause pain, numbness or tingling. When completing a mobilization exercise, remember:

  • Nerves are very sensitive tissue. They must be mobilized very gently. Never force a motion and do not push through discomfort.

  • Mobilize nerves slowly.

  • Nerves can be very long. Be sure to position all of your body parts exactly as described.

ExitCare Image MOBILIZATION - Nerve Root

  • Sit on a firm surface that is high enough for your right / left foot to swing freely. You may place a folded towel under your right / left thigh, if helpful.

  • Sit with a rounded or slouched back. Drop your head forward.

  • Keeping your right / left foot relaxed, slowly straighten your right / left knee, until it is fully extended or you feel a slight pull behind your knee or calf.

  • If you do not feel a slight pull, slowly draw your foot and toes toward you.

  • Hold for __________ seconds. Release the tension in your knee and ankle slowly.

Repeat __________ times. Complete this exercise __________ times per day.