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The Athletic Hip Series: The Various Hamstring Injuries

By: Maggie Gebhardt PT, DPT, OCS
Adjunct Clinical Professor- Mercer University, Division of Physical Therapy

Anyone who has had, or knows someone who has had, a hamstring tear knows it can look pretty bad. Typically people will report pain, hearing a pop, and a deep, ugly bruise that shows up a couple of days later that can extend past the knee. Even though this sounds really dramatic those are the kinds of injuries you actually want to have, because after the initial inflammation they tend to heal fairly quickly.

Then there are the more common and much less talked about tendiopathies. These are the injuries that come on slowly and you do not notice until it’s almost too late. They are the nagging, “pain in the butt” (pun intended), injuries that at times seem like they will never get better. Any place you have a tendon is a location where you can develop a tendinopathy, but typically at the origin of the hamstring muscles, what people often like to call the “SITS” bones, is where they are most commonly seen. This is one of the reasons that people with this type of injury will often complain of pain when sitting and crossing their legs. High hamstring tendinopathies take a long time to heal because unfortunately they are very difficult to offload in order to rest them…you use them all day to walk!

So what is one to do? Sometimes cortisone injections help, but usually only if coupled with good Physical Therapy. When I say good I mean the kind of PT that looks at the way you move, and how you’ve abused those hamstrings. Physical Therapy should not only address the tendon at the site of injury but should also address the movement issues that got you into this predicament in the first place. In our practice we typically see some sort of lower extremity  issue that has caused you to be inefficient in your running and walking. This could be anything from a stiff ankle to weak glutes. Any lower extremity issue can cause other areas in the leg to be overused and therein lies the art of physical therapy. Our job is to figure out the “how,” which is often the secret to what is going to get you better!

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