Osteopathy and prevention of hamstring strains

The prevalence of hamstring strains among people who play sports that involve running and or jumping is high. To add, once a hamstring strain has occurred, the risk that it will happen again is much higher.

Why do hamstring injuries occur? 

Research by Sherry and Best (2011) has confirmed what osteopaths have long understood. This is that the angle of the pelvis and trunk strength often play an integral role in the strength of the hamstring and the prevalence of repeated strains in sportsmen and women. In their study, it was found that 70% of participants who only followed a stretch and strengthening programme suffered a recurrent hamstring injury, compared to 7% of those who completed a pelvic and trunk stabilisation programme. 

Osteopathic treatment to realign the pelvis, combined with therapeutic exercise to increase core stability and hamstring strength is a very effective way of addressing this.

I am going to share a recent case which illustrates how an osteopathic approach helped an amateur runner break the cycle of recurring hamstring strain.

Case history of recurring hamstring strain

A female amateur athletics 1500m runner in her early 30s presented with a recurring painful left hamstring. There are different grades of strain from one to three, with three being a significant tear of the muscle fibres (up to 90%) and one being a minor tear (5-10% of fibres). She had a grade-one tear.

The patient said that each time she would rest it for a four-week period using ice at the start in the acute phase and then static stretches followed by strengthening exercises in the rehab phases of the injury. She would then start training again and it would recur within two to four weeks.

Whilst the diagnosis of what was causing the patient's pain was a grade one tear of her left biceps femoris (hamstring) the underlying cause of the repetition lay elsewhere.

On further examination, the patient’s left hamstring was under noticeably more tension on palpation whilst the muscle bulk was slightly less than the right. Osteopaths use their hands and finger pads to really feel the skin, fascia and muscle tension differences. They are one of our most useful tools in diagnosis.

And the anterior (front) aspect of the left side of her pelvis was slightly rotated forward leading to a slightly longer left leg. Her left foot was pronated too.

What does this mean?

This slight rotation can be caused by poor core strength of the trunk muscles and tight hip flexors such as the psoas, iliacus and rectus femoris. Not only do these big powerful muscles increase lordosis - the curvature of your lower back - but they can cause your pelvis to rotate slightly.

What does this do to your hamstring?

Your hamstring originates and attaches to the bottom of the pelvis behind your sitting bones (ischium). With the pelvis rotated slightly forward, the sitting bones move upwards and, in effect, stretch the hamstring, making it longer. It is then under more tension and prone to tears and strains.

Pronated left foot

In essence, the pronation can be as much part of the problem and needs to be addressed as much as the pelvic asymmetry. The overpronation (flat feet) that some people have causes an internal rotation of the leg and hip and the pelvis to tilt.

The osteopathic treatment

Osteopaths worked with the patient to return her rotated pelvis to a balanced symmetrical state through a combination of manipulation and muscle energy techniques (METs). Her tight hip flexors were made more flexible through traditional manual therapy techniques and healing of the muscle strain was encouraged by improving circulation and myofascial techniques.

She was then given a series of therapeutic exercises to improve hip flexor flexibility and core trunk stability, proprioception.

She was advised on her over-pronation and told to look at orthotics to provide arch support and to look at using a running shoe that provides more stability and reduces over-pronation. Osteopathy also improved foot joint articulation and improve circulation to the muscles that attach to the arch of the foot - the dorsi-flexors and inverters.

The results

The amateur athlete has been pain-free for the last six months!

If you're suffering from recurrent hamstring or other muscle injuries, you may benefit from visiting an osteopath so that you too can be pain-free. To find an osteopath near you, use our search tool. 

References:

Sherry MA and Best TM (2011) 'A Comparison of 2 Rehabilitation Programs in the Treatment of Acute Hamstring Strains', Journal of Orthopaedic & Sports Physical Therapy, Vol. 34, Issue 3, Pgs 116-125. Available at:  https://www.jospt.org/doi/abs/10.2519/jospt.2004.34.3.116