Treatment for Pulled Hamstring

Hamstring Injury - Pulled Hamstring Muscle
How to treat hamstring injuries, pulls, and strains
By Elizabeth Quinn, About.com Guide
About.com Health's Disease and Condition content is reviewed by the Medical Review Board

Hamstring injuries are common among athletes who play sports that require powerful accelerations, decelerations or lots of running. The hamstring muscles run down the back of the leg from the pelvis to the bones of the lower leg. The three specific muscles that make up the hamstrings are the biceps femoris, semitendinosus and semimembranosus. Together these powerful knee flexors are known as the hamstring muscle group. An injury to any of these muscles can range from minor strains, a pulled muscle or even a total rupture of the muscle.

Symptoms of a Hamstring Injury
A hamstring injury typically causes by a sudden, sharp pain in the back of the thigh that may stop you mid-stride. After such an injury, the knee may not extend more than 30 to 40 degrees short of straight without intense pain. Like most sprains and strains hamstring injuries are usually caused by excessive stretching (tearing) of muscle fibers or other soft tissues beyond their limits.

Severity of a Hamstring Injury
Hamstring strains are classified as 1st (mild), 2nd (moderate), or 3rd (severe) degree strains depending on the extend of the muscle injury.

Mild (Grade I) Hamstring Injury
•Muscle stiffness, soreness and tightness in the back of the thigh.
•Little noticeable swelling.
•A normal walking gait and range of motion with some discomfort.
•Flexing the knee to bring the heel up

Moderate (Grade II) Hamstring Injury
•Gait will be affected-limp may be present .
•Muscle pain, sharp twinges and tightness in the back of the thigh.
•Noticeable swelling or bruising.
•Painful to the touch.
•A limited range of motion and pain when flexing the knee.
Severe (Grade III) Hamstring Injury
•Pain during rest which becomes severe with movement
•Difficulty walking without assistance.
•Noticeable swelling and bruising.

Common Causes of Hamstring Injuries
Hamstring pulls or strains often occur during an eccentric contraction of the hamstring muscle group as an athlete is running. Just before the foot hits the ground, the hamstrings will contract to slow the forward motion of the lower leg (tibia and foot). Less commonly, a hamstring injury is the result of a direct blow to the muscle from another play or being hit with a ball. Some of the factors which may contribute to a hamstring injury includes:

•Doing too much, too soon or pushing beyond your limits.
•Poor flexibility.
•Poor muscle strength.
•Muscle imbalance between the quadriceps and hamstring muscle groups.
•Muscle fatigue that leads to over exertion.
•Leg Length Differences. A shorter leg may have tighter hamstrings which are more likely to pull.
•Improper or no warm-up.
•History of hamstring injury.

Treating Hamstring Injuries
Treatment for hamstring injuries depends upon the severity of the injury. Due to the pain and limited ability to use the muscle, a third degree strain usually results in a visit to a physician for evaluation and treatment. Less severe hamstring strains may be treated at home. These general treatment steps are commonly recommended for mild or moderate hamstring injuries.

•After an injury it's important to rest the injured muscle, sometimes for up to two or three weeks before you can return to sports after your injury.
•R.I.C.E - Rest, apply Ice and Compression. Elevate the leg if possible.
•An anti-inflammatory can be helpful to reduce pain and inflammation.
•A stretching program can be started as soon as the pain and swelling subsides.
•A strengthening program should be used to rebuild the strength of the injured muscle in order to prevent re-injury. Make sure you increase this gradually.
•A thigh wrap can be applied to provide support as the muscle heals.
Preventing Hamstring Injuries
•Warm up thoroughly. This is probably the most important muscle to warm-up and stretch before a workout.
•Stretching after the workout may be helpful.
•Try adding a couple sessions per week of retro-running or backward running which has been should decrease knee pain and hamstring injuries.
•Follow the "Ten Percent Rule" and limit training increases in volume or distance to no more than ten percent per week.
•Other ways to prevent injury are to avoid doing too much, too soon, avoid drastic increases in intensity or duration, and take it easy if you are fatigued.


Chiropractor, Fairfax VA

Patellofemoral pain syndrome Runners Knee

From professional athletes to weekend warriors, the condition known as "runner's knee" is a painful and potentially debilitating injury suffered by millions of people - although until now, it has been unclear just what causes it.

But new research from the University of North Carolina at Chapel Hill has zeroed in on what appear to be the main culprits of the condition, formally known as patellofemoral pain syndrome.

The study is believed to be the first large, long-term project to track athletes from before they developed runner's knee, said study co-author Darin Padua, Ph.D., associate professor of exercise and sport science in the UNC College of Arts and Sciences.

"Earlier studies have usually looked at people after the problem sets in," Padua said. "That means that while previous research has identified possible risk factors related to strength and biomechanics, it's been unclear whether those caused the injury, or whether people's muscles and the way they moved changed in response to their injury."

The research appears in the November issue of the American Journal of Sports Medicine.

Runner's knee - the bane of many types of exercise, from running to basketball to dance - affects one in four physically active people. If unchecked, it can lead to more serious problems such as patellofemoral osteoarthristis.

"Patellofemoral pain syndrome can be devastating," said Padua. "The pain can severely curtail a person's ability to exercise and the symptoms commonly reoccur. That said, athletes often have a high pain threshold and may ignore it. But if they do, their cartilage may break down - and if that gets to the point of bone on bone contact, nothing can be done to replace the damaged cartilage."

Padua and his colleagues studied almost 1,600 midshipmen from the United States Naval Academy. Researchers analyzed participants' biomechanics when they first enrolled at the academy, then followed them for several years to see if they developed patellofemoral pain syndrome.

A total of 40 participants (24 women and 16 men) developed the syndrome during the follow-up period. The study found:

- Participants with weaker hamstring muscles were 2.9 times more likely to develop the syndrome that those with the strongest hamstrings
- Those with weaker quadriceps muscles were 5.5 times more likely
- Those with a larger navicular drop (a measure of arch flattening when bearing weight) were 3.4 times more likely
- Participants with smaller knee flexion angle (those whose knees bent less on landing during a jump test) were 3.1 times more likely

Padua said the pain associated with the condition could be explained by those different factors coming together to create a focal point of pressure between the kneecap and the underlying bone.

"Overall, these people generally have weaker quads and hamstrings. As a result, they don't bend their knees as much when doing task, such as running or jumping. That means the contact area between the kneecap and the femur is smaller, so pressure is focused and pinpointed on a smaller area.

"Also, the more a person's arch falls when bearing weight, the more their whole leg may rotate inwards. That will mean their kneecap won't track properly, leading to yet more pressure and more potential pain."

Padua said the good news is that the study appears to confirm that if people can change the way they move and improve their leg strength, they can prevent or correct the problem.

Everyday athletes can also spot for themselves whether they are at risk: if their knee crosses over the big toe when squatting; the arches of their feet collapse when landing from a jump; and if they do not bend their knees much when they land, they stand a greater chance of developing the syndrome, Padua said.

The researchers are now looking into which exercises are best for improving the biomechanics involved. They have also developed a simple screening tool, called LESS (Landing Error Scoring System), for identifying people most at risk of runner's knee and similar conditions, and of suffering ACL (anterior cruciate ligament) injuries.

The study's lead author was Michelle C. Boling, Ph.D., a UNC doctoral student at the time of the study, now an assistant professor at the University of North Florida, Jacksonville, Florida. Other co-authors are Kevin Guskiewicz, Ph.D., professor and chair of the UNC exercise and sport science department; Stephen W. Marshall, Ph.D., associate professor of exercise and sport science, and of epidemiology and orthopedics in the UNC Gillings School of Global Public Health and the UNC School of Medicine, respectively; Scott Pyne, M.D, United States Naval Academy, Annapolis, Md.; and Anthony Beutler, M.D, Uniformed Services University of the Health Sciences, Bethesda, Md.

Source
University of North Carolina at Chapel Hill

Promising Pharmaceutical Agents Emerge As Sports Doping Products

Researchers from the German Sport University Cologne in Germany found that non-steroidal and tissue-selective anabolic agents such as Selective Androgen Receptor Modulators (SARMs) are being sold on the black market for their performance enhancing qualities. The availability of authentic SARMs was recently demonstrated for the first time by the detection of the drug candidate Andarine in a product sold via the Internet. Full findings of the study appear in the latest issue of Drug Testing and Analysis published by Wiley-Blackwell.

SARMs represent a promising class of therapeutics for the treatment of various diseases such as sarcopenia, osteoporosis, benign prostatic hyperplasia (BPH), and cancer cachexia. While none of these agents have yet been approved for therapeutic use, SARMs are gaining popularity in the sports doping community because they are believed to provide the benefits of traditional anabolic/androgenic steroids such as testosterone with fewer unwanted side effects.

In 2008, the World Anti-Doping Agency (WADA) prohibited the use of SARMs in sports due to their potential for misuse. WADA closely cooperates with pharmaceutical and biotechnological companies, as well as medicine agencies and drug evaluation bodies on the issue of therapeutics being misused in sports. WADA's preventive approach was validated with the recent finding of a commercially available, non-approved arylpropionamide-derived SARM termed Andarine. This product, declared as green tea extracts and face moisturizer to pass customs, was available on the Internet at a discount price of $100 USD.

To prove that SARMs lacking clinical approval are distributed and potentially misused in sports, Mario Thevis, Ph.D., and colleagues, analyzed the advertised substance using state-of-the-art mass spectrometric approaches with high resolution/high accuracy (tandem) mass spectrometry. "One unit (30 mL) was purchased online and delivered in a box labeled to contain face moisturizer and green tea extract. The sealed bottle did not declare any content and no further documents accompanied package," said Dr. Thevis. He went on to explain that LC-MS(/MS) analysis of this solution revealed the presence of S-4 at approximately 150 mg/mL with equal amounts in each container, yielding a total of 4.5 g of the SARM. The active ingredient was identified and characterized by a) its elemental composition (as determined by high resolution/high accuracy mass spectrometry, b) comparison to synthesized reference material regarding retention time and product ion mass spectrum, and c) elucidation of its mass spectrometric behavior. Besides the detection of the active ingredient S-4, a significant amount of byproduct was observed.

"Major concerns result from these findings," explained Dr. Thevis. "This product with considerable anabolic properties is readily available without sufficient research on its undesirable effects; this is especially significant where uncontrolled dosing is applied and drug impurities with unknown effects are present in considerable amounts as observed in the studied material."

The issue was recently addressed at the Conference of Parties to the International Convention against Doping in Sport, held October 26-28, 2009 at the United Nations Educational, Scientific and Cultural Organization's (UNESCO) headquarters in Paris. WADA President John Fahey said that government agencies will need to adopt laws and regulations to combat the trafficking and supply of illegal substances in order to rid sport of doping.

The ease of purchasing SARMs as a performance-enhancing drug supports the need to make early implementation of screening for emerging therapeutic compounds a routine part of sports drug testing. "Our study demonstrates once more that the misuse of therapeutics without clinical approval by athletes cannot be dismissed," Dr. Thevis concludes.

Full Citation: "Detection of the arylpropionamide-derived selective androgen receptor modulator (SARM) S-4 (Andarine) in a black-market product." Mario Thevis, Matthias Kamber, and Wilhelm Schanzer. Drug Testing and Analysis; Published Online: November 19, 2009 (DOI: 10.1002/dta.91:).

Source: Dawn Peters
Wiley-Blackwell

Cheerleading related injuries.

New National Study Finds More Than Half Of Cheerleading Injuries In U.S. Due To Stunts

Whether rallying the crowd at a sporting event or participating in competition, cheerleading can be both fun and physically demanding. Although integral to cheerleading routines, performing stunts can lead to injury. Stunt-related injuries accounted for more than half (60 percent) of U.S. cheerleading injuries from June 2006 through June 2007, according to a new study conducted by researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital.

Published as a series of four separate articles on cheerleading-related injuries in the November issue of the Journal of Athletic Training, the study focused on general cheerleading-related injuries, cheerleading stunt-related injuries, cheerleading fall-related injuries and surfaces used by cheerleaders. Data from the study showed that nearly all (96 percent) of the reported concussions and closed-head injuries were preceded by the cheerleader performing a stunt.

"In our study, stunts were defined as cradles, elevators, extensions, pyramids, single-based stunts, single-leg stunts, stunt-cradle combinations, transitions and miscellaneous partner and group stunts," said author Brenda Shields, research coordinator in the Center for Injury Research and Policy at Nationwide Children's Hospital.

The most common injuries were strains and sprains (53 percent) and injuries occurred most frequently during practice (83 percent). The top five body parts injured were the ankle (16 percent), knee (9 percent), lower back (9 percent) and head (7 percent).

The study also showed that nearly 90 percent of the most serious fall-related injuries were sustained while the cheerleaders were performing on artificial turf, grass, traditional foam floors or wood floors.

"Only spring floors and 4-inch thick landing mats placed on traditional foam floors provide enough impact-absorbing capacity for two-level stunts," explained Shields. "There is a greater risk for severe injury as the fall height increases or the impact-absorbing capacity decreases, or both."

Data for the study were collected using Cheerleading RIO™, an Internet-based reporting system for cheerleading-related injuries.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children's Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care.

Source: Nationwide Children's Hospital

Tayshaun Prince Back Injury

Prince has ruptured disc in lower back

AUBURN HILLS, Mich. -- The Pistons say forward Tayshaun Prince will be out of the lineup indefinitely due to a small rupture of a disc in his lower back.

The team said Saturday that the injury was confirmed following an MRI exam and evaluation by team doctors this week. The Pistons say Prince will continue to receive treatment for the injury.
Prince had been sidelined since earlier this month with a back injury.

The 6-foot-9 Prince has appeared in three games this season averaging 12.3 points, 5 rebounds and 2.3 assists. (www.espn.com)

Treatment Options for a Lumbar Herniated Disk
By: Peter F. Ullrich, Jr, MD

Introduction to Lumbar Herniated Disk Treatment

The care of a patient with a lumbar herniated disk is far from standardized and, to a certain extent, needs to be individualized for each patient. A lumbar herniated disk usually causes leg pain (sciatica or a radiculopathy) and is often referred to as a pinched nerve, bulging disk, ruptured disk, or a slipped disk.

The treatment options for a lumbar herniated disk will largely depend on the length of time the patient has had his or her symptoms and the severity of the back pain. Generally, patients will be advised to start with 6 to 12 weeks of conservative treatment (such as physical therapy or chiropractic care).

Surgical Treatments for a Lumbar Herniated Disk
If conservative treatment for the lumbar herniated disk does not provide pain relief after 6 to 12 weeks it is reasonable to consider surgery. At times, if there is severe pain and the patient is having difficulty maintaining a reasonable level of functioning, surgery may be recommended prior to completing a full 6 weeks of conservative care for the herniated disk.

Most patients will heal a lumbar herniated disk on their own, but it may take a prolonged period of time. While there are no hard and fast guidelines for how to heal a herniated disk, this article outlines some general guidelines for conservative treatment options and surgical treatments.

Conservative Treatments for a Lumbar Herniated Disk
There’s a wide variety of conservative treatment options for patients to try for treatment of a lumbar herniated disk. The primary goals of treatment are to provide relief of pain and to allow return to a normal functional level.

The most common conservative treatment options for a lumbar herniated disk include:
Rest, followed by slow mobilization
Pain medications
Chiropractic/osteopathic manipulations
Physical therapy
Epidural steroid injections

The recommended amount of conservative treatment for the herniated disk needs to be individualized for each patient. For those patients who are not in severe pain and can function well, a longer period of conservative treatment is reasonable (e.g. 12 weeks). For those patients with severe pain that is not responsive to conservative treatment, surgery to decompress the nerve is a reasonable option to treat the lumbar herniated disk.

Surgery for a Lumbar Herniated Disk
If a patient does not feel better after 6 to 12 weeks of conservative care, then surgery may be considered to treat the lumbar herniated disk. The goal of surgery is to help alleviate the pain faster. If a patient has severe pain and is unable to function at a satisfactory level, surgery may be a good option even before six weeks of symptoms.

Any patient who has progressive neurological deficits, or develops the sudden onset of bowel or bladder dysfunction, should have an immediate surgical evaluation as these conditions may represent a surgical emergency. Fortunately, both of these conditions are very rare, and most surgery for a lumbar herniated disk is an elective procedure.

In recent years, the morbidity (such as post-operative pain) of surgery for a lumbar herniated disk has decreased and the results have improved, so surgery is generally considered a very reasonable option to get better quicker.

Surgical treatment options for the lumbar herniated disk include:
Microdiscectomy (the most common procedure)
Lumbar laminectomy
Chymopapain injections
Arthroscopic lumbar discectomy
Microendoscopic surgery

A lumbar microdiscectomy (also called a lumbar micro-decompression) is considered the gold standard and is the most common surgery to alleviate pain from a lumbar herniated disk. (www.spine-health.com)


Chiropractor, Fairfax VA

Basketball, ACL and Biomechanical Sports Injury Prenvention Training

Effects of Sports Injury Prevention Training on the Biomechanical Risk Factors of Anterior Cruciate Ligament Injury in High School Female Basketball Playersfrom The American Journal of Sports Medicine current issue by Lim, B.-O., Lee, Y. S., Kim, J. G., An, K. O., Yoo, J., Kwon, Y. H.1 person liked this
Background
Female athletes have a higher risk of anterior cruciate ligament injury than their male counterparts who play at similar levels in sports involving pivoting and landing.

Hypothesis
The competitive female basketball players who participated in a sports injury prevention training program would show better muscle strength and flexibility and improved biomechanical properties associated with anterior cruciate ligament injury than during the pretraining period and than posttraining parameters in a control group.

Study Design
Controlled laboratory study.

Methods
A total of 22 high school female basketball players were recruited and randomly divided into 2 groups (the experimental group and the control group, 11 participants each). The experimental group was instructed in the 6 parts of the sports injury prevention training program and performed it during the first 20 minutes of team practice for the next 8 weeks, while the control group performed their regular training program. Both groups were tested with a rebound-jump task before and after the 8-week period. A total of 21 reflective markers were placed in preassigned positions. In this controlled laboratory study, a 2-way analysis of variance (2 x 2) experimental design was used for the statistical analysis (P < .05) using the experimental group and a testing session as within and between factors, respectively. Post hoc tests with Sidak correction were used when significant factor effects and/or interactions were observed. Results A comparison of the experimental group’s pretraining and posttraining results identified training effects on all strength parameters (P = .004 to .043) and on knee flexion, which reflects increased flexibility (P = .022). The experimental group showed higher knee flexion angles (P = .024), greater interknee distances (P = .004), lower hamstring-quadriceps ratios (P = .023), and lower maximum knee extension torques (P = .043) after training. In the control group, no statistical differences were observed between pretraining and posttraining findings (P = .084 to .873). At pretraining, no significant differences were observed between the 2 groups for any parameter (P = .067 to .784). However, a comparison of the 2 groups after training revealed that the experimental group had significantly higher knee flexion angles (P = .023), greater knee distances (P = .005), lower hamstring-quadriceps ratios (P = .021), lower maximum knee extension torques (P = .124), and higher maximum knee abduction torques P (= .043) than the control group. Conclusion The sports injury prevention training program improved the strength and flexibility of the competitive female basketball players tested and biomechanical properties associated with anterior cruciate ligament injury as compared with pretraining parameters and with posttraining parameters in the control group. Clinical Relevance This injury prevention program could potentially modify the flexibility, strength, and biomechanical properties associated with ACL injury and lower the athlete’s risk for injury.

Exercise Keeps Dangerous Visceral Fat Away A Year After Weight Loss

A study conducted by exercise physiologists in the University of Alabama at Birmingham (UAB) Department of Human Studies finds that as little as 80 minutes a week of aerobic or resistance training helps not only to prevent weight gain, but also to inhibit a regain of harmful visceral fat one year after weight loss.

The study was published online Oct. 8 and will appear in a future print edition of the journal Obesity.

Unlike subcutaneous fat that lies just under the skin and is noticeable, visceral fat lies in the abdominal cavity under the abdominal muscle. Visceral fat is more dangerous than subcutaneous fat because it often surrounds vital organs. The more visceral fat one has, the greater is the chance of developing Type 2 diabetes and heart disease.

In the study, UAB exercise physiologist Gary Hunter, Ph.D., and his team randomly assigned 45 European-American and 52 African-American women to three groups: aerobic training, resistance training or no exercise. All of the participants were placed on an 800 calorie-a-day diet and lost an average 24 pounds. Researchers then measured total fat, abdominal subcutaneous fat and visceral fat for each participant.

Afterward, participants in the two exercise groups were asked to continue exercising 40 minutes twice a week for one year. After a year, the study's participants were divided into five groups: those who maintained aerobic exercise training, those who stopped aerobic training, those who maintained their resistance training, those who stopped resistance training and those who were never placed on an exercise regimen.

"What we found was that those who continued exercising, despite modest weight regains, regained zero percent visceral fat a year after they lost the weight," Hunter said. "But those who stopped exercising, and those who weren't put on any exercise regimen at all, averaged about a 33 percent increase in visceral fat."

"Because other studies have reported that much longer training durations of 60 minutes a day are necessary to prevent weight regain, it's not too surprising that weight regain was not totally prevented in this study," writes Hunter. "It's encouraging, however, that this relatively small [amount] of exercise was sufficient to prevent visceral fat gain."

The study also found that exercise was equally effective for both races.

About the UAB Department of Human Studies

The UAB Department of Human Studies, housed in the School of Education, offers programs in counselor education, health education, community health, physical education, exercise science and fitness leadership.

Source: University of Alabama at Birmingham