Hamstrings & Groin Injuries
Hamstring & Groin Muscles
Pain and tightness in the hamstring and groin muscle (muscles at the back and inside aspect of your upper thigh respectively) are common complaints particularly in a sporting population. It ranges from chronic overuse and tightness in runners to acute strains in more dynamic sports such as football especially whilst kicking a ball, deep lunges required in hockey, rugby or netball. To enable peak performance, whether at amateur or elite level, understanding the mechanism of injury and how it can be treated will allow you to return to optimal health.
Anatomy of the Hamstrings & Groin Muscles
The hamstring muscles are made up of three muscles (semimembranosus, semitendinosus and biceps femoris) that originate from your ischial tuberosity (base of your pelvic bone) extending down the back of your thigh and attach to the tibia and fibula (lower leg bones). Their action is to bend the knee and extend the hip.
The hip adductor muscles that make up the groin consist of the adductor brevis, adductor longus, adductor magnus, gracilis, and pectineus. These groin muscles adduct the thigh (bring the femur and knee closer to the midline). The groin muscles are often injured with activities requiring cutting motions (side to side) or when kicking a ball.
There are three grades of injuries:
- Less than 10% of the muscle bulk (muscle fibres) are torn
- Cramping, tightening and / or sharp pain in the muscle during or after activity
- Mild pain and tenderness at the site of injury
- Minimal loss of strength and range of movement
- Recovery time approximately 2 weeks, but full tissue healing will take 6 weeks.
- You will feel pain at the site of the tear at the time of injury and subsequently during normal daily activities such as walking and during sport. Your sporting capabilities will be limited
- Loss of strength and range of motion at affected joints e.g., limited knee extension and hip flexion ranges
- 10-50% of muscle fibres torn
- Recovery time approximately 4-6 weeks
- Acute intense pain at the site of the muscle tear at the time of injury
- There will be significant loss of functional use and you will unable to weight bear fully or bend the ankle
- More than 50-100% of muscle fibres torn. If there is a complete tear of the muscle fibres, this will be referred to as a rupture
- Healing times for a grade III tear will vary depending on the level of dysfunction and may require a specialist orthopaedic review. In some cases, surgery may be required to suture the muscle to regain full function. Further investigation such as an MRI (magnetic resonance image) scan maybe required.
What are the Causes of Hamstrings & Groin Injuries?
There are varying factors as to why hamstring & groin strains occur. Some of the contributing factors are:
- Asymmetry in strength and control of any region in the musculoskeletal system especially the synergy of muscle action between the hamstrings / groin and the gluteal, calf’s and quadriceps muscles
- Weak abdominal and trunk core muscle control
- Tightness in the hip flexor and quadriceps muscles
- Poor biomechanics in your sport leading to improper techniques.
How Can Physiotherapy Help?
At PhysioMotion, our Physiotherapists will perform a comprehensive assessment to diagnose the grade of the injury and start a progressive treatment protocol to expedite recovery and return to sport. Early intervention is highly recommended to prevent any further injury and unwanted compensatory mechanisms in other regions of the body.
Accurate diagnostic skills from our therapists at PhysioMotion will also differentiate whether you have a hamstring or groin strain rather than referred pain such as sciatica or a hernia that may present as groin pain.
Below is a definitive outline of our treatment protocol.
Acute injury management & rehabilitation
- Preventing further injury by limiting over stretching or inappropriate loading
- Reduce inflammation and swelling through RICE – Rest, Ice, Compress, Elevate
- Inflammation is an important part of the healing process as it triggers the body’s cellular healing response. However, prolonged inflammation and swelling for more than 24 hour’s delays healing. Therefore, it is recommended that you take anti-inflammatory medications after the first 24 hours
- Manual therapy will involve soft tissue efflourage in the initial week post injury, but will progress to deeper muscular release techniques after the first 1-2 weeks to assist in stimulating tissue healing through increased circulation to the site of injury; desensitisation of nerve endings to reduce pain; and stretching of scar tissue as a result of healing
- At week 2-4, a strengthening program will be commenced to address intrinsic muscle weakness and to prevent any further loss of muscle function. The program will be progressed dependent on your specific activity requirements.