Salud y seguridad

Different Ways to Treat a Hamstring Pull or Tear

Las lesiones en los isquiotibiales, como distensiones y desgarros, son comunes en deportes que requieren correr mucho o fuertes aceleraciones y desaceleraciones. Los  isquiotibiales  están compuestos por un grupo de músculos y tendones que se extienden a lo largo de la parte posterior de la pierna desde la base de la pelvis hasta la espinilla. Si bien su función principal es doblar la rodilla, los isquiotibiales también contribuyen a la rotación de la parte inferior de la pierna.

Una distensión de los isquiotibiales se refiere a una lesión en la que el músculo o el tendón se estira o desgarra. Las distensiones menos graves a menudo se denominan “tirón de los músculos isquiotibiales”. Un desgarro del tendón de la corva, también conocido como ruptura, infiere una lesión más grave.

Algunas lesiones de los músculos isquiotibiales son leves y mejoran con el descanso y los analgésicos de venta libre (OTC). Otros son más graves y pueden requerir cirugía y rehabilitación extensa.

Síntomas de una lesión en el tendón de la corva

Una lesión aguda en el tendón de la corva generalmente causará un dolor agudo y repentino en la parte posterior del muslo que puede detenerlo a la mitad del paso. En algunos casos, es posible que escuche un “pop” audible o que sienta que la pierna cedió debajo de usted. Una lesión crónica de los isquiotibiales puede ocurrir si un desgarro o distensión no tratada empeora con el tiempo.

Después de que ocurra la lesión, a menudo no podrá extender la rodilla más de 30 a 40 grados sin sentir dolor. Las lesiones agudas casi siempre van acompañadas de espasmos, opresión y sensibilidad, que se desarrollan inmediatamente o después de varias horas. En el caso de una ruptura, a menudo puede sentir o ver una hendidura donde se produjo el desgarro. Por lo general, seguirán hinchazón y hematomas severos.

Causas de la lesión de isquiotibiales

Most hamstring injuries are caused when the muscles are overloaded. These include the biceps femoris, semitendinosus, and semimembranosus. Muscle overload occurs when a muscle is either stretched beyond its limits or challenged with a sudden, excessive weight load.

Most strains occur when the hamstring muscles are lengthened and contracted at the same time (known as an eccentric contraction). One such example is sprinting, during which the back leg is straightened while you propel yourself forward on bent toes.

Other injuries occur when the hamstring is overexerted when lifting weight with a sudden thrust of energy. Powerlifting is one such example.

Risk Factors for Hamstring Injury:

  • Differences in leg length
  • An imbalance between the quadriceps (front of the thigh) and hamstring muscles
  • Improper or no warm-up before exercise
  • Muscle fatigue during activity
  • Poor flexibility
  • Poor muscle strength
  • Pushing beyond your current limits
  • Tight hip flexors
  • Weak gluteus muscles (buttocks)

Diagnosis of Hamstring Injuries

Hamstring injuries can usually be diagnosed by the location and intensity of the pain as well as the restriction of movement. Most tend to occur either in the middle of the back of the thigh or just beneath the gluteus muscle near the point where the tendon connects to the bone.

Most cases do not require imaging tests to confirm the diagnosis. However, severe injuries may need to be assessed with magnetic resonance imaging (MRI), the gold standard for visualizing soft tissue injuries. Alternately, an ultrasound can provide a qualitative assessment of an injury by viewing the muscles and tendons in real-time. X-rays, while useful, can sometimes miss smaller tears.

Based on the evaluation, a hamstring injury can be classified as grade I, grade II, or grade III.

Grade I Hamstring Injury

  • Ability to flex the knee
  • Little noticeable swelling
  • Muscle stiffness, soreness, and tightness
  • A normal gait and range of motion, albeit with discomfort

Grade II Hamstring Injury

  • An affected gait
  • A limited range of motion
  • Muscle pain, sharp twinges, and tightness
  • Noticeable swelling or bruising
  • Pain to the touch and when flexing the knee

Grade III Hamstring Injury

  • Difficulty walking without assistance
  • Noticeable swelling and bruising
  • Pain during rest, becoming severe with movement

Treatment for Hamstring Injuries

The treatment of a hamstring injury is based on the severity of the symptoms. All but the most severe can usually be treated non-surgically. Those involving tendon avulsions, in which the tendon has pulled completely away from the bone, require surgery and an extensive rehabilitation program.

Non-Surgical Treatments

Most acute hamstring injuries can be treated at home with the RICE protocol, which involves:

  • R: Rest, often with crutches, to avoid placing any weight on the leg
  • I: Ice using a cold compress to reduce pain and inflammation
  • C: Compression with a compression bandage to reduce swelling, prevent tissue bleeding, and avoid further expansion of the tear
  • E: Elevation of the leg above the heart to direct blood away from the leg, thereby reducing pain and swelling

More serious injuries may require immobilization with a knee brace to keep your leg in a neutral position. Pain can be treated either with an analgesic such as Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) like Advil (ibuprofen) or Aleve (naproxen).

Once the injury is stabilized and the pain and swelling have subsided, physical therapy can be started, using gentle stretching to restore range of motion and strengthening exercises to increase muscle mass and weight-bearing strength.

Surgical Treatment

Avulsions of the hamstring invariably require surgery to reattach the rupture. Avulsions most commonly occur near the pelvis (proximal tendon avulsion),1 although they can also happen nearer to the shinbone (distal tendon avulsion2 ).

If an acute rupture occurs, the surgeon will usually wait 72 hours to allow the recoiled muscles to “relax.” Delaying beyond this point is usually unadvised as the muscle can begin to waste away (atrophy) and develop extensive scarring (fibrosis).

During the tendon avulsion repair, the surgeon will pull the hamstring muscles back into their original position and cut away any scar tissue at the ruptured end. The tendon will then be reattached to the bone with staples and/or stitches. If the muscle itself is ruptured, sutures will be used to reattach the ends without shortening the length too excessively.

After surgery, you would need to use crutches and a brace to keep your leg in a neutral position. Once ample healing has occurred, physical therapy and rehabilitation would begin, lasting anywhere from 3 to 6 months. Every effort would be made to control pain with regular ice application and OTC pain relievers. If needed, stronger NSAIDs may be prescribed.

Preventing a Hamstring Injury

Since hamstring injuries typically occur during sports and athletics, routine precautions should be taken in advance of the activities. Among the key prevention tips:

  • Add retro-running (running backward) to your workout which helps balance the gluteus and hamstring muscles while strengthening those around the knee.
  • Approach squats and other exercises that engage the gluteus and hip flexor muscles with caution, starting slowly and gradually increasing in depth.
  • Follow the 10% rule in which you increase the intensity, distance, or duration of your workout by no more than 10% week on week to avoid overexertion.
  • Estírate después de tu entrenamiento y antes. Es importante recordar que, con el  entrenamiento de fuerza , los músculos tienden a retraerse. Si se evita el estiramiento, estos músculos pueden eventualmente fijarse en esta posición semiflexionada.
  • Calentamiento antes del ejercicio con  estiramientos excéntricos de los isquiotibiales .
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Jett Kolio

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