HAMSTRING STRAIN CASE STUDY

This case study explores a patient we had a little while ago who experienced a hamstring strain.

How they presented / Mechanism of Injury:

  • 73 y.o. Male
  • Reported “He forgot he was no longer 40 and decided to join a social soccer team.”
  • Played a game 3 days prior to presenting. He reported that during the game he went to kick the ball and felt a big pull up the back of his thigh. He decided it was okay and continued to play on. He got through the remainder of the game walking, but was sore.

Self management (between injury and presenting to physio):

  • He iced his thigh that night and woke up the next morning stiff and sore. He reported that since the injury (3 days prior), he had been limping every day.
  • He was stretching every day but was experiencing a lot of pain while stretching.
  • He was taking nurofen 2x daily.

Aggravating activities / factors:

  • Walking
  • Stairs
  • Getting out of car

Assessment:

  • Squat – to 90 degrees okay but quads a bit sore
  • Lunge – 1/2 range and pain in quads on forward leg
  • Double leg bridge – able nil pain
  • Single leg bridge – x3 able, pain mid muscle belly left biceps femoris (hamstring) pain rating: 5/10
  • Passive Straight Leg Raise: L) 45 degrees pain in mid belly of left hamstring + R) 55 degrees pain mid hamstring
  • Observation: large bruise covering distal ⅓ of posterior thigh on left
  • Resisted knee flexion supine: minor awareness but okay Gr 4 strength, able to feel fibres in biceps femoris (hamstring) – not ruptured.
  • Palpation: Tender on palpation mid belly biceps femoris (hamstring)

Impression / Diagnosis:

Left Grade 2 biceps femoris strain, overload bilateral hamstring and quads due to poor conditioning prior to return to soccer.
In carrying out a thorough assessment of hamstring strength and length, it was clear that more than 50% of the hamstring fibres were strained but the hamstring did not sustain a full thickness tear.

Treatment:

  • Education re: needing to hold off stretching for a few days to ensure that the tear did not worsen. Gentle stretching okay but no more than 1/10 pain rating
  • Soft Tissue Massage to hamstrings and glutes.
  • Education Re: conditioning and need to prepare the body for new activity.
  • Home exercise programme:
    • Progressed through concentric (shortening) then eccentric (lengthening) hamstring program
    • Gradual return to running drills

Outcome:

Patient successfully returned to play 6 weeks post injury!

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