Hamstring muscle pathologies
Anatomy of the hamstring muscles
The hamstring muscles include 3 muscles:
- Semi-tendinous
- Biceps crural
- Semi-membranous
Semi-tendinous
Origin: it is inserted on the ischial tuberosity inside the bicep
Directions:
- It goes down
- In its ischial portion, it is covered by the gluteus maximus
- It covers the adductor magnus and the semimembranosus in front
- At the knee, it slides on the medial collateral ligament
Termination: it ends at the posteromedial part of the tibia and constitutes the deep plane of the crow's feet.
Role:
- Leg flexion on the thigh
- Extension of the thigh on the pelvis
- Internal rotation of the leg
- Retroversion of the pelvis
Innervation: it is innervated by a collateral of the sciatic nerve (L4/L5/S1)
Biceps femoris
Long portion of the femoral biceps
Origin: it is inserted on the ischial tuberosity by a large cone-shaped tendon
Termination: it ends with a wide, cylindrical tendon that runs around the external condyle of the femur:
- the styloid process of the fibula outside and behind the fibular collateral ligament
- the external tuberosity of the tibia
- the leg fascia
Short portion of the biceps femoris
Origin: it inserts on the interstice of the acrid line at its middle portion as well as on the lateral inter-muscular septum (LMIS).
Termination: it ends on the fleshy body of oblique direction downwards and outwards flows to the anterior face of the tendon of the long portion.
Roles of the biceps:
- Flexion leg on thigh
- Extension of the thigh on the pelvis
- External rotation of the leg
- Retroversion of the pelvis
Innervation of the biceps: collaterals of the sciatic nerve
Semi-membranous
Origin: It is inserted on the postero-lateral face of the ischial tuberosity, between the long biceps medial and femoral square lateral
Journey:
- Muscle fibers oriented down and in
- The semi membranous is covered by the gluteus maximus above, the semitendinosus and the femoral aponeurosis
- It covers the quadratus femoris, greater ADD, the upper end of the medial gastrocnemius, the medial condyle and the medial tuberosity of the tibia
Ending: It ends with
- a direct tendon on the posterior part of the medial tuberosity of the tibia
- a tendon reflected on the anterior part of the horizontal groove of the medial tuberosity of the tibia (passes between the tibia and tibial collateral ligament
- a recurrent tendon that constitutes the oblique popliteal ligament of the knee joint
Roles:
- Thigh to pelvis extension
- Flexion leg on thigh
- Internal rotation of the leg
Innervation: collaterals of the sciatic nerve
Location of hamstring injury
Muscular damage to the semitendinosus varies according to the location. They can affect :
- Proximal insertion : This is the most common. It can cause
- A tear out of the ossification core: the X-ray will confirm the diagnosis.
- An attack on the two proximal tendons: semitendinosus and biceps on the one hand, and semimembranosus on the other.
- Myotendinous junction: a few centimeters below the insertion. This generally generates a hematoma that is difficult to visualize with ultrasound because of its depth. An MRT is preferred to be certain of the diagnosis.
- Middle and distal portions: extensive elongations or tears in height on the superficial fascia of the semi-membrane or on deeper partitions.
Post-injury recovery protocol
Criteria for resuming running after injury
- Complete and painless recovery of joint amplitudes in the hip and knee
- Recovery of hamstring flexibility
- Ability to perform 3 sets of 10 repetitions of "heel and buttock" without pain or apprehension
Stages of post-injury recovery of the ischios
There are 5 successive steps in this protocol. The athlete can only access the next step if the previous session is painless and the exercises are mastered.
Step 1
- Jogging 2 times 10 min
- With 5 min rest between the 2 series
Step 2
- Lengthening of the stride with a speed between 40 and 60% of the VMA for 80 meters
- 3 sets of 5 reps with a walk back between reps
Step 3
- Increase speed to between 60 and 80% of your MAV for 30 meters
- 3 sets of 5 reps with a walk back between reps
Step 4
- Sprints at 90 - 100% max for 30 meters in the middle of an 80 meter length.
- 3 sets of 5 repetitions
- Specific work according to the sport
Step 5
- Sprints at 90 - 100% max for 60 to 80m
- 3 sets of 5 repetitions
- Variation of race types: shuttle runs, change of direction, figure eight runs, run and shoot/jump.
Avoiding recurrence of ischios injuries
It is important to follow these steps to limit the risk of recurrence.
Indeed, the ischio jmbers have the highest rate of recurrence of muscle injury!
There are several reasons for this:
- Polyarticular muscles
- Lack of warm-up
- Lack of flexibility
- Muscle weakness
- Fatigue
- Muscle imbalance
- Asynergic contractions
Marie Messager
Osteopath for sports
in Versailles Chantiers
78 - Yvelines
