What Is Hamstring Syndrome?
Runners, distance and sprinters alike, can suffer from a condition called hamstring syndrome. Hamstring syndrome develops as a result of the sciatic nerve getting trapped and/or the sheath that surrounds the sciatic nerve becoming irritated as it traverses around the outside of the ischial tuberosity. The ischial tuberosities are commonly known as our “sit bones” and are the origin site of the hamstring complexes. In active individuals, such as distance runners, sprinters, and athletes who have to do increased jumping, the area in which the sciatic nerve traverses around and down the back of the leg can become narrowed leading to irritation of the nerve and pain. Most individuals who are diagnosed with hamstring syndrome have complaints of pain at the “sit bones” which gradually worsens after consistent physical activities, pain with sitting and pain with resisted flexion of the knee on the involved side. Patients with hamstring syndrome will also have point pain at the sit bones with palpation by the therapist. Many individuals with hamstring syndrome have a history of hamstring injuries and/or low back pain that may have required surgery to resolve.
What Is The Treatment?
Treatment of hamstring syndrome requires compliance of the patient to stop all activities that aggravate the symptoms first and foremost. Second, the patient must cease stretching the hamstring. Stretching the hamstring when hamstring syndrome symptoms are present, is a common mistake; pulling on the muscle that caused the original insult will only aggravate the symptoms more. A positional modification while sitting must be made for the hamstring syndrome patient since sitting will typically aggravate the patient’s symptoms. The patient will be instructed in sitting on a wedge with the thicker side of the wedge under the sit bones. This new position will alleviate the stress that is placed on the hamstring while seated and will decrease the irritation placed on the sciatic nerve. The patient with hamstring syndrome can also take an active role in their rehabilitation by performing neural mobilizations of the sciatic nerve. As mentioned before, the sciatic nerve is getting irritated and possibly trapped by the hamstring complex creating the symptoms. Sciatic nerve mobilization “encourages” the nerve back into more appropriate gliding as the hamstring is engaged and then relaxed. Imagine a straw with a shoelace through it. The shoelace is the sciatic nerve and the straw is it’s sheath that is getting irritated. With irritation comes possible microscopic inflammation and even adhesion of the nerve within it’s sheath which will lead to the said symptoms of hamstring syndrome. Neural mobilizations, or nerve “flossing” will gently reduce the adhesions and encourage the inflammation out of the area by slowly moving the shoelace back and forth through the straw. To perform this “flossing” activity, the patient will lie on their back with their involved leg propped on pillows; 2-3 to start with and then as the patients symptoms decrease and progress is noted, the number of pillows will be increased to cause greater hip flexion. With the involved leg propped on pillows, the patient is given a belt that is looped around the foot and the patient then actively produces rhythmic knee extension and flexion with pressure through the belt to maintain the toes pulled towards the shin
during the entire exercise. The patient will slowly extend the knee to the point of symptom reproduction and then relax it back to the starting position. As the patient makes improvement, they should be able to straighten the knee completely without symptoms and at increased hip flexion angles that are produced by increasing the number of pillows.
Do I Need To Schedule An Appointment?
Patients who are compliant with activity cessation and prescribed exercises but who do not experience resolution and healing may be candidates for surgical release to alleviate the pressure on the sciatic nerve. Hamstring injuries can be very confusing and frustrating because they can happen in many different ways and can be difficult to resolve if not treated correctly. If you want more information about hamstring syndrome specifically, think you have hamstring syndrome, or want information about other types of hamstring injuries please contact Zion Physical Therapy to set up an appointment. The therapists at Zion have extensive knowledge regarding hamstring issues and are able to tease out the important signs and symptoms to get you on the right rehab track.