Sprains, partial tears, complete muscle tears and avulsion fractures in the hip and pelvis

A hamstring muscle tear is a common injury in all sports, characterized by a violation of the integrity of the muscle fibers. It is most common among athletes, but you can also get this injury at home.

The back of the thigh consists of three muscles:

• biceps (most susceptible to injury);
• semitendinosus;
• semimembranous.

In the upper part, all three muscles are attached to the ischial tuberosity, and in the lower part - to the lower leg. Their function is to flex the knee joint and extend the hip joint.

The causes of rupture of the hamstring muscles are intense exercise without prior warm-up, sudden movements or changes in position, impact, collision, or fall.

The injury has three degrees of severity, and therefore a distinction is made between a sprain, a partial tear and a complete muscle rupture.

Rupture of the biceps femoris muscle (biceps)

The biceps femoris muscle (biceps) is one of the largest muscles in the human body. The name of the muscle is associated with an anatomical feature - it has two heads - long and short.

A rupture of the biceps femoris muscle occurs as a result of a sharp starting jerk in athletes or a sharp throw of the leg forward. The cause of the injury is insufficient warming up of the muscles, uneven distribution of the load, incorrect technique for performing exercises with sports equipment, a fall or blow.

Typical symptoms of a biceps femoris rupture:

• sharp intense local pain in the biceps area;
• noticeable weakness in the hip;
• pain when bending the knee joint;
• upon palpation, a depression is felt in the muscle in an uncharacteristic place;
• stiffness of the knee joint;
• Over time, extensive bruising appears.

If a hamstring injury occurs, a splint is applied until doctors arrive.
The treatment method depends on the degree of fiber rupture. If less than half of the fibers are damaged, conservative therapy is prescribed. The patient is bandaged and prescribed rest and rehabilitation measures. The doctor prescribes NSAIDs, electrophoresis, and, if necessary, makes a novocaine blockade. If the biceps femoris muscle is completely ruptured or the tendon is torn from the bone, surgery is prescribed, after which a plaster cast is applied to the leg. Then comes the rehabilitation period. As a rule, you can return to sports no earlier than 5 months after the injury.

Diagnosis of hip pain

The specialists of the CELT Pain Clinic, like no one else, know how important it is to correctly diagnose such clinical manifestations as hip pain. The similarity of symptoms requires differentiation of different diseases, which will result in the prescribing of effective treatment.

In addition to taking an anamnesis, an examination is carried out by one of the following specialists:

• neurologist;
• traumatologist-orthopedist;
• rheumatologist;
• surgeon;
• oncologist.

In addition, our Pain Clinic performs the following diagnostic tests:

• X-ray of the hip, pelvis, lumbar spine;
• Magnetic resonance imaging of the lumbosacral spine.

If necessary, laboratory tests may be prescribed.

Semitendinosus rupture

The main function of the semitendinosus muscle is to regulate the tilt of the body at the hip joint. It is sometimes mistaken for hamstrings due to its similar purpose. The semitendinosus muscle performs the same functions, with the exception of one – inward rotation of the tibia. In the middle of the semitendinosus muscle there are tendon membranes, which is why it is called the semitendinosus.

A sprained semitendinosus muscle is quite common. At the moment of injury, a strong crunching sound is heard, accompanied by a sharp pain syndrome, the formation of edema and hematoma. A complete rupture of the semitendinosus muscle requires surgery to restore the integrity of the muscle fibers, followed by the application of a cast for up to five weeks. Sometimes the injury is complicated by separation of the tendon from the bone with a fragment of bone tissue.

Semimembranosus muscle rupture

The semimembranosus femoris muscle is located under the semitendinosus muscle and performs the same functions. With its help, flexion and internal rotation of the lower leg occurs, as well as extension and adduction of the thigh.

As a rule, a sprain of the semimembranosus muscle occurs due to poor warming up before training, excessive tension, or sudden movement. Symptoms of injury are severe pain, swelling, noticeable weakness in the muscle, and subcutaneous hemorrhage.

In case of partial tear of the semimembranosus muscle, rest is recommended for 2-3 weeks and drug therapy and rehabilitation are prescribed. If a complete rupture of the semimembranosus muscle occurs, surgical intervention is required to restore the integrity of the tissue, followed by the application of a cast for 6 weeks, medication and rehabilitation.

Risk factors for hamstring tears

There are several factors that increase your risk of getting a hamstring strain:

1. Previous hamstring injury. People who have experienced similar trauma in the past are at greatest risk for future similar trauma.
2. Muscle weakness and fatigue. These factors can change the biomechanics of a person's movements, which increases the risk of suffering a hamstring tear.
3. Lack of flexibility. Decreased elasticity increases the likelihood of getting a hamstring strain.
4. Insufficient warm-up. Warm muscles become more elastic, which reduces the risk of injury to the hamstrings.
5. Muscle imbalance. The hamstring muscles and the quadriceps muscles on the front of the thigh should work together. If one muscle group is weaker than another, the risk of injury increases.
6. Dehydration. This factor makes muscles more prone to cramps, making them more susceptible to injury.
7. Existing lower extremity injury. The body can compensate for an existing lower limb injury by transferring the load to other muscles, which increases the risk of getting a tear in the hamstring muscles.

Of all the risk factors listed, previous hamstring injury is the most significant risk factor for re-injury. Compared to healthy people, those who already have a hamstring injury are 5 times more likely to suffer from this type of injury. That is why timely and proper recovery after the first incident of injury is so necessary.

Symptoms of a Hamstring Tear

Depending on the severity and location of the injury, the victim may feel weak and be forced to give up physical activity for a long time. Regardless of which hamstring muscle is injured, the symptoms will be as follows:

• Acute pain. At the time of injury, you may feel a sharp and sharp pain in the back of the thigh.
• Strong "pop". The injury is sometimes accompanied by an audible or palpable “pop” and a sensation of muscle relaxation in the thigh.
• Difficulty walking and moving. After a hamstring injury, vigorous activity may be difficult or impossible. The victim may have difficulty walking, or difficulty getting up from a chair or going down stairs.
• Hematoma. Bruising and discoloration of the skin may occur along the back of the thigh.
• Swelling and deformation. Complete muscle rupture may be accompanied by palpable defects such as subcutaneous muscle heterogeneity. They can be felt and seen when attempting muscle contraction.
• Feeling of increased temperature in the injured area and general weakness.

There are three degrees of injury:

1. 1st degree injury is a slight sprain of the hamstring muscles. The victim may experience mild pain and tension in the back of the thigh, but may still be able to walk normally. Some discomfort may occur and the ability to work at maximum speed will disappear.
2. 2nd degree damage - partial rupture of the muscles of the back of the thigh. There is a change in gait, and possible lameness. The victim feels intense pain that increases when moving the leg. Edema quickly develops and a hematoma may form.
3. A grade 3 injury is a complete rupture of the hamstring muscles. Severe pain and severe weakness in the muscles occur. Swelling will be noticeable immediately, and a hematoma will usually appear within 24 hours. A possible complication in the form of damage to the sciatic nerve.

In case of severe 2nd and 3rd degree injuries, seek immediate medical attention. The doctor will conduct a comprehensive examination to assess the severity of the injury. An ultrasound of soft tissues or an MRI will be prescribed, which will allow for a more accurate diagnosis and determine the required recovery time.

Carrying out diagnostics

An experienced surgeon or traumatologist can accurately determine the presence of disorders during an external examination of the patient. The location of the bruises and the soreness of the injured area indicate the intensity of the impact that led to the sprain.

A qualified specialist will conduct a survey to clarify all the circumstances of the injury, flex and extend the injured leg in the joints, and also use palpation to determine the integrity of the joints, and only after that will be able to make the correct diagnosis. In some cases, additional examination may be necessary. In addition, a possible fracture or dislocation can be excluded using x-rays or computer diagnostics.

Conservative treatment of hamstring muscle tears

Conservative treatment of 1st and 2nd degree hamstring muscle tears includes medications and rehabilitation measures.

During the first three days after injury, complete rest is recommended. If there is intense pain, the doctor may do a novocaine blockade. For moderate pain, only painkillers are prescribed. In the first days after injury, it is appropriate to use ointments with a cooling effect to eliminate swelling and pain. As a rule, they contain menthol, which reduces pain, and nimesulide, which relieves inflammation. Non-steroidal anti-inflammatory drugs (Drotaverine, Ibuprofen, Mydocalm) are prescribed for oral administration.

Upon completion of the acute phase of inflammation, warming drugs are prescribed, for example “Apitoxin” or “Pepper extract”. They provide good vascular permeability, increase tissue elasticity and accelerate the recovery process. While taking medications, you must eat a diet high in dairy products and a source of omega-3. It is recommended to eliminate fatty foods and simple carbohydrates and take vitamin supplements.

Diagnosis of muscle damage

To confirm a muscle tear, the patient must undergo an ultrasound. An ultrasound examination will confirm or deny the presence of injury. If confirmed, ultrasound will detect a hematoma if it has formed. This is very important in order to evacuate blood from it in time and prevent inflammation.

It is also possible that the hematoma may not be detected. In such cases, the specialist prescribes a nerve block with novocaine to numb the injured muscle. The blockade is performed either every day or every 2-3 days, according to the doctor’s decision and in the presence of severe pain.

Surgical treatment of hamstring muscle rupture

Surgery is prescribed for complete rupture of the hamstring muscles. As a rule, it is carried out on an emergency basis. Surgical treatment ends with the application of a plaster cast for several weeks, depending on the individual characteristics of the patient. The doctor will prescribe NSAIDs, and you may need to take a course of antibiotics to prevent the development of infection. After the operation, a rehabilitation period begins.

Recovery period

After therapy, it is imperative to carry out rehabilitation measures. They include procedures such as:

• physiotherapy;
• swimming;
• physiotherapy;
• massage.

The rehabilitation period largely depends on the degree of complexity of the injury; for example, with a minor muscle strain, it lasts no more than 10 days. In more complex cases, when muscles, ligaments or tendons are torn, it may take six months to fully recover.

Rehabilitation after a hamstring muscle tear

Rehabilitation for a hamstring muscle tear includes:

1. Exercise therapy. The exercises are designed to restore muscle elasticity and mobility, prevent muscle fiber atrophy, and increase muscle strength and endurance.
2. Electrophoresis. Prescribed to relieve pain and accelerate the regeneration process.
3. Magnetotherapy. It is prescribed to activate metabolic processes and increase blood flow, which has a beneficial effect on the tissue healing process.
4. Acupuncture. Returns sensitivity of the skin over the injured area.
5. Massage. Prescribed 3-7 days after injury. The procedure is carried out once a day for an average of 2 weeks. Its action is aimed at improving the supply of oxygen to cells, restoring local metabolism and increasing tissue elasticity.

Exercise therapy exercises begin with simple movements - flexion and extension of the knee joint in a standing position or lying on the stomach. With the doctor's permission, exercises using weights are added. It is important to perform movements in full amplitude to prevent shortening of the muscle length and the formation of contracture. Exercise increases blood microcirculation and ensures the delivery of nutrients to damaged tissues. After 3-5 days, you can add stretching to the exercises to restore elasticity and flexibility.

Causes of hip pain

The causes of hip pain (as well as its nature) can be different. The hip may hurt on the side of the joint or in the soft tissues, and the discomfort can occur periodically and be intense, acute or chronic. Both the right and left hip can hurt; in addition, pain can be localized in the groin area.

At CELT you can get advice from a specialist algologist.

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Hip injuries

Hip injuries include:

• bruises of the pelvis, hip joint, upper thigh;
• fracture in the area of ​​the trochanters of the femur;
• sacrum fracture;
• dislocations of the femur;
• sprains and tears of muscles and ligaments;
• fracture of the femoral neck;
• compression fracture of the 5th lumbar vertebra.

It is worth noting that rupture of the hip ligaments can occur not only due to injury, but also due to the emergence and development of degenerative processes in them. A rupture is characterized by acute pain and impaired joint mobility.

Osteoarthritis of the hip joint

Coxarthrosis, or arthrosis of the hip joint, is a disease in which wear and tear occurs on the hip joint. It is one of the most common causes of pain in the right and/or left hip. A distinctive feature of this disease is pain localized in the groin and radiating down the lateral and anterior femoral surface. Often the sensations can be projected onto the buttock or radiate to the knee; they appear when walking or getting up from a chair. Other clinical manifestations of coxarthrosis include:

• significant limitation of mobility of the affected limb (inability to perform rotational movements, pull the leg towards the chest or move it to the side);
• crunch in the hip joint;
• shortening of the leg (appears in advanced stages of the disease).

More about coxarthrosis

Arthritis of the hip joint

There are a number of arthritis that can cause inflammation of the hip joints. Despite the fact that this phenomenon is quite rare, it exists and is mainly affected by people aged 15 to 40 years.

Painful symptoms are felt most strongly at night and their intensity is quite high. They do not subside even when changing body position. When walking, the pain subsides somewhat, and in the evening (after the patient has “dispersed”) they can completely disappear, but at night they will make themselves felt again.

Hip infarction – aseptic necrosis of the femoral head

Hip infarction - this is the diagnosis given to five percent of patients who complain of hip pain. This disease is characterized by rapid development; pain symptoms increase over 1–3 days and become almost unbearable at night. Their weakening is observed at 4–5 am. Men suffer from this disease 8 times more often than women.

Inflammation of the femoral tendons

This disease is diagnosed in 25–30% of the number of patients who come with complaints of pain symptoms. Most often, women suffer from this disease, and the peak incidence occurs during menopause, during which weakening of muscles and tendons is often observed. The development of the disease occurs rapidly - within a period of 3 to 15 days. The hip hurts on the side in the soft tissues along the outer surface, either on one side or on both. The discomfort is quite intense; they appear when walking or lying on the affected side. There is no limitation of movement in the hip joint.

More about trochanteritis

Piriformis syndrome

Another very common cause of hip pain is piriformis syndrome. It occurs during pathological processes in the lumbar spine and, as a rule, is one-sided. An increase in pain occurs within 1 to 3 days due to:

• stress;
• lifting weights;
• sudden unsuccessful movement.

The pain is localized in the gluteal and lumbar region, and the sacrum often hurts. Sometimes painful sensations descend along the back surface of the lower limb to the heel.

Other reasons

In addition, the hip can hurt inside or outside and for a number of other reasons:

• pathologies of the endocrine system, leading to the destruction of cartilage and bone tissue;
• pathology of arterial vessels;
• infectious processes in the bone tissues of the hip and pelvis;
• malignant bone tumors.

Recovery time after a hamstring muscle tear

On average, recovery from a hamstring muscle tear takes 2-3 weeks, depending on the location and extent of the damage. Unfortunately, there is a relatively high risk of injury recurrence, especially in the first two weeks after returning to activity. This is why correct diagnosis and timely treatment of hamstring muscle rupture is so important in order to avoid long-term complications: chronic pain syndrome and decreased physical performance.

Causes and types of damage

On the back of the thigh there are quite powerful muscles: semimembranosus, semitendinosus and biceps, all of which perform the function of flexing the tibia at the knee joint. At the top they are attached to the ischial tuberosity of the pelvic bone, intertwined with the iliofemoral and ischiofemoral ligaments. The lower ends of the muscles are attached to the bones of the lower leg, intertwining with the fibers of the posterior popliteal ligament.

With a sharp and strong muscle contraction, both muscle fibers and collagen fibers of the ligaments of the upper or lower third of the thigh can be damaged.

Such injuries occur mainly in athletes when a sharp lunge of the leg occurs in sprinters, football players, and basketball players. The main group of such injuries are children and adolescents involved in sports. The reason is fragility, a lag in the development of muscle tissue during the period of increased bone growth.

Based on the degree of damage, there are 2 types of ruptures:

• Partial tear of muscles and ligaments;
• Complete rupture of muscles and ligaments.

Preventing hamstring muscle tears

Numerous scientific studies have shown that in athletes, eccentric strengthening of the hamstrings with a slow phase of lengthening during contraction (see exercise #26) prevents new and repeated tears of the hamstrings. There is evidence that incorporating eccentric exercise into pre- and off-season training may reduce the occurrence of hamstring injuries and prevent recurrence. However, eccentric exercises can be quite painful, so it is recommended to gradually increase their intensity and duration to eliminate excessive muscle pain and increase elasticity.

Considering the previously listed risk factors for hamstring injuries and their recurrence, it is appropriate for athletes to develop a balanced general physical training program that includes:

• flexibility exercises;
• eccentric exercises;
• exercises to develop neuromuscular control.

A general physical training program taking into account the listed exercises can be quite effective in preventing primary and recurrent ruptures of the hamstring muscles.

Conclusion

It is recommended to treat hamstring muscle ruptures only with the help of specialists. Self-medication can lead to the development of complications and a tendency to relapse. Timely and proper treatment of a hamstring muscle tear will help speed up your return to sports and reduce the risk of re-injury. To prevent recurrence of injury, it is necessary to follow all recommendations of specialists. Before training, you should thoroughly warm up your muscles and avoid a sharp increase in loads after long breaks.

First aid

If you suspect a muscle strain or rupture, you should immediately begin treatment. Be sure to apply cold to the damaged area. Treatment should begin within the first 24 hours after injury. It is worth applying a cold compress every hour and holding it for 20 minutes.

In addition, it is recommended to use cooling gels or ointments with an anti-inflammatory effect. You need to apply the gel to the damaged surface in a thin layer and wait until it is completely absorbed. To prevent swelling from spreading, you need to keep your leg elevated.

It is recommended to seek help from a doctor, since only a specialist can exclude the presence of a rupture. However, if this is not possible and there are all signs of a sprain, then the next day after the injury you need to use ointments that have a warming effect. In addition, a sprain should be treated with a bandage. Such methods of therapy guarantee complete recovery of patients.

When a muscle ruptures, it is necessary to perform an operation that will help restore the integrity of the injured muscles by stitching them together.