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Hamstring tears and orthotics

Discussion in 'Biomechanics, Sports and Foot orthoses' started by AB10, Mar 18, 2010.

  1. AB10

    AB10 Welcome New Poster


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    Long time...first time.

    I had a patient in this week who is suffering from recurrent hamstring strains.
    Male
    24 y.o.
    Local Footballer
    Suffered 8 left hamstring tears and 1 right - through all sports of different mechanisms
    He was consulted all sorts of Allied health professionals to find a solution to his problem - Who have mostly focused on establishing hamstring and core strength and trunk support.
    He has decided to conbsult podiatry as he feels hes running out of ideas.
    He presents with very flat feet with significent rearfoot eversion through late contact - early midstance in gait. There wasn't any noticible over internal tibial rotation. No abductory twist present, very slight early heel off, patient has great flexibility at the hip and ankle joints, no noticible difference between either sides.
    The paitent was assessed by a colleauge of mine, and he is returning in a week to see me.
    Ive found some evidence to suggest there is some correlation between hamstring tears and over-pronation. And between foot orthotics and a reduction in hamstring activity.
    Does anyone have any clinical experience dealing with a similar problem. Im inclined to cast him for orthoses anyway and at the very least prevent any furure lower limb problems he might confront, although the main reason he presents is to prevent the reoccurance of his hamstring problems.
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. efuller

    efuller MVP


    Did you watch him run? It made me think of a high school team mate who had very flat feet and we made fun of him because his heel stayed on the ground so long when he ran. I could see his heel because he was faster than me.

    Anyway, you can approach this from the joint power perspective. You get a certain amount of your movement from the muscles at each joint of the lower extremity. Just thinking out loud here. If he got very little power out of his ankle, he would need more from the hip and knee. The hamstrings provide power to both hip and knee. An orthotic may help by making the foot stiffer so that more power can be provided by the ankle. Or the best thing maybe to strenghten the hamstrings and the core.

    Some thoughts,
    Eric
     
  4. Griff

    Griff Moderator

    In my experience footballers tend to have some of the worst pelvic control I see (maybe due to the penchant for a sway back posture and sitting on their ass whilst watching movies or playing x-box most of the day). If the gluteals, in particular Gluteus Maximus, stop functioning as the primary hip extensor then these individuals tend to become what I term 'hamstring dominant'. I've certainly seen a few footballers who have had the works thrown at them regarding their ongoing hamstring issues (manual therapy, faciliated stretching etc etc) and things didn't clear up until better Gluteal function (and consequently proximal stability) was achieved.

    With this in mind you could argue that if your orthoses help with regard to neuro-muscular recruitment proximally (can't think of ref off the top of my head) then this may be the mechanism by which they reduce the pathological loading of the hamstrings.

    Just thinking aloud regarding the mechanism of injury - of course this doesn't take into account the local status (conditioning) of the musculature etc

    Ian
     
  5. Graham

    Graham RIP

    From a sagittal perspective. Failure to advance over the first mtpj due to FHL will likely result in failure to attain full hip extension while walking and running., consequently remaining in a flexed position resulting in tight Hams. Any ballistic acceleration, especially in possible negatively heeled cleats, puts a eccentric demand on the Hams which it is no longer able to cope with hence the pull. (For Simon this is just another crazy assumption!)

    He would benefit from a device with a suitable Kirby skive, FF lat posting and first ray cut a ways. (Been there. Done that) - Works well!
     
  6. The hamstrings are the primary decelerator of hip flexion and knee extension during the latter part of the forward recovery phase (swing phase) in running athletes. Neoprene thigh sleeves work well to reduce the pain and increase function in hamstring strains in running athletes. Also hamstring stretches and quad strengthening both seem to balance the power at the hamstrings to minimize recurrent hamstring strains. Foot orthoses in this individual may help, but will probably not be as great a help as the thigh sleeves, hamstring stretching and quad strengthening.
     
  7. JackieSmith

    JackieSmith Member

    Hi Kevin, hope it's not a daft question but could you explain the rationale for quadriceps strengthening in this instance? I keep reading about 'imbalances' between quad and hamstrings strength (ie. Quads being too much more powerful) being a precursor to hamstring strain? Is is the case that the hamstrings will cope as long as they aren't too tight?

    Thanks for your help!

    Jackie (recent grad, uk).
     
  8. Jackie:

    Here is a good article for you to get you started.
     
  9. KBruce

    KBruce Member

    I can give a personal experience which may help with this:
    From the age of 15-20 I had hamstring problems all through football, I played to a professional level with an English club. In my last season at age 19 I tore the hamstring 10 times (5 on each) once just jogging up an incline. They were never severe, grade 1 and mild grade 2's and I would be back training in 2 weeks usually.
    The treatment I was given included improving hamstring flexibility, Neoprene thigh sleeves and later long slow running of 1 hour everyday followed by lots of light hamstring weights. At the time not being a podiatrist myself I was assessed very badly by the club podiatrist who said "your feet are fine" after seeing me jog from corner flag to halfway line.
    Overall I dont think orthotics would have helped and knowing what I do now believe as Ian puts it was hamstring dominant, even when walking or standing I was overusing the hamstrings with minimal use of the gluteals.
    So I think there is a lot more to think about with recurrent hamstring problems and although orthotics may provide some assistance, there is a bigger picture to consider.
    Kevin
     
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