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Acute First-Time Hamstring Strains During Slow-Speed Stretching

Clinical, Magnetic Resonance Imaging, and Recovery Characteristics

Carl M. Askling, PT^,,*, Magnus Tengvar, MD, Tönu Saartok, MD, PhD and Alf Thorstensson, PhD

From the Swedish School of Sport and Health Sciences, Stockholm, Sweden, the Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden, and the Department of Radiology, Sophiahemmet Hospital, Stockholm, Sweden

^* Address correspondence to Carl M. Askling, PT, Box 5626, 114 86 Stockholm, Sweden (e-mail: carl.askling{at}ihs.se).

Background: Hamstring strains can be of 2 types with different injury mechanisms, 1 occurring during high-speed running and the other during stretching exercises.

Hypothesis: A stretching type of injury to the proximal rear thigh may involve specific muscle-tendon structures that could affect recovery time.

Study Design: Case series (prognosis); Level of evidence, 2.

Methods: Fifteen professional dancers with acute first-time hamstring strains were prospectively included in the study. All subjects were examined, clinically and with magnetic resonance imaging, on 4 occasions after injury: at day 2 to 4, 10, 21, and 42. The clinical follow-up period was 2 years.

Results: All dancers were injured during slow hip-flexion movements with extended knee and experienced relatively mild acute symptoms. All injuries were located proximally in the posterior thigh close to the ischial tuberosity. The injury involved the semi-membranosus (87%), quadratus femoris (87%), and adductor magnus (33%). All injuries to the semimembranosus involved its proximal free tendon. There were no significant correlations between clinical or magnetic resonance imaging parameters and the time to return to preinjury level (median, 50 weeks; range, 30–76 weeks).

Conclusion: Stretching exercises can give rise to a specific type of strain injury to the posterior thigh. A precise history and careful palpation provide the clinician enough information to predict a prolonged time until return to preinjury level. One factor underlying prolonged recovery time could be the involvement of the free tendon of the semimembranosus muscle.

Key Words: dancer • magnetic resonance imaging • palpation • tendon • stretching • hamstring

This article has been cited by other articles:

				C. M. Askling, M. Tengvar, T. Saartok, and A. Thorstensson Proximal Hamstring Strains of Stretching Type in Different Sports: Injury Situations, Clinical and Magnetic Resonance Imaging Characteristics, and Return to Sport Am. J. Sports Med., September 1, 2008; 36(9): 1799 - 1804. [Abstract] [Full Text] [PDF]

				L. T. Bui-Mansfield and S. D. O'Brien Reply Am. J. Roentgenol., June 1, 2008; 190(6): W380 - W381. [Full Text] [PDF]