Hamstring injuries are very common in sports and can involve any part along the entire length of the muscles and tendons from the hip to the knee. The hamstring origin is found on the part of the pelvis called the ischial tuberosity, which is easily felt as it is the hard bone that we all sit on in our buttocks. The majority of the muscles form a common tendon that attaches in this area. The muscle bellies considered the hamstring muscles are found on the back of the thigh. The hamstrings attach below the knee on the upper tibia and fibula – the two bones that make up the lower leg.
Injuries can happen at any point along this course, but hamstring injuries involving the tendons attaching to the lower leg are quite rare. When they do occur, these injuries usually involve the tendon from the biceps femoris muscle that attaches on the upper fibula. Injuries to this tendon are mostly associated with high energy injuries such as a knee dislocation or a significant ligament injury to the knee. As you can imagine, there is often additional damage found alongside this type of injury. Unfortunately, these types of injuries commonly need complex surgical repair and other reconstructive procedures. The tendons that attach to the inside part of the lower leg are usually not injured significantly but can be involved with bursitis (when the fluid filled sac that envelops the tendons gets inflamed). This can be treated with conservative means in the majority of cases.
Injuries to the muscle bellies themselves are the most commonly seen hamstring injury. These are often the easiest to recover from, but are also known for sticking around and being nagging injuries throughout an athlete’s season. This has been the case with numerous professional athletes, including Miles Austin of the Dallas Cowboys. These muscle belly injuries almost always heal without any need for an invasive procedure but they need time, something many athletes can be reluctant to allow for. Not allowing enough time for this type of injury to heal can lead to chronic problems and reinjury.
Another location of injury to the hamstring complex is at its origin on the ischial tuberosity on the pelvis. With explosive maneuvers, such as the beginning of a sprint or during the start of water skiing, this area sees a tremendous amount of stress. The entire hamstring complex origin can pull off the ischial tuberosity with or without a piece of bone. If it does so and retracts away from the ischial tuberosity it will most likely require surgical repair. There are numerous studies to indicate that patients that have it repaired do better than those who do not. One of the major nerves to the lower leg – the sciatic nerve – travels very close to the ischial tuberosity and can be involved in the scar that forms if these injuries are not treated surgically relatively soon after injury. If this is the case it can be a significant source of ongoing pain. Patients with chronic tears and sciatic nerve irritation also do well with repair and removal of the scar tissue in this area although the surgery is slightly more complex.
If you have acute injury with weakness and significant bruising or simply a nagging discomfort that is present in this area, I recommend you have it evaluated by a physician. Hamstring injuries are often accompanied by a significant amount of bruising and pain. At times the entire back of the thigh and groin can be black and blue due to the bleeding that occurs. Consulting with a physician will help you understand the extent of your hamstring injury and your best options for treatment and rehabilitation.
Dr. Christian Balldin is an orthopaedic surgeon, fellowship trained in sports medicine, with The San Antonio Orthopaedic Group. He treats patients aged 3 years and up for all orthopaedic conditions with the exception of the spine. To learn more about Dr. Balldin, visit his web page here. To schedule an appointment with Dr. Balldin, call 210.281.9595.
The awareness, evaluation and treatment of concussions are a hot topic lately. In the sports world especially, we are hearing about it more and more. The NFL is attempting to limit the exposure of its players to violent hits and fining (or even suspending) the players that do deliver these types of hits. Pee wee football coaches are trying to teach better tackling and not to lead with the helmet to not only protect the brain but also the spine to avoid catastrophic injuries such as spinal cord injury.
However, concussions are not only present in football. In almost every sport there is a chance for head injury and thus concussions. The sport with the highest rate of concussions is actually women’s soccer.
Concussions are common with the CDC estimating 1.6 – 3.8 million occurring annually. In 90% of these, loss of consciousness does not occur. The symptoms of concussions include:
- Difficulty concentrating
- Dizziness and problems with balance
- Blurred vision
- Light sensitivity
- Memory difficulties
The cumulative effects of concussions are really dangerous and not to be taken lightly. Having repeated concussions throughout an athlete’s life can predispose them to Chronic Traumatic Brain Injury (CTBI). It is the most common effect from repeated brain injury. It can have serious vocational, persistent cognitive deficits and personal effects.
The so called “Second Impact Syndrome” (SIS) is when an athlete sustains a second concussion while still not recovered from the first. During the recovery period of a concussion, even minor trauma, such as a trivial hit to the head, can cause significant increases in intracranial pressures and devastating consequences.
The best way to manage concussions is to treat them appropriately when they do occur. A coordinated effort between the athletic trainer, physicians involved, neuropsychologist, the athlete, the athlete’s family as well as the coach should be undertaken in order to have a safe return to play and/or to exertion. A recent article in the Journal of Bone and Joint Surgery discussed the matter and made the following points:
- Acute concussion symptoms are mostly self limited with resolution within two weeks
- Athletes should rest physically and cognitively until symptoms have resolved at rest and with exertion
- Neuropsychological testing should be used as part of overall evaluation when attempting to decide when an athlete is ready to return
- A history of multiple concussions or a history of prolonged symptoms might necessitate retirement from collision/contact sports
- Additional research still needed on long term consequences of concussions
The treatment of concussions is evolving, as it should, since we still do not fully understand the complex neural pathways that are affected. Recognizing when a concussion has occurred is one of the most important steps. This can only happen if we continue to educate those involved in sports on how to recognize the signs and symptoms of concussions. A goal for the near future should be to have all young athletes involved in contact/collision sports baseline tested for concussion using objective computer programs. Baseline readings taken prior to play would then be available to compare against if an incident occurs during the season. This data would be part of the overall examination when attempting to treat and return an athlete to play. This of course requires an organized effort on all parties involved. Dr. Christian Balldin is an orthopaedic surgeon, fellowship trained in sports medicine, with The San Antonio Orthopaedic Group. He treats patients aged 3 years and up for all orthopaedic conditions with the exception of the spine. To learn more about Dr. Balldin, visit his web page here. To schedule an appointment with Dr. Balldin, call 210.281.9595.
To link to the study that Dr. Balldin is referencing, click here.
There are numerous causes of hip pain in the active adolescent and adult population, including but not limited to:
- A loose body, like a piece of cartilage, inside the hip joint itself.
- Impingement of the femur bone and the hip socket. This is when there is extra bone that forms on either or more often both locations in response to stress which can result in pain as well as decreased range of motion.
- A tear of the labrum (the elastic tissue surrounding the socket of the hip joint) which is very commonly seen in combination of impingement.
- Snapping of tendons over the hip joint capsule itself or occasionally more on the outside of the hip involving the iliotibial (IT) band
- Greater trochanteric bursitis which is inflammation in an area on the outside of the hip that is normally present to decrease friction of the surrounding tissues
- Strains of the muscles surrounding the hip joint, including the hip flexors and groin.
- Pain actually generated in the lower back, which radiates to the hip area.
The vast majority of these conditions can be treated non-surgically using methods like rest, anti-inflammatory medication, occasionally local injections as well as physical therapy.
However, when you are dealing with a loose body floating around in the joint time can be of the essence. The longer it is left unattended, the more damage it may do to the remaining healthy cartilage. In these cases, the loose body should be removed sooner rather than later using a minimally invasive procedure called hip arthroscopy (“What is Arthroscopy?”). When appropriate, hip arthroscopy can also be used to repair tears of the labrum or to correct impingement by removing the excessive bone.
In cases where hip pain cannot be resolved using non-surgical techniques, hip arthroscopy offers a great, minimally invasive alternative to open hip surgery which allows for a smooth and speedy recovery in the majority of cases.
Dr. B. Christian Balldin is an orthopaedic surgeon, specializing in sports medicine, at The San Antonio Orthopaedic Group. His fellowship training at The Steadman Clinic in Vail, CO included training in hip arthroscopy. To learn more about Dr. Balldin, please visit his web page here. To schedule an appointment with Dr. Balldin, please call 210.281.9595.
The anterior cruciate ligament (ACL) is one of the four major ligaments of the knee. ACL tears are very common in sports where athletes are expected to change direction and pivot frequently such as in football, basketball and soccer.
There are a high number of sports-related ACL injuries across the board, but this seems to be especially true in women’s basketball and women’s soccer. Numerous studies have tried to explain this phenomenon and, though there is no complete consensus, some proposed explanations include:
- Women have slightly different and narrower anatomy in the area of the knee where the ACL runs making it prone to impingement and thus injury.
- There is difference in the balance of the musculature surrounding the knee between male and female athletes.
- Female athletes show different landing dynamics of the knee when jumping and cutting.
- Hormonal differences may make the ACL more prone to rupture in women.
Another contributing factor to ACL injury is overuse. Year round play, which is becoming more and more common in today’s environment, makes athletes more prone to ACL tears and to sports injuries in general. In baseball, we see elbow or shoulder injuries because of too many pitches as early as little league. In football, basketball, and soccer, we see a high number of ACL injuries. During the season, it is crucial to get the all important rest that allows the body to rejuvenate and avoid overuse injuries.
Athletes need to make sure they are in good physical condition prior to starting the season, engage in proper warm-up and cool-down activities and implement certain exercises within their training regimen to decrease their chances of ACL tears. Multiple studies have looked at implementing exercise programs to make the body more aware of how to land and change direction safely. While in use, these programs showed a decrease in number of ACL tears, but the effect appeared to dissipate when the exercises were not performed any longer.
Due to the nature of certain sports, we will never be able to prevent all sports-related ACL tears, but following these guidelines may help you sidestep an injury.
Dr. B. Christian Balldin is an orthopaedic surgeon, specializing in sports medicine, at The San Antonio Orthopaedic Group. To learn more about Dr. Balldin, please visit his web page here. To schedule an appointment with Dr. Balldin, please call 210.281.9595.
TSAOG is very pleased to welcome Dr. B. Christian Balldin to our practice! He starts this Monday, August 27th!
Dr. Balldin is an orthopaedic surgeon who has completed additional fellowship training in sports medicine at the Steadman Clinic in Vail, Colorado.
He will be treating all orthopaedic conditions, with the exception of the spine, for patients aged 3 years and up.
Dr. Balldin’s special interests include:
- Sports-related injuries and cartilage restoration procedures
- Arthroscopy of the shoulder, elbow, hip, knee and ankle
- Complex knee ligament reconstructions
- Fracture and trauma care
- Joint replacements of the shoulder, hip and knee
To schedule an appointment with Dr. Balldin, please call 210.281.9595.
To learn more about Dr. Balldin’s background and training, please visit his webpage here.
Recruiting rising stars in orthopaedics is one more way TSAOG makes your health our mission.