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'Neurogenic Hamstrings' – not just found in footballers! Are Caudal Epidural Steroid Injections useful in rehabilitating hamstring injuries?

hams4th September, 2012

Hamstring injuries or strains are perhaps one of the most difficult conditions to treat in sports medicine - these are especially common in athletes, but also the general population as people have increased their activity levels.

The reasoning behind the cause of hamstring strains continues to be confusing and inconclusive for both medical practitioners and researchers. The fact that these injuries frequently re-occur perhaps suggests that we are not effectively managing this problem!

According to British football statistics:
"Hamstring injuries account for 12% of the total injuries, with an average of five per club per season, resulting in 15 missed matches and 90 missed training days" (Woods et al. 2004).

Demonstrating just how much it affects the footballing population!

On the basis of the research by Vad et al. (2000), the majority of these hamstring injuries may be due to neurological problems arising from the central nervous system. Inflammation and irritation of the nerve roots exiting the vertebral foramen of the lumbar spine, may in fact cause increased basal tone of the hamstring muscles making them more susceptible to injury.

A study by Kornberg and McCarthy (1992) found that there was a high incidence of positive slump tests (a method of testing the tension of a nerve), in a group of injured football players compared with a control group. Research suggests that this abnormal neural (nerve) tension or neural tethering may be responsible for the symptoms associated with 'neurogenic hamstrings.'

It has been proposed that these neural influences may predispose select groups of people to hamstring pain of a neurogenic (nerve) origin, particularly those who engage in track and field sports such as sprinters. For this reason, amateur athletes and many elite athletes face ongoing problems with continued high-level training and competition.

How can we help?

Caudal Epidural Steroid Injection (ESI)

Although ESI therapy is a relatively new method used to treat hamstring injuries of neurogenic origin, the Blackberry Clinic prides itself on being at the forefront of these treatments. Our Sports Injury or Pain Management Specialists are able to administer these injections, which are undertaken in our purpose built fluoroscopic theatre suites.

Cortico-steroids commonly used for their anti-inflammatory properties are injected into the epidural space surrounding the spinal nerve or the articular facet where the nerve root exits. This aims to reduce the sensitivity of the nerves, which may help return hamstring muscles to a normal resting tone and/or reduce any referred posterior thigh pain.

Physical Therapy and Rehabilitation

It is suggested that an extensive post-epidural programme needs to be implemented to ensure a thorough rehabilitative process is completed and the risk factors for reocurrence as identified above are addressed. This can be put together by one of our qualified practitioners, such as a Physiotherapist, Chiropractor or Osteopath.

It has been highlighted that patients with low back pain or sacro-iliac joint dysfunctions can result in increased hamstring torque. Therefore, it is suggested that epidural steroid injection , combined with treatments administered by a Physiotherapist, Chiropractor or Osteopath, may have a role to play in preventing and treating hamstring injuries.

Having up-to-date research to hand allows our practitioners to utilise their skills in the best way, providing you with the highest quality of care for managing these hamstring problems.

 

References

Aggen, P.D. and Reuteman, P. (2010) Conservative Management of Sciatic Nerve Injruy Following Hamstring Tear. NAJSPT, 5(3), 143-154.

Kornberg, C. and McCarthy, T. (1992) The effect of neural stretching technique on the sympathetic outflow to the lower limbs. JOSPT, 16(6), 269-272.

Lempainen, L. (2009) Surgical Treatment of Hamstring Injuries and Disorders. Annales Universitatis Turkuensis,1-66.

McLain, R.F., Kapural, L. and Mekhail, N.A. (2005) Epidural steroid therapy for back and leg pain: mechanisms of action and efficacy. Spine Journal, 5(2), 191-201.

Sports Injury Bulletin (2012) Injection Therapy. Accessed 12 June 2012. [Online]http://www.sportsinjurybulletin.com/archive/injection-therapy

Szalai, K. and Illyés, A. (2005) Sacral epidural steroid injections used for the prevention of hamstring injuries. FACTA UNIVERSITATIS Series: Physical Education and Sport, 3(1), 37-44.

Turl, S.E. and George, K.P. (1998) Adverse neural tension: a Factor in repetitive hamstring strain? Journal of Orthopaedics & Sports Physical Therapy, 27(1), 16-21.||

Vad, V. et al (2000) An unusual cause for chronic pain in the proximal hamstring (buttock) area, Medicine and Science in Tennis – www.stms.nl/april2000/artikel18.htm

Walsh, J., Flatley, M., Johnston, N. and Benett, K. (2007) Slump Test: Sensory Responses in Asymptomatic Subjects. The Journal of Manual and Manipulative Therapy,15(4), 231-238.

Woods, C., Hawkins, R.D., Maltby, S., Hulse, M., Thomas, A. and Hodson, A. (2004) The Football Association Medical Research Programme: an audit of injuries in professional football – analysis of hamstring injuries. Br J Sports, 38: 36-41

Worrell, T.W. and Perrin, D.H. (1992) Hamstring muscle injury: the role of strength, flexibility, warm-up, and fatigue. Journal of Orthopaedic and Sports Physical Therapy, 16, 12-18.

The information within this blog is in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor. If your symptoms do not seem to be improving seek medical/professional help immediately.