he most common mus-cle strains athletes expe-rience are hamstringinjuries. Of the three

hamstring muscles, the bicepsfemoris is most often involved.1,2

Hamstring injuries can be causedby several factors, all of whichrespond well to chiropractic care.Sadly, many people attempt totreat their own hamstring prob-lems, which can lead to chronicconditions.

Hamstring muscle imbalancesoften contribute to (or may becaused by) pelvic malpositionsand spinal subluxations.3 Chiro-practic care for hamstring injuriesshould include a lower extremitypostural evaluation, since custom-made orthotic support may berequired, especially for rearfootfunction.

Hamstring FunctioningThe hamstring group is made

up of three muscle masses thatoriginate from the ischial tuberosi-ty. The medial two are the semi-tendinosus and the semimembra-nosus muscles. The biceps femorismuscle runs along the lateral sideof the posterior thigh. Properfunction of all three is very impor-tant for gait efficiency and stabilityof the knee joint.

The main functions of the ham-strings are to:• control knee extension by thequadriceps• extend the hip joint, and• flex the extended knee joint

When the quadriceps musclesextend the knee joint, the ham-strings act as a brake to slow for-ward movement of the tibia. This

requires an eccentric (lengthening)contraction of the hamstring mus-cles. Quadriceps muscles that aretoo powerful can overwhelm thehamstrings, resulting in a suddenmuscle tear during a strenuousactivity, such as sprinting.4

Levels of ActivityDuring running, the hamstrings

are most active during the last 25%of the swing phase, and the first50% of the stance phase.5 This firsthalf of stance phase consists ofheel strike and maximum prona-tion. The leg muscles, includingthe hamstrings, function to controlthe knee and ankle at heel strikeand to help absorb some of theimpact. A 1999 study showed asignificant decrease in electromyo-graphic activity in the hamstringswhen wearing orthotics.6 In fact,the biceps femoris had the greatestdecrease in activity of all musclestested, which included the tibialisanterior, the medial gastrocne-mius, and the medial and lateralvastus muscles. Previous studieshad already demonstrated a signif-icant decrease in tibial internalrotation7 and on pronation velo-city8 when using orthotics. Theresearchers theorized that theadditional support from the orth-otics helped the hamstrings to con-trol the position of the knee and toabsorb some of the shock of heelstrike.

Caring for and Preventing HamstringInjuries

The best way to treat any injuryis to prevent it from happening inthe first place. However, when anathlete presents with a hamstringinjury, acute care and return to

sports activities are top priority.The final stage, though, must con-sider the need for custom-madeorthotics in order to reduce ham-string stress and prevent re-injury.

Acute care. Hamstring injuries arebest treated with the PRICE for-mula: protection for the injuredmuscle (an elastic wrap helps pre-vent further injury); rest fromstrenuous activities; icing toreduce inflammation, swelling,and pain; compression to decreasebleeding and congestion; and ele-vation to encourage drainage andprevent lymphatic stasis. Passivestretching and lengthening shouldbe started as soon as tolerable toprevent the muscle injury fromhealing in a shortened position.

Adjustments and muscle balanc-ing. Pelvic and spinal misalign-ments and dysfunctions are com-monly found in association withhamstring strains. Because there isoften no way to tell whether mus-cular strain affected the pelvis andspine, or vice versa, both areasmust be treated for a completeresponse. Additionally, pre-exist-ing muscle imbalances may con-tribute to hamstring strains. Thegluteus maximus muscle is oftenrelatively weak, causing the ham-string to work harder to extend thehip joint. This may be found alongwith an iliopsoas muscle that isshortened or hypertonic on thesame side. The tightness of theiliopsoas inhibits the gluteus max-imus, thereby placing the ham-string at a disadvantage.9

Orthotic SupportA custom-made, flexible foot

S E P T E M B E R / O C T O B E R 2 0 0 3 45

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Injured Hamstrings And Orthotic Support

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orthotic that helps to position therearfoot at heel strike, absorbssome (or most) of the impact, andreduces overpronation can speedhealing from a hamstring injuryand reduce the possibility of recur-rence. Therefore, an importantcomponent must be a varus wedge(or pronation correction) under thecalcaneus. The use of man-madeviscoelastic materials (such as Zor-bacel®) under the heel is neededto decrease the shock wave trans-mission up the leg. And finally,sufficient support for the arches ofthe foot (especially the medial lon-gitudinal arch) must be includedto prevent prolonged pronation inthe first half of the stance phase.An orthotic that incorporates all ofthese factors should be providedto athletes who want to return tofull participation in their sport.

Reduce Strain, Improve GainWe now have several reasons to

include orthotics in the treatment

protocol for hamstring strains.The electromyography investiga-tions have shown that the use oforthotics has a direct effect on thehamstring muscles. By significant-ly reducing the strain of running, awell-designed, custom-made orth-otic can help to speed a full returnto sports, and also prevent re-injury. About the AuthorAn enthusiastic speaker, Dr. WilliamAustin provides an energetic approachto learning. He draws from over 35years of healthcare experience, whichincludes athletic training, emergencymedicine, English bonesetting, andchiropractic. Dr. Austin has developedtwo successful practices. His patientsrange from newborns to centenarians,couch potatoes to professional ath-letes.

Dr. Austin is a 1986 graduate of LoganCollege of Chiropractic, and is current-ly Director of Professional Educationat Foot Levelers, Inc. of Roanoke, VA.

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