Worthing Physiotherapy & Sports Injury Clinic



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The Hip

The hip joint is a big, robust, mobile yet very stable joint. It has the biggest ligaments and muscles in the body surrounding it that move and controls it.

Groin (Adductor) from fast twisting in squash and football account for a substantial number of hip injuries we treat. Hamstring and quadriceps strains from the repetitive loading of endurance running or high loads of sprint distance also respond well to treatment. Joint problems such as impingement syndromes and early / moderate OA can also make good gains from treatment.

We look at how the whole leg, from foot to pelvis, act together. Like the shoulder, the balance of muscle activation around the hip is important in maintaining sound lower limb biomechanics. Careful assessment of limb and spinal function is essential for accurate diagnosis of hip problems, treatment and  future injury prevention.

Example: Hamstring strains:

    grade one

the signs may not be present until after the activity is over. There may be a sensation of Hamstring cramp or Hamstring tightness and a slight feeling of pain when the muscles are stretched or contracted.

    grade two

there is immediate pain which is more severe than the pain of a grade one injury. It is confirmed by pain on stretch and contraction of the muscle. A grade two Hamstring strain is usually sore to touch.

    grade three

is a very serious injury. There is an immediate burning or stabbing pain and the athlete is unable to walk without pain. The muscle is completely torn and there may be a large lump of muscle tissue above a depression where the tear is. After a few days with grade two and three injuries a large bruise will appear below the injury site caused by the bleeding within the tissues


The immediate treatment of a Hamstring muscle injury consists of the RICE protocol - rest, ice, compression and elevation (never apply ice directly to the skin). This is aimed at reducing the bleeding and damage within the Hamstring muscle tissue. Resting may be the common sense approach, but it is one that is often ignored by competitive athletes. This is unwise, since it does not take much to turn a grade one Hamstring strain into a grade two, or a grade two Hamstring strain into a grade three. As a general rule, grade one Hamstring strains should be rested from sporting activity for about 3 weeks and grade two injuries for about 4 to 6 weeks. In the case of a complete rupture, the Hamstring muscle will have to be repaired surgically and the rehabilitation afterwards will take about 3 months

Regardless of the severity of the Hamstring injury the treatment in the first few days is the same. The Hamstring should be rested in an elevated position with an ice pack applied for twenty minutes every two hours, if practical (never apply ice directly to the skin). A compression bandage should be applied to limit bleeding and swelling in the tissues. After the early stages have been spent resting, more active rehabilitation can be started.

Gentle resistance exercises, deep tissue massage and stretching are important as they help to align the scar tissue that forms during the healing process. By aligning the scar tissue along the normal lines of stress the tensile strength of the Hamstring is enhanced. Ultrasound treatment is effective during this phase.

At first gentle resistance is provided by a therapist, but as the muscle gets stronger then resistance bands can provide more of a challenge. The sets and repetitions are gradually increased and eventually Core Strengthening can be started.

Core Strength and Core Stability exercises can improve muscle function across the trunk and pelvis and this can reduce the risk of Hamstring injury. Core strength exercises on a mat using a Swiss Ball and resistance bands are ideal. Once Core Strength and Hamstring strength are improved, then a return to functional activity is possible. With a grade one Hamstring strain gentle jogging can be initiated between seven and nine days after injury and straight line sprinting is usually started after 3 weeks.



  2008 Worthing Physiotherapy & Sports Injury Clinic: Chartered Physiotherapists in Worthing, West Sussex