햄스트링
넓적다리뒤근육, hamstring
햄스트링은 넓적다리의 뒤칸(posterior compartment of thigh)에 분포하는 세 개의 근육, 넙다리두갈래근(biceps femoris m.), 반막근(semimembranosus m.), 반힘줄근(semitendinosus m.)을 통틀어 일컫는 말이다.
허벅지를 펴고 무릎을 굽히는 역할을 한다. 뭉치거나 부상을 당하기 쉽고 뭉쳤을 때 요통이 일어나기 쉽다.
이름의 의미
햄스트링이란 단어는 ham(무릎 뒤)[과 string(힘줄)의 두 단어가 합성된 단어다. 17세기 중엽부터는 '무릎 뒤쪽의 힘줄'이라는 뜻과 함께 '햄스트링을 끊어 다리를 불구로 만든다'라는 동사로서의 의미를 지니게 되었다.
햄스트링이란 이름으로 불리는 세 근육들에는 공통점들이 몇 존재한다.
궁둥뼈결절(ischial tuberosity)에서 일어나고, 엉덩관절과 무릎관절을 모두 가로지르므로 두 관절에 모두 작용한다. - 단, 넙다리두갈래근 짧은갈래는 엉덩관절보다 밑인 넙다리뼈 거친선(linea aspera)에서 일어나고, 그러므로 엉덩관절에는 작용하지 않는다.
궁둥신경(sciatic n.)의 정강신경 부분이 지배한다. - 단, 넙다리두갈래근 짧은갈래의 경우 궁둥신경의 온종아리신경 부분의 지배를 받는다.
넓적다리의 뒤칸에 분포한다.
엉덩관절 폄근(extensor), 무릎관절 굽힘근(flexor)으로 작용한다. - 위에서도 언급했듯 넙다리두갈래근 짧은갈래만 엉덩관절에 작용하지 않는다.
이들의 작용은 엉덩관절 굽힘근이자 무릎관절의 폄근인 넙다리곧은근(rectus femoris m.)과 정확히 반대되며, 따라서 햄스트링과 넙다리곧은근은 대항근(antagonist) 관계에 있다.
운동
대표적인 햄스트링 운동으로는 레그 컬, 시티드 레그 컬, 스티프 레그 데드리프트 등이 있다. 이 분야 끝판왕 운동으로 노르딕 햄스트링 컬이 있다.
햄스트링 부상
체중을 온전히 두 다리로 지탱하며 걷는 이족보행을 채택한 인류인 이상 햄스트링은 싫어도 발달이 되기 마련이다. 햄스트링 근육은 보행에서도 상당히 중요하기 때문. 특히 운동을 즐겨하고, 그 중에서도 근육 발달량이 여성들보다 더 많을 수밖에 없는 남성들은 당연히 햄스트링도 더 발달할 수 밖에 없다.
그러나, 문제는 부상은 큰 근육일수록 심각하다는 점이다. 가속도가 붙은 신체를 반대 방향이나 진행 방향 이외의 방향으로 움직이려 할 때 햄스트링에 가해지는 부하는 상상을 초월한다. 이때 햄스트링에 과도한 부하가 가해지면 부상을 입게 된다.
가벼운 부상인 경우엔 그냥 허벅지 뒤쪽 근육이 뭉친 듯한 느낌을 받지만 심한 경우엔 햄스트링 근육이 완전히 끊어지거나 햄스트링이 붙어있던 엉덩이 뒤쪽 고관절에서 떨어져 나가는 경우도 있다.
이러한 특성으로 인해 주로 극단적인 방향 전환이 잦은 스포츠를 플레이하는 축구 선수들이나 농구 선수, 쇼트트랙 선수들이 발목, 아킬레스건, 십자인대와 더불어 자주 햄스트링을 다친다. 실제로 축구 소식을 들어보면 꽤 잦은 빈도로 ‘ㅇㅇ선수가 햄스트링 부상으로 몇 주간 결장한다.’ 같은 뉴스가 나온다. 한국에선 마이너한 장르라서 잘 안 알려져있긴 하지만 사이클 선수들 특히 경륜선수들이 이 부상이 항상 수식어로 따라올 정도로 많이 다치는 부상이기도 하다.
특히 햄스트링 근육 단련을 게을리 했거나 스피드를 많이 사용하고 그 중에서도 가속도와 방향전환이 주무기인 운동 선수들이 자주 햄스트링 부상에 시달린다. 신체를 급격하게 비트는 데 충분한 종아리와 허리 근육들의 힘을 햄스트링이 미처 감당하지 못하기 때문이다.
야구에서도 축구만큼 자주 발생하는 부상이다. 야구라는 스포츠가 공격에서 주루플레이, 수비에서 움직이느라 뛰는 일이 빈번하고, 에브리데이 스포츠라 일주일 내내 경기를 치르기 때문에 야구 선수에게도 결코 반갑지 않은 존재다. 특히 가만히 서 있다가 공이 배트에 맞는 순간 갑작스럽게 부하가 가해지면서 움직이다보니 부상 시 다른 종목보다 더 큰 고통을 호소하는 경우가 많다. 햄스트링 부상이 잦아지거나 정말 심하게 다치는 경우 주력을 상실하여 심각하게 느려지는 모습을 보이기도 한다. 이 때문에 한 번 부상입은 선수는 복귀 후 팀 차원에서 도루나 전력질주를 금지시키기도 한다.
허벅지 뒤쪽 중 가운데 부분을 눌렀을 때 통증이 있거나, 힘이 들어간 상태에서 무릎을 굽히거나 근육을 펼 때 허벅지에 통증이 심하다면 햄스트링 부상을 의심할 수 있다. 근육 부상의 특성상 발달이 잘 되어있을수록 더 아픈데, 이 부분을 자주 사용하는 만큼 엄청나게 발달시킨 축구선수들이 이 부위를 부상당했을 때의 고통은 상상을 초월한다. 물론 일반인들도 당하기 쉬운 부상이기도 한다. 2013년 기준 약 4만 명이 햄스트링 부상으로 병원에 실려오며, 그 중 68% 정도는 남자다. 특히 10, 20대 남성이 전체의 28% 정도로 젊은 남성이 당하기 쉬운 부상이다.
예방법은 스트레칭을 충분히 해야 하고, 본인이 감당할 수 있는 선에서 운동을 해야 한다. 원래 운동할 때는 그럭저럭 할 만 하다. 근육 긴장이 풀리면서 부상을 알아채기 때문에 절대 무리하지 마라. 일단 부상을 당했다면 얼음찜질을 해주고 당분간은 허벅지를 쓸 생각은 절대로 하지 말자. 걷는 것도 힘들어서 절뚝거리며 다니게 된다. 실제로 운동선수들도 한 번 부상당하면 기본 몇 주는 의료진 신세를 지게 되니 조심하자.
문제는 부상에 회복하고 나서도 운동 능력이 완전하게 잘 돌아오지 않으며 재발도 잦다는 것이다. 특히 운동선수의 경우 부상이 반복될 경우 달리기 능력을 아예 상실하는 지경까지 이르기도 한다. 대표적인 케이스가 반복된 햄스트링 부상 이후 도루 갯수가 현저하게 줄어든 정근우.
이범호가 햄스트링 부상으로 현역 커리어 후반 내내 고생한 가장 대표적인 야구선수이다. KIA 이적 첫 해이자 세는 나이로 31세이던 2011년 이 햄스트링 부상을 당했고, 나이가 들면서 이 부상의 여파로 3루 수비 범위가 좁아지는 문제에 직면하게 되다가 결국 2019 시즌 직전 이 햄스트링이 손상되어 그 해 7월 은퇴하였다. 그래도 시즌을 통째로 날린 2012시즌과 은퇴시즌을 제외하면 대부분 햄스트링을 달면서도 풀시즌을 뛰긴 했다.
2018 FIFA 러시아 월드컵에서 알란 자고예프가 개막전 시작 21분 만에 이 부상을 당했다. 그리고 이날 21분 이후에는 8강전 크로아티아전에서야 연장 전반 교체 투입됐고 경기를 뛰었다(...). 야구도 비슷한 사례로 2008년 베이징 올림픽에서 진갑용이 햄스트링 부상을 입은 채 결승전 9회 포수 수비에 임했다. 물론 강민호의 퇴장으로 인해 어쩔 수 없이 출전했다.
NBA에서는 크리스 폴이 자주 햄스트링 부상을 당하는 것으로 유명하다. 당연 그 부상이 플레이오프 등 중요한 경기도 예외는 아니여서... 일례로 2018년 NBA 플레이오프 서부 컨퍼런스 결승전에서 이 부상을 당하면서 팀의 시리즈 역전패의 원인으로 지목되고 말았다.
Anatomy
Where are the hamstrings, and what do they do?
The hamstrings make up the bulk in back of the thigh. They are formed by three muscles and their tendons. The hamstrings connect to the ischial tuberosity, the small bony projection on the bottom of the pelvis, just below the buttocks. (There is one ischial tuberosity on the left and one on the right.) The hamstring muscles run down the back of the thigh. Their tendons cross the knee joint and connect on each side of the shinbone (tibia).
The hamstrings function by pulling the leg backwa rd and by propelling the body forward while walking or running. This is called hip extension. The hamstrings also bend the knees, a motion called knee flexion.
Most hamstring injuries occur in the musculotendinous complex. This is the area where the muscles and tendons join. (Tendons are bands of tissue that connect muscles to bones.) The hamstring has a large musculotendinous complex, which partly explains why hamstring injuries are so common.
When the hamstring is injured, the fibers of the muscles or tendon are actually torn. The body responds to the damage by producing enzymes and other body chemicals at the site of the injury. These chemicals produce the symptoms of swelling and pain.
In a severe injury, the small blood vessels in the muscle can be torn as well. This results in bleeding into the muscle tissue. Until these small blood vessels can repair themselves, less blood can flow to the area. With this reduced blood flow, the muscles cannot begin to heal.
The chemicals that are produced and the blood clotting are your body's way of healing itself. Your body heals the muscle by rebuilding the muscle tissue and by forming scar tissue. Carefully stretching and exercising your injured muscle helps maximize the building of muscle tissue as you heal.
In rare cases, an injury can cause the muscle and tendons to tear away from the bone. This happens most often where the hamstring tendons attach to the ischial tuberosity. These tears, called avulsions, sometimes require surgery.
Causes
How do hamstring injuries occur?
Hamstring injuries happen when the muscles are stretched too far. Sprinting and other fast or twisting
motions with the legs are the major cause of hamstring injuries. Hamstring injuries most often occur in running, jumping, and kicking sports.
Water skiing, dancing, weight lifting, and ice skating also cause frequent hamstring injuries. These sports are also more likely to cause avulsions.
The major factors in hamstring injuries are low levels of fitness and poor flexibility.
Children very seldom suffer hamstring injuries, probably because they are so flexible. Muscle fatigue and not warming up properly can contribute to hamstring injuries.
Imbalances in the strength of different leg muscles can lead to hamstring injuries. The hamstring muscles of one leg may be much stronger than the other leg, or the quadriceps muscles on the front of the thigh may overpower the hamstrings.
Symptoms
What does a hamstring injury feel like?
Hamstring injuries usually occur during heavy exercise. In especially bad cases, an athlete may suddenly hear a pop and fall to the ground. The athlete may be able to walk with only mild pain even in a severe injury. But taking part in strenuous exercise will be impossible, and the pain will continue.
In less severe cases, athletes notice a tight feeling or a pulling in their hamstring that slows them down. This type of hamstring injury often turns into a long-lasting problem.
The hamstring may be pulled, partially torn, or completely torn. The injury can happen at the musculotendinous junction (mentioned earlier), within the muscle, or where the tendon connects on the ischial tuberosity (avulsion). In the rare case of a complete tear, the pain is excruciating. The torn tissues may form a hard bunch in the back of the thigh when the leg is bent. The skin may also bruise, turning purple from bleeding under the skin. This is not necessarily dangerous but can look somewhat alarming.
Diagnosis
How do health care providers diagnose the condition?
When you visit Peak Performance Physical Therapy, our Physical Therapist will take a detailed medical history that includes questions about your exercise schedule, your activities, and the way you warm up. You will also need to describe your symptoms.
Our Physical Therapist will examine the back of your thigh. The physical exam will involve flexing and extending your leg. The probing and the movement may hurt, but it is important to identify exactly where and when you feel pain.
Hamstring injuries are grouped into three categories, according to the severity. The following images show each grade of injury:
Grade One - Mild
Grade Two - Moderate
Grade Three - Severe
Grade one injuries are muscle pulls that do not result in much damage to the structure of the tissues. Grade two injuries are partial tears. Grade three injuries are complete tears.
Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the Physical Therapists at Peak Performance Physical Therapy have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
Peak Performance Physical Therapy provides services for Physical Therapy in Baton Rouge.
Our Treatment
Non-surgical Rehabilitation
It is very important to treat and rehabilitate your hamstring injury correctly. Incomplete or improper healing makes reinjury much more likely.
Although every patient recovers at a different rate, as a general rule, for minor muscle pulls, you may need two to four weeks to safely get back to your activities. For more severe muscle tears, you may need rehabilitation for two to three months, with complete healing possibly taking four to six months.
When you begin your Physical Therapy program at Peak Performance Physical Therapy, within the first five days after your injury, the main goal of our treatment is to control the swelling, pain, and hemorrhage (bleeding). Hamstring injuries are initially treated using the RICE method. RICE stands for rest, ice, compression, and elevation.
Rest
Rest is critical. Our Physical Therapist may recommend a short period (up to one week) of immobilization. Severe tears may require a longer period of rest. This may mean you spend most of your time lying down. You may need to use crutches to get around. If you put too much weight on your hamstring after an injury, more damage may occur and more scar tissue may form. Our Physical Therapist can help you learn how to properly move about on your crutches.
Ice
We will apply ice to the injured hamstring. This will help to control swelling and pain but doesn't stop it completely. This is important because your body's inflammatory response actually helps your muscles heal. Cold treatments slow the metabolism and blood flow in the area. Cold also reduces your sensations of pain by numbing the nerves. And experiencing less pain helps you relax, reducing muscle spasms.
A plastic bag full of ice cubes or crushed ice, held on with an elastic bandage, is the most effective type of cold treatment. The ice should be kept on the injury for 10 to 15 minutes. You can also use cold gel packs, chipped ice, or cold sprays. We recommend that cold treatments should be repeated at least four times a day for the first two to three days. They can be done as often as every two hours if needed. Do not keep the ice on the skin too long or frostbite may occur.
Compression
Compression can help reduce the bleeding in your muscle to limit swelling and scarring. To apply compression, your Physical Therapist may wrap your hamstring firmly in an elastic bandage. It is unclear exactly how effective compression is in hamstring injuries, but patients often report having less pain with the wrap.
Elevation
Elevation can help reduce swelling. It also keeps your leg immobilized. The key to elevation is to raise and support the injured body part above the level of the heart. In the case of a hamstring injury, this requires lying down and supporting the leg up on pillows.
Medication
Our Physical Therapist may also recommend a short course of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to help relieve the swelling and pain. For muscle injuries, pain relief may be the major benefit of NSAIDs. They do not always treat the swelling of muscle injuries very effectively.
Health care providers disagree on when to give NSAIDs. Some think you should start using them right after the injury and stop using them after three to five days. Others think you should not use them for two to four days so you don't interrupt your body's natural healing response. The inflammation is an important part of your body's work to heal your injury. It is important that you follow your health care provider’s advice.
Stretching & Exercise
As your hamstrings begin to heal, it is critical that you follow your Peak Performance Physical Therapy exercise program to regain your strength and mobility. Our specially designed exercises encourage your body to rebuild muscle instead of scar tissue. The exercises also help prevent reinjury. Rehabilitation can be slow, so you will need to be patient and not push yourself too hard or too fast.
Early in your rehabilitation, our Physical Therapist may recommend that you do some of your exercises in a swimming pool or on a stationary bike set to low resistance. These exercises allow you to take your hamstrings through a range of motion without having to hold up your weight. When you can walk without a limp and feel very little tenderness, we will have you start a walking program. Eventually you can work up to jogging.
Stretching will be a key feature of your Peak Performance Physical Therapy rehabilitation program. Our Physical Therapist will show you how to stretch properly. Plan to continue these stretches even after you heal, because a reinjury of the same hamstring is common. Increasing your flexibility may help you avoid another hamstring injury in the future. It is important that you maintain good flexibility to keep your hamstrings healthy.
We may begin your strengthening exercises with isometric exercises. These exercises involve contracting the muscles without moving your leg joints. As your hamstrings get stronger, we will add light weights. It is important that you feel no pain during these exercises.
You should maintain your general level of fitness throughout your rehabilitation. Our Physical Therapist can suggest workouts that don't stress your hamstrings.
Most hamstring injuries get better with treatment and rehabilitation. Even world-class athletes with severe hamstring injuries are usually able to return to competition. By keeping the hamstrings flexible and giving the body time to heal, you should be able to return to the activities you enjoy.
Post-surgical Rehabilitation
Surgery is rarely needed, and only if there is a complete avulsion or tear. If you do have surgery, you will begin your recovery with a period of rest, which may involve using crutches. Our Physical Therapist can show you how to properly use your crutches to aviod putting too much weight on your healing leg. After surgery our Physical Therapists can start you on a careful and gradual exercise program for your post-surgical rehabilitation.
When your recovery is well under way, regular visits to Peak Performance Physical Therapy will end. Although we will continue to be a resource, you will eventually be in charge of doing your exercises as part of an ongoing home program.
Peak Performance Physical Therapy provides services for Physical Therapy in Baton Rouge.
Surgery
Avulsion Repair
Surgery is rarely needed for hamstring injuries. However, it may be needed for an avulsion to reattach the torn hamstring tendon to the pelvis. If surgery is delayed after an avulsion, the tendon may begin to retract further down the leg, and scar tissue may form around the torn end of the tendon. Both of these factors make it more difficult to do the surgery.
To begin the operation, an incision is made in the skin over the spot where the hamstring tendon normally attaches to the pelvis. The surgeon locates the torn end of the hamstring tendon. Forceps are inserted into the incision to grasp the free end of the torn hamstring tendon. The surgeon pulls on the forceps to get the end of the hamstring back to its normal attachment. The surgeon cuts away scar tissue from the free end of the hamstring tendon.
The original attachment on the pelvis, the ischial tuberosity, is prepared. An instrument called a burr is used to shave off the surface of the tuberosity. Large sutures or staples are used to reattach the end of the hamstring tendon to the pelvis.
When the surgeon is satisfied with the repair, the skin incisions are closed.
Muscle Repair
Surgery may be needed to repair a complete tear of a hamstring muscle. An incision is made over the back of the thigh where the hamstring muscle is torn. The muscle repair involves reattaching the two torn ends and sewing them together.