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Hamstring & Thigh Injuries

Hamstring & Thigh Injuries

The upper leg is formed by the femur (or thigh bone), the heaviest and strongest bone in the body which runs from the hip joint to the knee. The top of the femur forms a rounded head that joins with the hip in a deep and secure joint. The bottom of the thigh bone joins with the tibia and forms the knee joint.

The patella (knee cap) forms a joint with the smooth patellar surface at the bottom of the femur. There are numerous muscles acting on the thigh which control movement at the hip and knee, as well as helping us stand upright against the pull of gravity. At the front of the femur are a group of four muscles collectively known as the quadriceps, they help to straighten the knee for actions such as kicking a ball. 

About the Hamstring & Thigh

At the back of the leg are three muscles which form what we call the hamstring group (named so because butchers use their tendons to hang hams, which are thigh and hip muscles). These muscles act to bend the knee and straighten the leg at the hip joint. On the inside of the upper leg we have the adductor muscles which are referred to as the groin muscles, their function is to bring the thigh back to a central position.

To help stabilise the hip joint there are three ligaments; the ischiofemoral, pubofemoral and the iliofemoral ligament, which is, not only, the strongest of the three but also the strongest in the entire body.

Types of Hamstring & Thigh Injuries

The most common injuries to this part of the body are ligament and muscle strains.

Hamstring Strain: Actions such as running, jumping and lunging involve the use of the hamstring tendons and muscles. Hamstring injuries are common in athletes and sports such as football see many players side lined with hamstring issues. A hamstring injury can be relatively minor with the fibres becoming strained (grade one tear) or the muscle can completely rupture (grade three tear). A grade three tear can cause severe pain and several months out of action.

Thigh Injuries: The most common injury sustained in relation to the thigh are a strained quadriceps, which are the muscles located in the front of the thigh (anterior muscles) and made up of four individual muscles in the Rectus Femoris, Vastus Medius, Vatus Lateralis and Vastus Intermedius. Their main function is to extend the knee (and lower leg) and assist in hip flexion with the muscle being active when the knee joint is bent or in motion. The quadriceps are pivotal when running or lifting and therefore a strain here can have an impact on activity and your overall motion.

Abdominal Strain

Abdominal Strain

Causes

An abdominal muscle strain is common in athletes and people who engage in a lot of heavy lifting as a part of their job, but the injuries can affect anyone. Some people experience abdominal strain injuries when they lift shopping or even just by sitting up suddenly and awkwardly. The injury occurs if the muscle is stretched beyond its normal limits to the point that it becomes torn.

Symptoms

In most cases, abdominal strains occur as a part of an exercise or a traumatic event, so you will know that you have damaged something and the diagnosis should be easy. The symptoms of strained abdominal muscles are usually pain when attempting to perform a sit-up and/or pain when bending backwards or stretching your abdominal muscles.

Diagnosis

If you think you have strained your abdomen and the injury does not get better within a week or two, consult a doctor specialising in sports injuries or a physiotherapist for advice.

Management

If you strain your abdomen, you should rest and compress the affected injury. Many doctors recommend using ice (applied using a bag or wrapped in a towel) to bring down the swelling around the area, but there are some doctors who feel that using ice is not a good idea because ice impairs blood flow and can slow down the healing process. Contact your doctor for advice if you are not sure what you should do.

You should rest the injury for at least two weeks, although some injuries can take one to three months to repair, and you will need to carefully and gradually rehabilitate the muscles during that time.

You can reduce the likelihood of suffering abdominal strains and other injuries by warming up properly before sport and cooling down properly afterwards. You should try to stay hydrated during exercise, and try to eat something that contains some carbohydrates a while before you exercise. If your exercise session is going to last more than an hour, consider using an energy drink instead of water to replenish your energy stores.

You can strengthen you core muscles using a Swiss ball. This will make you more resilient against injury. In addition, you can reduce the chances of suffering a serious injury by paying careful attention to the form with which you perform exercises. Poor form is risky for any exercise, but the risk of injury is more severe with core exercises because if they are not performed correctly, then you could injure not just your abdominal muscles but also your back. It is much better for you to do an exercise slowly, with lower weight, than to try to move through the repetition with a weight that is too heavy for you.

Hamstring Injury

Hamstring Injury

The hamstrings are actually a group of three muscles in the back of the thigh which work together to flex (bend) the knee. The muscle becomes strained when it gets stretched too far, something which is common when an athlete is trying to get the most out of their stride length or a footballer makes a sudden effort to chase a ball down the field. Indeed, any activity that involves a lot of jumping and running or sudden start-stop movements is likely to place the hamstrings under pressure and at risk of hamstring injury.

Hamstring injury is more common if your quadriceps (the muscles at the front of your thigh) are considerably stronger than your hamstrings, you didn’t warm up or stretch before the activity, you’re a teenager experiencing a growth spurt and your muscle strength isn’t keeping pace with the growth of your bones, or your gluts are weak or not engaging properly and your hamstrings are compensating.

Causes

Injury to the hamstrings, which usually occurs in the form of a strain, is both common and painful, and has been known to ruin the season or career of many a world-class athlete. It’s not uncommon to see an athlete to pull up in pain and clutch the back of their thigh during an major sprint final or on the football pitch, as they’ve felt the tell-tale ‘pop’ in their hamstring.

Athletes in all sports, but particularly those in power events such as sprinting and sports such as football and basketball, are at particular risk of hamstring injury. Some precautions can be taken against a pulled hamstring, particularly those that are caused by weak gluteal muscles or inadequate quad-to-hamstring strength ratios, but unfortunately some individuals are more susceptible to injuring this muscle than others. Wearing compression shorts can help in both the prevention and treatment of hamstring injuries.

Symptoms

While mild hamstring strains don’t hurt that much, severe ones can be excruciatingly painful and can make standing or walking impossible. Pain normally comes on suddenly during exercise and is often accompanied by a popping or snapping feeling. Bruising, tenderness and pain in the back of the thigh and lower buttocks when straightening the leg, walking or bending over are other tell-tale signs of a hamstring strain.

Diagnosis

It is always important to obtain a professional diagnosis to understand the extent of the injury (grade 1 to 3).

A physical examination by a physiotherapist could achieve this though an MRI may be required to look at the tear or rupture of the muscle.

Management

Minor hamstring strains often heal on their own, given time. Application of the RICE protocol (rest, ice, compression and elevation) will speed up the healing process. Anti-inflammatory painkillers may help with swelling and pain, but should only be used on the advice of a doctor and as a short-term treatment for pain. The doctor or physiotherapist will prescribe strengthening and stretching exercises to help injured people return to full health and to prevent future injury to the area. The most severe cases of hamstring tears may need surgery.

In summary, hamstring injury, which generally occurs in the form of an acute muscle strain, can be both painful and debilitating. Minor injuries can heal quickly with the application of the RICE protocol and the wearing of compression shorts, but more severe cases may need surgery and specialist treatment.

Hip Arthritis

Hip Arthritis

Hip stiffness and discomfort is commonly caused by hip arthritis and usually starts in middle age.

People with a history of sports injuries can be prone to hip pain, although general wear and tear as a result of sports or work is responsible for most cases of hip arthritis, or osteoarthritis of the hip.

Causes

It is caused by damage to the hyaline cartilage, which covers of the surfaces of the hip ball and socket joint. In severe cases, this can lead to bone rubbing on bone rather than being protected by smooth friction-free cartilage. This can cause small cracks to appear, which the body then tries to repair by creating more bone. Cysts can also form in the bone beneath the surface of the joint and its surfaces may flatten as the body tries to create a larger surface area to cope with natural forces. These cartilage and bone changes can then lead to the ligaments supporting the joint and the capsule around it becoming stretched.

Symptoms

Hip pain is the main symptom of the condition, being felt in the groin and sometimes up into the back and down the thigh. Sufferers may start to limp as the arthritis gets worse and muscles start to waste. Weakness in the gluteal muscles causes the hip to drop with each step, creating what is called a Trendelenburg Gait.

The condition is likely to worsen over time but this does not usually happen in a regular fashion. Instead, sufferers can experience periodic flare-ups, which become increasingly frequent and more intense. The time period between these episodes will shorten until a person has pain all the time, when resting.

Diagnosis

Hip arthritis can be diagnosed with an X-ray that will show if there has been a loss of the joint space in between a pair of bones. Once the condition has been confirmed, there are things you can do during flare ups to minimise hip pain and reduce swelling. These can include taking anti-inflammatory drugs and applying an ice pack for 20-minute periods every two hours.

Management

It is a strange factor of the condition that when it first starts, rest is needed to alleviate the symptoms. In its more advanced stages, however, immobility can actually make the problem worse. This is because the muscles start to waste, meaning that they are providing less stability to the joint. In turn, this increases ligament strain and can cause more pressure on the joint surfaces and more pain.

In very severe cases, a hip replacement operation or surgery to re-surface the joint may be necessary but there are other options before this is required. Try to exercise frequently in order to maintain muscle strength. Invest in a buoyancy belt and try swimming pool exercises, where the water and the belt support your body. Resistance bands are another good option for strengthening muscles. If surgery is necessary, consider wearing compression shorts afterwards. These will reduce vibrations and muscle movements. Thermal shorts and wraps can also be useful in alleviating hip pain.

Hip Bursitis

Hip Bursitis

A bursa is a fluid-filled sac which prevents bones and tendons from rubbing against each other.

Causes

If the bursa becomes traumatised from injury or repetitive strain, it becomes swollen, inflamed and painful. When bursitis occurs in the hip, it is known as Trochanteric Bursitis.

Symptoms

One of the first symptoms of hip bursitis is severe hip pain, coupled with warmth and swelling in the surrounding area. Where the degree of inflammation is more severe, there may be further pain which radiates out from the hip area to encompass parts of the leg. Long-distance runners are particularly prone to this type of injury, but any repetitive motion can increase the risk of bursitis as well as a knock or blow to the upper thigh and hip area.

Diagnosis

A patient with hip bursitis usually complains of hip pain which can be severe enough to prevent sleeping at night, and he or she will usually experience pain or discomfort when walking and when tackling stairs, as these put pressure on the inflamed bursa. A medical practitioner or sports physiotherapist will usually make a diagnosis based on symptoms, but an ultrasound can be used if necessary in order to confirm the diagnosis.

Management

It is extremely important to rest the affected hip as much as possible in the early stages of recovery, as movement places strain on the bursa and creates further inflammation and hip pain. The application of ice packs is recommended to reduce swelling, making sure not to allow ice to come into contact with the skin to avoid the risk of frost burns. The standard advice is to apply ice packs for around twenty minutes every couple of hours at first, in conjunction with painkillers such as paracetamol or anti-inflammatory drugs such as ibuprofen.

Chronic cases of hip bursitis involving hip pain which continues for more than a few weeks may require a corticosteroid injection into the hip. After a further week of recovery, the patient is usually able to begin a rehabilitation programme to return to regular activities. Any further occurrences of hip pain should be taken as the body’s warning to take things more gently for the time being until the injury is fully healed.

Exercises which stretch the hip and thigh can help to rehabilitate the hip joint, and most physiotherapists recommend the use of resistance bands and Swiss balls to build up core strength before embarking on more vigorous exercise. Trying to return to a former exercise programme too soon can delay healing and so should be avoided.

The advice is to take care with any exercise regime, particularly running, which can cause stress to the hip and thigh joints and can lead to hip pain. Increasing the distances run by gentle increments allows the body’s structures to develop appropriate levels of fitness and strength, which helps to prevent injuries from occurring.

Hip Labrum Tear

Hip Labrum Tear

Playing sport puts pressure on all your joints, and you are very lucky to go through an entire sporting lifetime without sustaining some kind of injury.

Causes

Hip injuries are very common, due to the twisting and turning motions required in most sports, with a hip labrum tear one of the more common experienced.

Symptoms

You will usually notice hip pain immediately, at the front of the joint. This is often caused by a acetabular labrum tear, which can usually be identified using a CT or MRI scan. There is now a procedure which can help to fix this problem relatively quickly, with surgeons using an arthroscopic technique. The labrum helps to stabilise your hip, acting as a shock absorber, and injury is often associated with sports such as football and rugby.

Diagnosis

If you are suffering from hip pain you need to speak to your GP who may want to refer you for a scan to confirm the diagnosis. From here you will generally be referred for surgery. This is done under general anaesthetic but as it only takes about an hour you won’t usually need to stay in hospital.

After your surgery, you’ll need to use crutches for a few days to avoid overloading your hips and further hip pain. Then you’ll see a physiotherapist to help you recover your full range of movement. Hydrotherapy pools are often good for hip patients, as they allow you to mobilise your joints without compressing them. Try using a buoyancy belt in the water as this can give you extra support and help to keep your hips mobilised.

Management

Once your hips are mobile again then you need to start work on strengthening them. You will work on getting the affected side back to full strength before returning to your usual exercise programme. It is often a good idea to wear compression shorts after surgery as these can help to support you during your exercises and avoid further injury. You should be back to normal in about three months.

It’s hard to avoid hip labral tear if you regularly play sports. But you can be sensible about the amount of weight bearing exercises you do and try to avoid putting undue pressure on any of your joints. You will need to rest if you have been suffering from hip problems, so don’t try to force yourself back into your usual regime too quickly, as you could run the risk of injuring yourself further.

Physiotherapists will help you to gradually ease yourself back into sport - helping you to get back to optimum levels of fitness and will always give you appropriate exercises to work the affected muscles, helping to remobilise and rehabilitate them. It is important that you listen to expert advice and carry out these exercises properly for them to have the best effect and avoid further hip pain.

IllioPsoas Syndrome

IllioPsoas Syndrome

IllioPsoas syndrome is also known as hip flexor muscle strain or snapping hip syndrome.

Causes

This strain is perhaps the most common cause of pain in the hips of athletes and manual laborers. The IllioPsoas is located deep in front of the hip joint, and is used to flex the hip, for example when kicking a ball.

Symptoms

Hip pain can interfere with a lot of day-to-day activities. If the IllioPsoas, the muscle that attaches the to the thigh bone via the IllioPsoas tendon, becomes irritated or inflamed then you will experience difficulty moving the leg. You may also notice some stiffness, or hear clicking and popping when you move your legs. Pain is common when stretching the hip flexor, lifting the knee, or attempting to kick. The pain may be mild at first, but worsen with heavy use and take a long time to subside after exercise.

Diagnosis

Illiopsoas syndrome does not always occur after a traumatic event. In many cases it is an over-use injury, and something that develops slowly over time, starting as an occasional click or feeling of tightness and gradually becoming more severe. If you experience chronic pain in your hips, or find that pain flares up after exercise, the first thing that you should do is stop using the affected joint, and contact a sports injury expert. Resist the urge to 'train through pain'. This kind of bravado will not do you any good. It will just aggravate the injury and could cause even more damage.

Management

If your sports injury specialist gives you the go-ahead, you can try to strengthen the affected joint with resistance bands. These are ideal because they allow you to work at your own pace and employ variable levels of resistance in a way that is safer than using weights. You can also use stabiliser pressure devices and biofeedback devices to ensure that your technique is correct. Many people find that wearing compression shorts protects their hips and reduces their risk of suffering from a serious injury. Warming up properly and using dynamic stretching can help to reduce injury risks too.

Hip pain is something that can be quite frustrating because it affects not just exercise but also day to day life. If your hip pain is severe or long-lasting then you may need to see a physiotherapist, get steroid injections, or potentially have surgery. Being pro-active about exercise and rehabilitation after you notice the injury for the first time is important. You may be forced to take a few weeks off from training to repair your hips, but it is better to take a break of a few weeks today, rather than be forced out for months while you await surgery.

Osteitis Pubis (Pubalgia)

Osteitis Pubis (Pubalgia)

Osteitis Pubis, or instability of the Pubis Symphysis, is an injury affecting the pelvis.

Causes

Resulting from overuse, it is a common side effect of activities such as dancing and ice skating and those that involve a kicking action. Over time, repeated movements can cause micro trauma to the Pubic Symphysis bone. Eventually, there may be an inflammatory response, erosion of the joint and slow healing. Those most at risk of developing Osteitis Pubis are pregnant women and those with rheumatological issues.

Symptoms

Those with Osteitis Pubis often feel pain during and following activity. The tenderness felt around the Pubic Symphysis typically radiates into the groin or up into the abdomen. The pain can be difficult to localise, as it moves around the pelvic area and may include hip pain.

Diagnosis

Persistent groin or hip pain should be fully investigated by a GP to eliminate the chance of other more serious conditions. Once this has happened, Osteitis Pubis can be diagnosed with investigations such as x-rays and MRI scans. Occasionally, an MRI might reveal the presence of asymptomatic Osteitis Pubis, especially among athletes.

Management

Unfortunately, Osteitis Pubis can be problematic for between six months and two years. Treatment is not always effective. Therefore focus tends to be on preventative measures, such as avoiding overtraining or activities that involve repetitive kicking movements.

When symptoms are very acute, treatment can be limited. Rest is recommended in the first instance to allow the inflammation in the tissues to heal.

Non-Steroidal Anti Inflammatory Drugs (NSAIDs): May be effective for those with a degree of affected tissue, although these will have no effect on bone damage. A pneumatology consultant may prescribe biphosphates if the patient is suspected of having brittle bones (osteoporosis). These work by binding to the surface of the bone, slowing down bone erosion and allowing for more effective bone development.

Corticosteroids: Sometimes considered if there is no resolution after a period of rest. After one of two injections, patients are often able to return to previous activities. A programme of exercises may be recommended to stretch the pelvic muscles, usually once any groin or hip pain has resolved.

Surgery: Rarely advocated. However, in cases where the condition has not responded to less invasive treatment within a year, or if the Pubic Symphysis is found to have a mechanical instability, it may be an option. Joint stability is restored with a plate and screws. The patient will usually be required to use crutches for a few weeks following the surgery and will not be able to return to sporting activities for about three months.

Prevention: Core strength and stability exercises are a good way to ensure good muscle function and improved stability across the pelvic area. This can help counteract the effect of any large forces applied and decrease the chances of Osteitis Pubis developing. Overtraining is also best avoided, especially where activities involve repetitive kicking movements. A proper warm-up and warm-down should be performed before and after sporting activity.

Care should be taken to investigate any onset of pelvic or hip pain to ensure early treatment and damage limitation where necessary.

Thigh Muscle Strain

Thigh Muscle Strain

When a tear occurs in a quadriceps muscle it can be classified as first, second or third degree thigh muscle strain, depending on its severity.

Causes

This type of strain is very common in those who enjoy sporting activities and often occurs when playing football or similar sports where the kicking action is repeated regularly. When the quadriceps muscles are strained, the muscles in front of the thigh that are responsible for straightening of the knee will be affected.

Symptoms

Common signs and symptoms include pain the thigh muscle, swelling, stiffness, weakness and instability and locking of the leg, all of which can cause minor or major discomfort. The severity of a muscle thigh strain will dictate the type of treatment required, and it can be as simple as the patient wearing a thigh support or brace, or serious enough to require surgery.

Diagnosis

With thigh strain that is categorised as grade one, the signs of injury may not appear initially and will only show up once the physical activity engaged in has come to an end. With this degree of strain there may only be a slight twinge of pain if the leg is moved to and fro, or the sensation of tightness or a cramp in the muscle may be evident.

Grade two strains are characterised by a much more severe, immediate pain, and walking will be extremely uncomfortable. A grade two strain is confirmed by muscle pain on contraction or stretch and is generally rather sore if touched.

A grade three strain is a serious injury in which there is a pulled muscle in the thigh and it completely ruptures. A patient who suffers from a grade three strain will feel an instant stabbing pain or a burning sensation that will make it almost impossible to walk. A depression and a lump may be evident in the thigh at the location of the tear, and both grade two and three injuries will have bruising.

Management

Treatment for this type of muscular injury should follow the RICE protocol, with the abbreviation standing for Rest, Ice, Compression and Elevation. Grade one injury suffers should rest for at least three weeks, grade two injuries between 4-6 weeks, and when a complete rupture occurs, such as in grade three injuries, surgery may be required and a minimum three month rest period advised. No sporting activity should be undertaken during this rest period and physiotherapy or rehabilitation may be necessary.

Recovery after a thigh muscle strain may be slow and it is essential that the patient rest their leg and allow for proper healing. A thigh support or brace may be worn to help aid this process and to protect the muscle from further strain. Thigh strain can range from being a minor inconvenience to completely debilitating and those who are active must ensure they look after the torn muscle or the injury can worsen or reoccur in the future.

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