Hamstring Sprain / Tendinopathy
Hamstrings are a group of muscles present at the back of thigh. They extend from the sit bones in pelvis to just below the knee joint and play an important an important role is daily activities such as walking & running. The names of the individual three muscles included in hamstrings are semimembranosus, biceps femoris and the semitendinosus. These, work in opposition to the muscles in the front of the thigh (quadriceps) and the two group of muscles together stabilize movements of the knee and pelvis.

INCIDENCE
Hamstring injuries account for approximately 12–16% of all injuries in athletes. They are seen more commonly in sports that involve sprinting, acceleration, deceleration, rapid change in direction and jumping such as football, basketball, rugby and baseball. Runners, ballet dancers and older adults who do a lot of walking are also at increased risk. Reinjury rates are high and generally require more time away from the field. Although any injury for a sportsperson is painful, this one can be quite frustrating for both the sufferer and the treating physician.

SYMPTOMS
Symptoms vary depending on the severity of the problem. When the upper part of hamstrings is involved the most common symptom is deep buttock pain or irritation at the back of thigh (minor sprains) associated with tightness or cramping sensation. Pain can radiate down the back of thigh and is generally aggravated by physical activity such as walking, running uphill, high speed or long distance running, leaning forwards, squats and sitting on a firm surface for long duration. Morning increase in severity of pain is not uncommon in this condition. In the early stages pain may reduce after warm up and then recur after activity. This changes with time with the pain persisting throughout the day.

Partial or complete tear of hamstrings may present with severe stabbing pain, bruising with inability to weight bear or walk. Sciatic nerve is present close by and its irritation can cause pain to radiate further down the leg. In severe cases the tendon may completely tear away, often taking a piece of bone with it and this is addressed as avulsion injury.

RISK FACTORS & BIOMECHANICS
Muscle attaches to the bone with the help of a special type of tissue called tendon. To simplify, you can look at these as ropes tying the muscles to the bones. Injuries can involve the muscles or the area where the muscle transforms into the tendon (myotendinous junction) or the tendon itself. Generally the closer the injury is to the pelvis / sit bones the longer it takes to heal. Of the three muscles, biceps femoris is the most commonly injured one.

The hamstrings cross two joints and help to bend the knee and move the hip backwards (extension). They play an important role in propelling the body forwards as we move. Hamstring injury may occur by high speed mechanisms such as running or low speed mechanisms such as stretching. Sudden loading of muscle while it is stretched as while kicking a football is also a common injury mechanism.

The risk factors most consistently associated with hamstring muscle strain-type injuries are age, previous hamstring injury and quadriceps peak torque. As mentioned previously hamstrings and quadriceps oppose each another and it is not uncommon to see imbalance between the two groups of muscles with the latter being stronger. This is expressed as low hamstring to quad ratio which essentially means weaker hamstrings. Weak hamstrings can quickly turn into tight hamstrings and require hamstring to work harder which tires them easily. Tight, tired and weak muscles are predisposed to injuries. When the hamstring are injured, other nearby body muscles are called into action such as those in lower back and hip predisposing them also to injuries/ pain.

Risk factors foe hamstring injury can be classifies into modifiable and non-modifiable ones.

Modifiable risk factors

Volume of training and rapid variations
Muscle fatigue
Weak hamstrings
Repeated overloading with insufficient warm-up
Over striding during running or abruptly changing direction
Lower back, core and pelvis weakness or trunk instability
Prolonged sitting (work, cycling etc)
Biomechanical issues such as unequal leg length
Non-Modifiable risk factors

Previous hamstring injuries – most consistent risk factor with two to six times increased risk of recurrence. Most repeat injuries occur within two months of return to the sport but the risk remains elevated up to three times for an year after initial injury.
Age – teens and young adults are more likely to experience hamstring injuries as muscles do not tend to grow at the same speed as bones. Aging adults are also at a higher risk possibly due to reduced muscle cross-sectional area.
Genetics (collagen types)
HAMSTRING INJURY GRADES
Most hamstring injuries occur in the thick, central part of the muscle or where the muscle fibres join tendon. Muscle strains are graded from 1 to 3 depending on their severity

Grade 1 – or hamstring pull is most minor form and usually heals readily. Most patients with this are able to walk easily although may notice pain at the back of the leg after prolonged or quick walking.

Grade 2 – this is associated with more pain (often shooting type) and patients may struggle to walk / limp.

Grade 3 – represents more marked muscle tears including complete tears which present with more severe pain, swelling and difficulty weight bearing. These may require several months of rehabilitation.

Neck Pain Treatment in Gurgaon
Neck Pain is a pain posteriorly anywhere between the skull base and thoracic spine. It is the largest cause of musculoskeletal disability after low back pain. Approximately two-thirds of the population will suffer from neck pain at some time in their life with high prevalence in middle ages. Fortunately for most people the acute pain resolves within days or weeks although in some it may reoccur or become chronic.

Neck pain may be a result of...

Local pathology
Whiplash (flexion-extension) injuries/ trauma
Be a part of a more widespread systemic problem such as ankylosing spondylitis, rheumatoid arthritis, fibromyalgia etc.
Be a result of referred pain from neighboring areas for example the shoulder joint

Neck pain usually has a multifactorial etiology -poor posture, neck strain/injuries, anxiety, depression and stress can play a role in magnifying the perceived pain. Quite often the diagnosis of simple or nonspecific neck pain is used implying postural and mechanical causes; this is contrary to other serious causes of neck pain such as fracture, tumour, infection etc.

Pain from upper neck can radiate towards the head leading to frequent headaches and that from the lower part of the neck can radiate to the shoulder, arm, chest wall and the scapula. Reduced neck movement along with localized areas of muscle tenderness known as trigger points are commonly observed along with pain.

Chronic Headache Pain Treatment in Delhi

Headache is a common problem. Fortunately a significant proportion of headaches can be managed by commonly used painkillers. In certain types of headaches prophylactic agents are used to reduce the frequency of attacks. However, there still remains a subgroup of patients with difficult to manage headaches despite all measures. For this subgroup pain clinic offers interventions and multi-disciplinary input, over and above the traditional approach of using painkillers. Multi-disciplinary approach helps in addressing concomitant magnifiers/ triggers such as anxiety, depression, altered sleep cycle, medication overuse, life style and poor posture.

In clinical practice, an overwhelming majority of headaches are either a tension-type headache, migraine, cluster headache or medication overused headache. Extra cranial sources of headaches such as nerves, joints and muscles can be easily missed. The term Cervicogenic Headaches is used for headaches originating from cervical spine pathology or surrounding soft tissues. Examples include neck facet or Atlantoaxial joint pathology, headaches secondary to third occipital nerve, supraorbital neuralgia, and occipital neuralgia, sternocleidomastoid and trapezius muscle spasms. These types of headaches may be accompanied by neck pain, stiffness and are commonly undertreated.

Facet Joint Injections & Radiofrequency ablation
Headaches originating from facet joints are more commonly observed in the elderly and after whiplash injury (flexion/extension injuries). Clinical diagnosis is often difficult as the features overlap with other types of headaches. Diagnostic injections can help identify the pain generators in such cases. Pain originating from these joints can be felt in the base of the skull, neck, upper back, mid-back and shoulders. Please follow the link to Facet joint injections to find out more on this treatment.

Third Occipital Nerve Block and Radiofrequency
The third occipital nerve originates from the cervical spine and supplies sensation to a joint in the neck (C2-3 zygapophyseal joint) and a small area at the back of head. This nerve or the joint it supplies can be a source of headaches localised to the back of head on one side. Sometimes the headache can spread towards the top of the head. This occurs more commonly after whiplash injury.

A diagnostic block involving injection of local anaesthetic close to the nerve can help determine if this nerve is the source of your headache. This is performed under x ray guidance. If the diagnostic test is positive then radiofrequency ablation of the nerve can provide long lasting relief.