Tearing of the ischiocrural muscles

Ischiocrural muscles: anatomy and tears

The ischiocruralis are three muscles located in the posterior region of the thigh called respectively: semimebranosus, semitendinosus, biceps femoris. These three muscles share: origin (ischial tuberosity), innervation (tibial nerve), biarticularity and function (leg flexor and extensor of the thigh).

Stretches and tears of the ischiocrural are caused by intense or too abrupt contractions during knee flexion or hip extension. For these reasons the tears of the ischiocrural muscles are common above all in the centometrists, in long jumpers, in middle-distance runners, in tennis players and athletes of other disciplines characterized by sudden jerks, strong decelerations (eccentric work) and abrupt changes of rhythm.

Causes

To generate movement the various muscles or muscle groups work in sync: when a muscle shortens, the muscle with the opposite function must relax stretching out so as not to impede movement. When we kick (extend the leg) the quadriceps muscle contracts and the ischiocruralus lengthen. The same thing happens when we bring our thigh closer to the abdomen.

When instead we bend the knee (flexion) by bringing the heels closer to the pelvis the ischiocrural muscles contract and the quadriceps relaxes. In many athletes there is a certain imbalance of strength between the ischiocrural muscles and the quadriceps in favor of the latter. Because of this imbalance the ischiocrural muscles tend to get tired early with respect to the quadriceps. In a fatigued muscle, the Golgi tendon organs and the neuromuscular spindles can become ineffective in preventing its excessive elongation (stretching / tearing of the ischiocruralis) following the contraction of the quadriceps. This alteration can also prevent the muscle from becoming too short by subjecting its fibers to excessive contractions and by predisposing the muscle to localized tears especially where the muscle fibers merge with the tendon ones (musculotendinous passage).

Symptoms

The tearing of the ischiocrural muscles is responsible for a violent and sharp pain that occurs in the back of the thigh immediately after the trauma. Other typical symptoms are: pain on palpation, hematoma and tactile perception of a step in the back of the thigh near the injured area (in case of severe injury).

Muscle tears can be classified using a gravity scale consisting of three stages. The first level includes the less severe tears that cause only modest muscle breaks (less than 5% of the fibers). Partial or complete tears of the muscle are instead classified respectively as second and third degree tears.

The symptoms are obviously more serious the greater the number of injured muscle fibers. First degree injuries, for example, are almost imperceptible and, apart from a slight local hypertonia (muscle contracture) normally do not cause swelling or significant movement limitations. If, on the other hand, one of the three ischiocrural muscles suffers a second degree tear, the lesion interferes with normal walking, causes pain on palpation, knee flexion movement against resistance and in the last degrees of knee extension. In third degree muscle tears, the athlete often hears a noise similar to a snap at the moment of injury. In these cases the pain is particularly intense and the athlete, who immediately collapses to the ground, is forced to walk with the aid of crutches.

An MRI allows in any case to determine the true extent of the lesion.

Treatment

In the acute phase of the trauma (first two or three days) apply the RICE protocol (rest, elevation, compression, ice). Anti-inflammatory drugs can be useful in this first phase to reduce pain and inflammation.

After three or five days, as soon as the load pain and swelling decrease, it is important to start a program of strengthening and stretching exercises. The strengthening of ischiocruralis is in fact necessary to prevent the chronicization of the lesions. However, it is important to gradually increase the intensity of these exercises: in the initial phase, for example, it is necessary to work with moderate loads and a high number of repetitions; in this way the local blood supply, oxygen and nutrients will be favored, facilitating the regeneration process and limiting the formation of scar tissue. Among the most useful physical therapies we mention ultrasounds and tercar therapy.

Prevention

• always perform a general and specific warm-up of the muscles
• make sure you are in the right physical condition to withstand the effort
• carefully assess the practicability of the pitch
• choose suitable clothing, cover well in the winter months and, if necessary, use specific creams during the heating phase
• always perform stretching exercises to improve muscle elasticity and flexibility both in the preparatory and anti-fatigue phases