■ ■ ■ Description

Hamstring syndrome is a rare nerve condition in the hip that causes pain and occasionally loss of feeling in the back of the thigh, often to the bottom of the foot. It involves compression of the sciatic nerve at the hip by a band of ligament-like (fibrous) tissue between two of the three hamstring muscles or between the muscle and bone of the pelvis. The hamstrings are three muscles that go from the pelvis or upper thigh across the back of the knee to the leg. This muscle group is important for bending the knee, straightening the hip, and stabilizing the knee. It is also important for running and jumping. The sciatic nerve usually passes near these muscles, and the pelvis then runs under these muscles in the thigh.

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■ ■ ■ Common Signs and Symptoms

• Tingling, numbness, or burning in the back of the thigh to the back of the knee and occasionally to the bottom of the foot

• Tenderness in the buttock

• Pain and discomfort (burning or dull ache) in the hip or groin, mid-buttock area, the back of the thigh, and sometimes to the knee

• Heaviness or fatigue in the leg

• Pain that is worse with sitting, running fast, kicking, or trying to stretch the hamstring muscles

• Pain that is lessened by laying flat on the back

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■ ■ ■ Causes

Pressure on the sciatic nerve at the hip by a fibrous band from the hamstring to bone in the pelvis or other hamstring muscles

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■ ■ ■ Risk Increases With

• Sports that require jumping, sprinting, hurdling, or sitting; also, more commonly seen in soccer players and football kickers

• Recurrent hamstring muscle strains

• Poor physical conditioning (strength and flexibility)

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning:

  • Hip flexibility

  • Muscle strength and endurance

  • Cardiovascular fitness

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■ ■ ■ Expected Outcome

This condition is usually curable with appropriate treatment  or sometimes spontaneously within 2 to 6 weeks. Uncommonly, surgery is necessary.

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■ ■ ■ Possible Complications

• Permanent numbness in the affected knee, leg, and foot

• Persistent pain in the knee, leg, and foot

• Increasing weakness of the extremity

• Disability and inability to compete

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■ ■ ■ General Treatment Considerations

Initial treatment consists of rest from the offending activity and nonsteroidal anti inflammatory medications to help reduce inflammation and pain. Stretching exercises of the hamstring muscles are useful. Referral to physical therapy or an athletic

trainer may be recommended for further treatment, including ultrasound and other therapies. Injections with cortisone,

often with numbing medicine, to the area where the nerve is being pinched may be recommended to help reduce the nerve inflammation and pinching. If this conservative treatment is not successful, surgery may be necessary to free the pinched nerve by cutting the fibrous band where the nerve is being pinched. Surgery is uncommonly necessary but does provide almost complete relief in most patients who undergo this operation.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers may be prescribed as necessary by your physician, usually only after surgery. Use only as directed and only as much as you need.

• Injections of corticosteroids may be given to reduce inflammation.

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■ ■ ■ Heat and Cold

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 weeks despite treatment

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)

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