Anatomy
The 3 large thigh muscles (hamstrings, hamstrings) have muscle attachments on the ischial tuberosity (tuber ischiadicum), where in children and adolescents there is a growth zone (apophysis). The hamstrings bend the knee and extend the hip.
The hamstring muscles include the semitendinosus and biceps femoris (which attach to the conjoin tendon on the sit bones) and the semimembranosus, which attaches to the same place. See foto
A. Bursa trochanterica m. glutei maximi
B. M. gluteus maximus
C. M. biceps femoris (caput longum)
D. M. semitendinosus
E. M. semimembranosus
F. M. adductor magnus
G. M. gracilis
H. M. quadratus femoris
I. Bursa ischiadica m. glutei maximi
Cause
With repeated, uniform (over)loads (running, sprinting), the hamstring tendons overload the growth zone at the ischial tuberosity (tuber ischiadicum), causing an irritation condition with ‘inflammation’ in the growth zone (apophysitis).
The condition is typically seen in athletically active 11-15 year olds. In rare cases, a single violent impact can cause a piece of the sit bone to tear off in the growth zone (Calderazzi F, et l. 2018).
Training load should be reduced during periods of rapid growth (measure the height of young athletes every 3 months). Training should generally be varied and avoid repetitive movements. Alternate between different exercises over time to reduce strain. Quality of training is more important than quantity.
Symptoms
The pain in the growth zone of the ischial tuberosity can sometimes extend to the back of the thigh. The pain is aggravated by pressure on the ischial tuberosity (e.g. sitting), running (sprinting), stretching and activation of the hamstring muscles (bending the knee against resistance).
Apophysitis can last from a few weeks to months and years. Prolonged courses are particularly common in young people who exercise a lot and do not respond to the pain with relief from the pain-inducing activity.
Examination
Diagnosis is usually made through a general clinical examination, where the known pain can be caused by pressure on the ischial tuberosity and activation of the gluteal muscles. However, the severity of soreness is not always a measure of the extent of the injury. For more pronounced tenderness or sudden onset of pain, a medical examination is recommended to ensure proper diagnosis and treatment.
If there is any doubt about the diagnosis, an ultrasound scan and possibly an MRI scan can be performed, especially in cases of sudden onset of severe pain and suspected tears (X-rays often miss tears).
Treatment
Treatment includes relief, stretching and rehabilitation within the pain threshold. The sooner treatment is started, the sooner the symptoms subside.
It is important that the athlete, parents and coach are informed, understand and respect the need for load management during the rehabilitation period in order to avoid long-term injuries that can last six months to a year (Longo UG. et al., 2016 ).
In some cases with significant (> 1,5 cm) tearing of a piece of the sitting bone in the growth zone, it may be necessary to surgically reattach the torn piece of bone, while cases with modest tearing are usually treated with weight bearing and gentle rehabilitation (Calderazzi F, et l. 2018).
Complications
If the progress is not smooth, you should consider whether the diagnosis is correct or if there are complications.
In particular, the following should be considered:
