**12. Gastrocnemius tear**

Some times in the clinical history we have reports of previous ruptures that left an obvious muscle deformity (such a depression in the rectus femoris), but from the functional point of view the athlete's performance is unaffected even although the defect could be very large and

The hamstring muscles are located on the back of the thigh and function to flex the knee and extend the hip. These muscles form the back and inside out of the thigh (semitendinosus, semimembranosus and biceps femoris (long and short head) the latter being the outermost of

When this group of muscles are injured, the athlete reports having felt a "pull" especially when they are doing explosive exercises, and so the athlete stops and suspends all activity immedi‐

There are hamstrings injuries that can occur in a slow and chronic manner, so the symptoms are vague and can be confused with pain in the lower back; not all injuries to this muscle group

The causes of this injury can be very marked imbalance quadriceps strength (muscle imbal‐ ance), also often are due to lack of elasticity or warm-up previous to ballistic sports activity [10]. When this injury occurs, pain is widespread, edema occurs quickly and the patient is unable to stand or walk on the injured leg. Moreover, in the course of a few hours a hematoma is

On physical examination (with the patient lying prone) pain in the area of the tear is provoked by palpation and the patient cannot perform an isometric knee flexion or hip extension nor

**Figure 19.** a) With the patient facing down ask to rise the affected leg as high as he can; b) With the knee flex at 90°

When the examiner bends the knee of the affected leg (to relax the hamstrings) palpation of the entire length of the hamstrings can locate the site and of the muscle injury (figure 19b).

(a) (b)

)

present, which can be displaced by gravity towards the back of the knee.

can the athlete perform hip extension (figure 19a).

palpate al the hamstring muscle to locate the exact spot of the muscle injury

might even need surgery, [8].

**11. Hamstring**

150 Muscle Injuries in Sport Medicine

these muscles).

are acute, [9].

ately.

These muscles are the gastrocnemius (medial and lateral head), and soleus and all combine to form the Achilles tendon. Their function is to help flex the knee and the foot (plantar flexion) and also the supination of the foot. Injuries in the calf are often due to lack of adequate warm up, stretching, or by overexertion when the muscle is already fatigued.

Generally speaking, the injury usually occurs acutely and patients say it feels as if someone had stuck in the back of the leg, yet when they turn around nobody is behind them, [11].

Pain is present immediately and the athlete can no longer stand and may have to be removed from the field on a stretcher. On physical examination, the prone patient is examined and the site of injury can be determined by palpation; edema is not always present (figure 20).

**Figure 20.** The gastrocnemius with patient prone is palpate all along

With the athlete still lying prone, the knee is flexed to 90°. Pain is triggered when the athlete is asked to perform plantar flexion.

A complication of this condition is when the Achilles tendon ruptures; it is very important to rule out this complication. With the patient in a sitting position, compress the muscles (figure 21) to make the toes goes directly downward (Thompson sign). If this movement does not occur, the tendon could be completely torn and surgical treatment may be necessary.

Standing on the toes causes too much pain and the patient is unable to apply equal force by both legs to remain standing (figure 22).

**Author details**

Francisco Arroyo\*

**References**

Medical Director, Sport Med. FIFA Medical Clinic of Excellence Guadalajara, Mexico

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**Figure 21.** Thompson´s sign. With the knee flex at 90° squeeze the gastrocnemius muscle to provoke a tip toe of the foot

**Figure 22.** Standing on a tip toe position is painful
