HAMSTRING INJURY ??? TAE KWON DO

Abstract

HISTORY A 14-year old male competitive Tae Kwon Do participant presented with right buttock and posterior thigh pain for over 1 year. He recalled the onset of pain following a high fast kick with his right leg. The coach and athlete attributed the pain to a pulled hamstring and treated it with ice and rest with some relief. After approximately 10 months of the pain he took 2 weeks off from Tae Kwon Do. The pain returned immediately upon returning to Tae Kwon Do. He received 24 sessions of intense physical therapy. The pain was elicited with high kicks and aggressive flexion of the right lower extremity. The pain was fairly constant during Tae Kwon Do practice. No radiation of pain to his lower extremities. No pain with sitting, standing or walking. No paresthesia or weakness. PHYSICAL EXAM Normal gait. Tenderness over the right ischial tuberosity. Pain with active and passive elevation of the right lower extremity to approximately 45 degrees while lying supine. Pain on resisted extension of right hip. There was no tenderness over the pyriformis. Hips range of motion was normal. Slump test was negative. Lower extremities: motor, sensory, and DTR's were normal. No muscle atrophy. L/S spine was normal. DIFFERENTIAL DIAGNOSIS Pyriformis syndrome. Referred pain from lumbo-sacral spine. Stress fracture of the ischium or pubic ramus. Ischial tubersoity avulsion. Compartment syndrome of the posterior thigh. Ischio-gluteal bursitis. Hamstring strain. TESTS AND RESULTS Plain film of pelvis: Normal MRI of pelvis and right hip: -traction type erosion along the lateral aspect of the ischial tuberosity at the origin of the semimembranosus -non retracted undersurface tear with its epicenter at the lateral margin of the ischial tuberosity. FINAL/WORKING DIAGNOSIS Right hamstring tear at is origin. TREATMENT AND OUTCOMES Specific therapeutic exercise regimen. Specific modification of activities. Deep friction massage.