Nagging Hamstring? Carpentry vs. “The Electrical”

by Chris Centeno, MD /

nagging hamstring

I had the honor a while back of taking one of my sons to a college football rivalry game at my alma mater. It was a great game despite one of our star players suffering from a nagging hamstring problem (but he still broke 200 yards of rushing)! As I walked back to our hotel at midnight with my son, I thought about reaching out to the team surgeon to help. More importantly, I thought about how the innate differences between the surgical approach (carpentry) and the neurologic approach (wiring) in conceptualizing what’s wrong with this player’s hamstring might make that interaction challenging. Let me explain.

Our musculoskeletal systems are made up of bone, joints, ligaments, and muscles (the structural parts). However, all too often physicians also forget they’re made up of nerves (the wiring) that tell the muscles how to move the other parts. In fact, it’s even more complex than that because there are millions of tiny sensors in every muscle that feed information back along the wiring to the spinal cord and brain to fine tune movement. Orthopedic surgery, and hence much of modern sports medicine, is very focused on the structure and like medical carpentry, does a great job of cobbling the broken parts back together using increasingly sophisticated techniques. However, what happens when what’s causing the structural problem is likely due to the wiring? This is in essence a problem for the electrician, but when the carpenter is looking at the problem, it’s often missed.

The hamstring is a complex of muscles in the back of your thigh that bend your knee, pull the knee meniscus out of the way, and fine tune the rotation of your tibia leg bone on the femur thigh bone. Tears in the muscle as a result of sports are common and can end or nag an athlete’s entire career. Because of new technologies like platelet rich plasma and stem cell injections using precise imaging guidance (interventional orthopedics), the number of surgeries being performed for these problems is dramatically decreasing. However, many times there’s another dimension to the problem that’s missed. This is often a low level irritation of the spinal nerve (usually S1) that goes to the hamstring muscle and causes the tendon to degenerate because of lack of nutrients to the area as well as the inefficient contraction of the structure which causes it to yank on it’s attachments. In our clinical experience, identifying and treating this last part can make the difference between a successful and failed treatment. Again, in essence, understanding that the structure (carpentry) can be dictated by the complex wiring.

The trainers at my alma mater did a great job with this player’s hamstring injury. However, you could see that despite this athlete’s stellar performance, he wasn’t anywhere near 100% as he went out midway through the game so the trainers could work on him on the sidelines. Some of the things the trainers were doing were wiring related treatments like contract-relax holds. These exploit the feedback from the tiny sensors in the muscle tendons to tell the wiring to release the tight muscle. However, when a hamstring injury meets a carpenter’s mindset, the focus is all too often only on the structure of the muscle tear. The surgeon carpenter often ignores the electrical issues that may have caused and facilitated the injury. In this case, the irritated nerve in the low back (which may not be causing any low back pain per se) that needs to be treated. In the case of our injured player who has a tremendous NFL career ahead of him, taking a close look at the wiring is essential for his future. If these issues are found, what can be done? We’ve successfully treated many of these hamstrings tears without surgery by both precisely injecting PRP or stem cells into the tear and using the patient’s own growth factors injected around the irritated nerve in the low back.

The upshot? A hamstring muscle tear or any muscle or tendon tear always needs to be viewed as the whole machine, which includes the structure and the wiring. If a part in your car engine went bad, the first thing a modern mechanic does is to hook it up to the diagnostic systems that check the wiring and the many sensors and computers in the engine. If a problem is found, fixing the wiring is as important as fixing the part. However, what if your mechanic ignored the wiring? In many ways, that’s what happens in today’s modern orthopedic sports surgery world. For this young player or for any weekend warrior, a hamstring tear often has more to it than just the structural issue – it usually involves some faulty wiring that caused the tear in the first place!

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
View Profile

Get Blog Updates by Email

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Providers Near Ashburn, VA

Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
Learn More
Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
Learn More
Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
Learn More
Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
Learn More
Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
Learn More

Is Regenexx Right For You?

Request a free Regenexx Info Packet

REGENEXX WEBINARS

Learn about the #1 Stem Cell & Platelet Procedures for treating arthritis, common joint injuries & spine pain.

Join a Webinar

RECEIVE BLOG ARTICLES BY EMAIL

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Subscribe to the Blog

FOLLOW US

Copyright © Regenexx 2019. All rights reserved. | Privacy Policy

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.