What is the treatment for contracture of the ischiogastrocnemius (ischiogambieri) muscles, also known as hamstring contracture?

From the Guidelines

The most effective treatment for contracture of the ischiogastrocnemius muscles involves a combination of rest, physical therapy, and gradual stretching exercises, with a focus on preventing further contracture and promoting recovery, as recommended by the American Heart Association/American Stroke Association guidelines 1.

Treatment Approach

The treatment approach for hamstring contracture should prioritize early intervention to prevent further complications and promote recovery. This can be achieved through:

• Rest and avoidance of activities that exacerbate the condition
• Physical therapy focusing on gentle stretching exercises, holding each stretch for 30 seconds and repeating 3-5 times, as well as strengthening exercises to improve muscle strength and flexibility
• Use of over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) to manage pain and inflammation
• Application of ice to the affected area for 15-20 minutes every 2-3 hours during the first 48-72 hours, followed by heat therapy to promote relaxation and reduce muscle spasms

Prevention Strategies

Prevention strategies are crucial in managing hamstring contractures, including:

• Proper warm-up before exercise
• Maintaining good flexibility through regular stretching
• Avoiding sudden increases in exercise intensity
• Regular massage therapy and foam rolling to release muscle tension

Management of Spasticity

In cases where spasticity is a contributing factor to hamstring contracture, management strategies may include:

• Positioning, passive stretching, and range of motion exercise to provide relief, as recommended by the American Heart Association/American Stroke Association guidelines 1
• Use of oral medications such as tizanidine, baclofen, or dantrolene, as discussed in the management of adult stroke rehabilitation care guideline 1
• Consideration of surgical correction or other invasive modalities in severe cases, as recommended by the American Heart Association/American Stroke Association guidelines 1

Consultation with a Healthcare Provider

If symptoms persist beyond 2-3 weeks despite home treatment, consultation with a healthcare provider is recommended to determine the best course of treatment and prevent further complications, as emphasized in the management of adult stroke rehabilitation care guideline 1.

From the FDA Drug Label

Tizanidine’s capacity to reduce increased muscle tone associated with spasticity was demonstrated in two adequate and well controlled studies in patients with multiple sclerosis or spinal cord injury.

Response was assessed by physical examination; muscle tone was rated on a 5 point scale (Ashworth score), with a score of 0 used to describe normal muscle tone A score of 1 indicated a slight spastic catch while a score of 2 indicated more marked muscle resistance. A score of 3 was used to describe considerable increase in tone, making passive movement difficult. A muscle immobilized by spasticity was given a score of 4.

The treatment for contracture of the ischiogastrocnemius (ischiogambieri) muscles, also known as hamstring contracture, is not directly addressed in the provided drug label for tizanidine. However, tizanidine is used to reduce increased muscle tone associated with spasticity.

• Key points:
  • Tizanidine reduces muscle tone in patients with spasticity.
  • The reduction in muscle tone is measured using the Ashworth scale.
  • Tizanidine is used in patients with multiple sclerosis or spinal cord injury.

Since the question is about hamstring contracture, which is not the same as spasticity, and the drug label does not provide information on the treatment of hamstring contracture, the answer is not directly available from the label. However, based on the information provided, tizanidine may be considered for the treatment of muscle tone disorders, but its use for hamstring contracture would be off-label. 2

From the Research

Treatment Options for Hamstring Contracture

The treatment for contracture of the ischiogastrocnemius (ischiogambieri) muscles, also known as hamstring contracture, can be managed through various methods.

• Physical therapy and splinting are initial management options, as seen in the treatment of upper extremity contractures 3.
• Botulinum toxin injections can be helpful in relieving spasticity and determining the underlying cause of the contracture 3, 4, 5.
• Surgical management options, such as release or lengthening of the causative muscle/tendon unit and joint capsular release, may be required in some cases 3, 5.
• Postoperative splinting is important to maintain the improved range of motion and protect any associated tendon lengthening or transfer 3.

Specific Treatments for Hamstring-Induced Flexion Contracture

For hamstring-induced flexion contracture, the following treatments have been used:

• Diagnostic hamstring lidocaine injections to confirm hamstring rigidity as an etiology for flexion contracture 4.
• Therapeutic hamstring botulinum toxin A injections to improve extension range of motion 4.
• A combination of posterior capsular release, botulinum toxin injection, hamstring tenotomy, and peroneal nerve decompression has been shown to improve flexion contracture after total knee arthroplasty 5.
• Chemoprotection with botulinum toxin has been proposed as an alternative approach to prevent tendon repair failure and controlled mobilization in the treatment of proximal hamstring-ischiial tuberosity avulsion fracture repair 6.