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Leg Pain

Pulled Hamstring: A Pain Real Pain in the Leg!

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editors: Melissa Conrad Stöppler, MD

A pulled hamstring can be a painful injury not only to an athlete, but also for the regular weekend warrior One moment the runner is gliding down the track; the next he is collapsed in a heap clutching his thigh, writhing in pain. Another dream lost because of a pulled hamstring. While a pulled "hammy" is often thought of as an athlete's injury, it can happen to even the most unfit of us. While professional athletes suffer injuries in front of huge crowds, and millions more see the pain in slow motion on television, few people are there to watch you trip on a step.

Pulled hamstrings often happen on the playing field because the athlete is trying to push the body to perform to its maximum capacity while sprinting or jumping. For the rest of us, a pulled hamstring happens because we don't prepare for the routine activities of the day like walking or climbing steps. As we age (one risk factor), we lose flexibility (another risk factor), and we tend to lose general muscle strength and fitness, and are more susceptible to fatigue (adding even more risks).

Leg Pain Overview

While leg pain is common occurrence after injury, there are many non-traumatic causes of leg pain. Pain in the legs can be present because of conditions that affect bones, joints, muscles, tendons, ligaments, blood vessels, nerves, and skin. Most often, inflammation of tissues is the end result of these diseases, and the inflammation is the source of pain.

Anatomy of the Leg

The structures of the leg begin with the skeleton. The large bones of the leg are the femur (thigh bone), and the tibia and fibula of the shin. Smaller bones are found in the feet and toes. Major joints include the hip, knee, and ankle, but the small joints in the feet and toes also are important since they help support the body and diffuse the force that is generated by walking.

The joints are stabilized by thick bands of tissue called ligaments. The end of the bone that comprise the joints are covered with cartilage to help them glide through their range of motion.

Muscles attach to bone and have tendons that stretch across a joint. When a muscle contracts, the joint moves. Major muscle groups that affect leg movement include the buttocks, the quadriceps (in the front of the thigh), the hamstrings (in the back of the thigh), and the gastrocnemius (in the back of the calf). There are other smaller muscles, including those in the foot, that help stabilize the multiple joints in the feet.

There are two sets of blood vessels in the leg. The arterial system delivers blood, rich with oxygen, from the heart. The venous system drains blood from the leg and returns it to the heart, ridding tissue of carbon dioxide and other waste products of metabolism.

Nerves from the spinal cord supply information to the leg, transmitting signals from the brain that allow purposeful movement. They also return information or sensations to the brain. These include the sensations of pain, light touch, pressure, temperature, and position.

Illness and injury can affect any of these structures, causing discomfort and pain. More than one mechanism may be occurring at the same time. Some illustrative examples include:

Patients with poorly controlled diabetes may develop diabetic neuropathy, in which some of the symptoms may include pain and loss of sensation in the feet. Diabetes is also one of the risk factors for peripheral vascular disease, which may cause narrowing of blood vessels in the legs. This may cause exercise-induced pain when muscles don't get an adequate blood supply to meet their metabolic needs.
An injured muscle will cause pain because of inflammation and swelling, but it may also affect the balance of muscles surrounding a joint. If this imbalance persists, the joint may start to hurt because of chronic stresse placed upon it.

Picture of the muscle and nerve anatomy of the leg