Recurrent Hamstring Injuries in Elite Athletes - A Paradigm Shift to Mechanical Dysfunction of the Sacroiliac Joint as One Causation

Recurrent hamstring injuries are a significant and troubling issue in the elite athletic community. Reinjury may occur in up to 34% of patients in the kicking and running sports. We hypothesised that a proportion of these patients may have mechanical dysfunction of the sacroiliac joint as a causative mechanism. We recruited 23 elite athletes with recurrent hamstring injuries and lateralising lower back pain into the study after careful screening. Diagnosis was confirmed by scintigraphic SPECT/ CT imaging. Patients who failed directed physiotherapy were offered injection of the sacroiliac joint with platelet rich plasma (PRP). All 23 athletes (Av age 35 years, 19 M, 4F) had MRI evidence of hamstring tears (Av 4.2 tears) and met criteria for a diagnosis of sacroiliac joint dysfunction with mean clinical scores of 6.8 (Range: 7-9). Four patients returned to sport after physiotherapy and 19 underwent peri-articular PRP injection under ultrasound guidance. The baseline VAS was 80 (mean) and after treatment 9, indicating a significant response to treatment (p=0.002). All patients with SIJ dysfunction and recurrent hamstring tears responded to treatment. A plausible explanation for the relationship is the alteration in muscle sequencing around the pelvis following SIJ dysfunction.