On August 22, in a potential playoff preview with the Boston Red Sox, Jason Kipnis appeared to aggravate his right hamstring while running to first base in the first inning. Kipnis was removed from the game and underwent an MRI, which confirmed re-aggravation of the injury. Indians’ skipper, Terry Francona, also indicated scar tissue could also be present. The Tribe veteran was placed on the 10-day disabled list on August 23 and Erik Gonzalez was recalled from AAA Columbus to fill his spot on the 25-man roster. This marks Kipnis’ second stint on the disabled list for his hamstring injury and third DL trip overall in 2017.
My take. Hamstring injuries have a tendency to be problematic and that is exactly what we have seen this season with Jason Kipnis. The team needs to remain cautious and conservative in their approach to management of this injury and keep the end goal of a deep postseason run in mind. If the Indians dial things back and keep things conservative, I anticipate Kipnis will be out deep into September. Kipnis needs to be healthy going into the postseason and taking some time to get his hamstring back to full function is the first step in doing so.
What is it? The hamstring is located on the back of the thigh and is comprised of three muscles. The semimembranosus, semitendinosus and biceps femoris compromise the hamstring and function to flex (bend) the knee and extend the hip. A muscle strain involves the over-stretching of a muscle past its normal range of motion. Muscle strains are commonly referred to as a “pulled” muscles and are graded based on severity. Grading of strains uses a scale from one to three, with grade one strains being the least severe in nature and grade three strains the most severe. Grade one injuries involve a slight over stretch of a muscle or tendon, grade two injuries involve partially tearing of the muscle or tendon and grade three injuries are complete tears of the involved structure. Muscle strain injuries can also be termed mild, moderate and severe respectively. Symptoms of a hamstring strain include soreness on the back of the thigh, discoloration, decreased range of motion of knee straightening and/or bending, decreased strength and decreased functional ability. In general, hamstring injuries more towards the middle of the muscle heal faster than those more proximal (closer to the thorax) to the hip.
How is it fixed? Conservative management of less severe hamstring strains usually involves a period of rest and avoiding activity which aggravates pain symptoms. Initial physical therapy intervention involves pain control via ice and activity modification. Stretching early on in the rehab process is usually gentle and then is progressed as pain and soreness decrease.
During the pain reduction stage of rehab, efforts will also be made to ensure adequate hip and core stability and range of motion are present. If the athlete is lacking strength or range of motion in either of these areas, physical therapy will involve interventions to address the deficits in these muscle groups. As the individual’s pain/soreness reduces, progression through the rehab process can occur.
The final stage of the rehab process includes the introduction of dynamic functional activities with the goal of returning to sport without restriction. Advancement through conservative physical therapy intervention is based on the symptoms of the individual and their response to each session.
After the individual can successfully complete dynamic, functional activities without exacerbation of symptoms, return to play considerations are made. In order for the athlete to return to play, the ability to complete all sport specific activities such as running, jumping, throwing and batting without pain or deviation must be present. In more severe hamstring injury cases surgery may be indicated. Rehabilitation length is significantly prolonged in surgical management of a hamstring injury.
We will continue to monitor the status of Jason Kipnis throughout the rehabilitation process and will provide the most up to date injury breakdown, analysis and explanation as new information becomes available.
Brandon Bowers, PT, DPT, is a graduate of the University of Toledo, Doctor of Physical Therapy Program and currently practices in Columbus, Ohio. He is an avid Cleveland sports fan and has experience rehabbing athletes of all levels and from a variety of sports. Follow Brandon on Twitter for more Cleveland Indians injury insight and analysis: @blbowers12
The information provided is the professional opinion of Brandon Bowers, PT, DPT and is based on his clinical experience and the most current clinical evidence available. This information should not be interpreted as or substituted for medical advice for a specific condition or diagnosis.