WWW.SPORTEX-MEDICINE.COM Diagram 1: Flow chart of the principle exercise stages in progression of force/loading of muscle for the patient Cyclical Isometric

contraction mid range (Figure 1)

Isometric contraction

multiple joint angles (Figure 1)

concentric/ eccentric

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contractions in mid range, low speed (Figure 1)

Figure 3a Cyclical Figure 3c Figure 1: Figure 3b

concentric/ eccentric

contractions in outer range, high speed (Figure 2)

Figure 2: Closed

kinetic chain & sport specific eccen- tric muscle control (Figures 3a,b,c)

Antagonist concentric

contraction with

eccentric "catch" of agonist outer range, high speed (Figure 2)

Antagonist concentric

contraction with

eccentric "catch" of agonist outer range, low speed (Figure 2)

Antagonist concentric

contraction with

eccentric "catch" of agonist mid range, high speed (Figure 1)

Antagonist concentric

contraction with

eccentric "catch" of agonist mid range, low speed (Figure 1)

contractions in mid range, high speed (Figure 1)

Cyclical

concentric/ eccentric

Cyclical

concentric/ eccentric

contractions in outer range, low speed (Figure 2)

Progression of force loading

Figure 1: This figure demonstrates a mid range position for working the hamstrings ie. the hip is in a neutral position. Within this position, the patient can be pro- gressed through single then multi-angle iso- metric contractions of the hamstrings. This is then followed by continuous flexion and extension of the knee, with the hamstrings having to work concentrically then eccentri- cally, initially this is done at slow then faster speeds. Once this continuous movement has been achieved, greater resistance can be applied starting again at the slower speed. In order to fully activate (strengthen) the biceps femoris, a pattern of movement is adopted rather than straight knee flexion, the nature of which is discussed below.

The exact sequence of movement used to strengthen the mus- cle is determined during examination (3), here for instance it may be found that hamstring contraction during hip extension is the most pain-provocative, hip extension would then be emphasised during the movement pattern. The pattern involves the following (with the patient lying on their front): moving from the lengthened position (for biceps femoris) of hip adduc- tion and internal rotation, knee extension and internal rotation the muscle is then contracted concentrically to pull the limb into hip extension, abduction and external rotation, knee flex-

ion and external rotation. The limb is then lowered out to the starting position (eccentric muscle action).

Final progression

The final exercise progressions for both figures 1 and 2 is to perform an eccentric ‘catch’, the quadriceps contract concentrically, on com- mand the patient reverses the direction of limb movement attempting to quickly flex the

knee. This is again initially done with a slow contraction of the quadriceps then progressively faster.

Figure 2: This figure demonstrates an outer range position for working the hamstrings ie. the hip is in a flexed position. Within this position, the patient can be progressed through single then multi-angle isometric contractions of the hamstrings. This is then followed by continuous flexion and exten- sion of the knee, with the hamstrings having to work concentrically then eccentrically, initially this is done at slow then faster speeds. Once achieved, greater resistance can be applied starting again at the slower speed.

In order to fully activate (strengthen) the biceps femoris a pat- tern of movement is adopted rather than straight knee flexion. The exact sequence is determined during examination (3), but could for instance involve the following: moving from the lengthened position of hip flexion, adduction and internal rota- tion, knee extension and internal rotation, the muscle is con- tracted concentrically to pull the limb into hip extension, abduction and external rotation, knee flexion and external rota- tion. The limb is then lowered out to the starting position (eccentric muscle action).

SportEX 11

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