Yudu - sportEX medicine - 1999-2010

PRACTITIONER PROMPT Hamstring injury rehabilitation

Accurate diagnosis Establish correct diagnosis, differ- entiate between: ● Hamstring muscle strains ● Posterior compartment syndrome of the thigh ● Hamstring syndrome ● Ischiogluteal bursitis ● Adverse neuromeningeal tension ● Piriformis syndrome ● Lumbar spine pathology ● Sacroiliac joint pathology

Hamstring strengthening Progression of force application: ● mid-range isometric contractions ● mid-range multi-angle isometric contractions ● mid-range concentric-eccentric contractions, slow to fast velocities of contraction

● outer-range isometric contractions ● outer-range multi-angle isometric contractions

● outer-range concentric-eccentric contractions, slow to fast velocities of contraction

● closed kinetic chain and sport specific actions ● application of force in functionally specific patterns

Treat pain and

inflammation ● PRICE ● Electrotherapeutic modalities ● Specific soft tissue mobilisations ● Transverse frictions

Condition Hamstring strain

● for biceps femoris a combination of hip exten- sion, abduction and lateral rotation along with knee flexion and tibial lateral rotation

● for semitendinosus/semimembranosus a com- bination of hip extension, adduction and medial rotation along with knee flexion and tibial medial rotation

Hamstring flexibility ● Appropriate healing time (14 days post-injury)

● Isolation of stretch to ham- string muscle

● Appropriate direction of stretch

● For biceps femoris a combi- nation of hip flexion, adduc- tion and medial rotation along with knee extension and tibial medial rotation

● For semitendinosus/semi- membranosus a combination of hip flexion, abduction and lateral rotation with knee extension and tibial lateral rotation

● Progess from sustained stat- ic stretches to controlled ballistic stretches

Site of pain Effect of SLR Onset of symptoms Effect of hamstring Effect of activity on palpation and slump test (sudden/ traumatic contraction or gradual)

Musculo-

tendinuous hamstrings

Hamstring syndrome Ischial tuberosity Posterior compartment

syndrome of thigh Ischiogluteal

bursitis

Piriformis syndrome

Lumbar spine pathology

Sacroiliac joint pathology

Adverse

neuromeningeal tension

Positive for hamstrings

Tight posterior Negative thigh

Ischial tuberosity

Piriformis muscle

Positive for hamstrings

Positive for neural

Lumbar spine Positive for neural

Sacroiliac joint

Positive for neural

Along course Positive for of sciatic nerve neural

Sudden/traumatic Gradual

Decreased strength Pain increases with and painful

activity No effect Sudden or gradual No effect Gradual No effect

Sitting aggravates, movement eases

Increases with activity, decreases immediately with rest

Very specific activity will

aggravate, relief not immediate on cessation of activity

Gradual Gradual (occasional, sudden) Gradual (occasional, sudden) Gradual Weak no pain Weak, no pain No effect Weak, no pain

Pain increases with activity

Increases and decreases

with certain postures and activities

Increases and decreases

with certain postures and activities

Increases with activity, relief not immediate on cessation of activity

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for special- ist medical advice in each individual case. To the extent permissable by law, the publisher, editors and contributors accept no liability for any loss, injury or damage howsoever incurred (including negli- gence) as a consequence, whether directly or indirectly, of the use of any person of the contents of this article.