HAMSTRING REHABILITATION

difficult to determine whether the postural changes were the cause or occurred as a result of the injury (2).

Grades of hamstring injury The American Medical Association (AMA) (8) has described three grades of hamstring injuries: 1. First degree injuries are the result of stretching the musculo- tendinous unit where only a few muscle or tendon fibres are involved

2. Second degree injuries involve a more severe tear without complete disruption of the musculotendinous unit

3. Third degree injuries refer to a complete rupture of the muscu- .....lotendinous unit.

Rehabilitation considerations The rehabilitation programme should be designed with the individual patient in mind and must take into account: a) The site of injury (origin, insertion, muscle belly or musculo- tendinous junction)

b) The severity or grade of injury c) Which muscle(s) of the hamstring group are involved d) How long since the injury occurred e) Whether or not any other injuries are present

The rehabilitation should also be sport and position-specific in order to return the athlete to their chosen sport as quickly and efficiently as possible. Being a complex muscle group the hamstrings require a complex and varied programme.

It is impor-

tant when establishing the rehabilitation programme to bear in mind the different stages of muscle healing (8) which are:

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On presentation the patient had an antalgic gait with a sudden short stride on the injured leg as well as some bruising and swelling over the posterior thigh. He had an ecchymosis and pain on pal- pation of the mid-belly of biceps femoris. Pain was also reproduced on isometric contraction of the hamstrings (tested in the mid posi- tion to prevent further injury) although he had full active range of movement at both hips and knees. Neurological and differential diagnostic tests were performed to confirm the type and extent of the injury.

It was diagnosed that the patient had a second-degree mid-belly hamstring injury.

The rehabilitation A sport and position-specific rehabilitation programme can then be devised to return him to the field as quickly and effectively as a possible. When designing a rehabilitation programme it is impor- tant to define the physiological biomotor profile of the athlete to construct the protocols relative to these demands, otherwise the training gains will not be retained. Consequently, muscle imbal-

Figure 3: Figure showing the specific physiological profile and biomotor needs of the player (P)

POWER

● Acute phase (1-5 days) ● Sub-acute phase (5 days to 2 weeks) ● Remodelling phase (1-6 weeks) ● Functional phase (2 weeks to 6 months) ● Return to sport

For the purpose of treatment and rehabilitation we use the same time scales but work within the following phase descriptions.

Phase 1: Acute phase (1-5 days) Phase 2: ROM phase (range of movement/flexibility) (5 days to 2 weeks) Phase 3: Loading phase (endurance, hypertrophy, strengthening and power) (1-6 weeks) Phase 4: Sports specific phase (2 weeks to 6 months) Phase 5: Fitness test and return to sport

Presentation and diagnosis If we consider the rehabilitation of a 29-year-old football centre back, who presents to the physiotherapy clinic 72 hours after injury reporting feeling a tearing sensation followed by excruciating pain in his posterior thigh during the 80th minute of the game, which occurred while sprinting to catch the opposition attacker. He was able to walk off the field with assistance but with severe posterior mid-thigh discomfort. He saw the team physiotherapist immediate- ly who prescribed

protection, rest, ice, compression and elevation (PRICE), which the patient followed.

P STRENGTH 10 SportEX ENDURANCE