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3) Maintain hamstring muscle strength and hypertrophy 4) Controlled collagen stimulation 5) Stimulate maximal full range pain free isometric and isotonic contraction. (CR10 0-1 and RPE progression 1-3)

6) Progressive resistance training for Type I and Type IIa muscle fibres.

Rehabilitation programme 1) Flexibility Aims: 1) Regain and maintain full range of movement of hip and knee (single joint first and then bi-articular) a) Active – controlled manual active stretch and hold, within the pain free range of movement

b) Passive - controlled PNF eg. hold-relax, hold-contract-relax

2) Maintain general stretch of the contralateral limb and the rest of the body.

Flexibility should be treated as a separate activity in its own right and may be performed as a daily routine. Incorporating flexibility just at the beginning of rehabilitation, exercise or practice is not sufficient to gain full sport-specific flexibility and prevention of injury.

2) Endurance Commence endurance-based exercises (Table 1) without any additional resistance keeping the exercise relatively pain free with a Borg CR10 pain scale level below 2 (weak/light).

3) Resistance Resistance exercises are then commenced using a subjective resis- tance and relatively high repetitions to maintain muscle endurance and prevent further atrophy (tables 2 and 3). 1) The load used for each exercise should be individually determined using the Borg scale for rate of perceived exertion (RPE) 10+ and controlled by the CR10 pain scale (see p16)

2) The range of movement will commence within the inner and middle range progressing to outer range to complete a full range of movement

3) Begin with 4 sets and progress to 6 sets as the exercises get easier

Exercise

Seated hamstring curl Standing hamstring curl Prone hamstring curl

Exercise Leg Press

Dumbbell half squat Dumbbell Romanian

dead lift Table 3: Closed kinetic chain resistance exercises for phase 2 rehabilitation SportEX 13 Exercise Duration

Prone knee bends 30 seconds - 5 minutes duration (CR10 <2)

Low impact step 1-10 minutes duration depending on machine

symptoms (CR10 <2)

Static cycle 400m walk

1-10 minutes duration (CR10 <2)

Start slowly and increase speed every 100m until gently jogging

Table 1: Endurance-based exercises for phase 2 of rehabilitation

4) Begin with 12 repetitions and progress to 15 repetitions as the exercises get easier

5) Speed of movement is in second counts eg. 2-1-3-1 = biceps ....curl. Curl to a two second count (2), hold for one second (1), ....lower to a three second count (3) and rest for one second (1)

Progression for OKC and CKC in Phase 2 (tables 2 and 3) ● The load remains at RPE 10+ and CR10 <2 1. Start with 4 sets and 12 repetitions, progress by increasing repetitions to 15

2. Add a set, 5 sets x 12 repetitons, and progress by increasing ....repetitions to 15 3. Add a set, 6 x 12, to 6 x 15 ● Increase the range of movement within CR10 < 2 criteria to full ROM

● Increase the speed of movement to 2-1-2-1 and then 2-0-2-0, which is continuous movement.

Rehabilitation Phase 3 (Loading) Entry criteria 1) Completion of rehabilitation Phase 2 2) Full range active stretch of hamstrings 3) Full range pain free sub maximal resisted contraction 4) Pain free maximal isometric contraction all ranges 5) 400m + jog.

Rehabilitation objective 1) Maintain full hamstring ROM 2) Hamstring strength re-establishment

Range Sets No. of

of movement Inner - Middle Inner - Middle Inner - Middle

4-6 4-6 4-6

Table 2: Open kinetic chain resistance exercises for phase 2 rehabilitation Range Sets No. of

of movement Inner - Middle Inner - Middle Inner - Middle

4-6 4-6 4-6

Rest

repetitions between sets 12-15 12-15 12-15

30 sec 30 sec 30 sec

Load

RPE 10+CR10 <2 RPE 10+CR10 <2 RPE 10+CR10 <2

Speed