HAMSTRING REHABILITATION

3) Endurance re-establishment 4) Muscle STREND training (strength and endurance) 5) Co-ordination 6) Fatigue endurance training 7) Progressive resistance training for Type I, IIa, IIc and some IIb during fatigue.

Rehabilitation exercises 1) Flexibility Flexibility should continue from controlled movements to incorporate sport specific activities and movements at a slow controlled rate with momentum: a) Active - Start with slow pendular movements within the free active ranges of all articular components for the hamstring. Progress to very slow rate/controlled sport-specific movements eg. kicking actions b) Passive

- contract, relax;

PNF techniques eg. hold, relax, contract, hold progressing to full end range stretch.

2) Resistance Make sure you record and date the load you are using for each exercise in a record chart and re-record and date all load changes (Table 4).

3) Endurance ● Step machine - 10–15 mins - Start Borg RPE 11, progress to RPE 14 then 17 ● Static cycle - 10–15 mins - Start Borg RPE 11, progress to RPE 14 then 17 ● Rowing machine - 10–15 mins - Start RPE 11, progress to RPE 14 then 17 ● Hamstring running programmes

Borg RPE 11 is approx 60% VO2 max, RPE 14 approx 70% VO2 max, RPE 17 approx 85% VO2 max

4) Co-ordination

● Running drills ● Trampet ● Wobble board ● Gym ball ● Ball skills.

Rehabilitation phase 4 Entry criteria 1) Completion of phase 3 (loading) 2) Full bilateral symmetrical ROM 3) Able to perform exercises at Borg RPE 17+ and CR10 0.3. for:

Exercise Seated hamstring curl Standing leg curl Prone l g hamstring curl e hamstring curl Range Sets of mo

f Movement Full

Full Full 6 6 6

a) open kinetic chain b) Closed kinetic chain (Table 5) c) Power/endurance exercises (Table 6).

Rehabilitation objectives 1) Complete multi-functional movements 2) Continue load progression to power training 3) Progressive maximal neural stimulation for IIb fibers 4) Preparation for return to team training and game.

Rehabilitation exercises 1) Flexibility Continue daily active stretching as a separate programme.

2) Resistance Make sure you record and date the load you are using for each exercise in a record chart and re-record and date all load changes (tables 5 and 6).

3) Position specific ● Plyometric training ● Acceleration patterns ● Deceleration patterns ● Forward, back, side and oblique pattern runs.

4) Fitness test preparation ● Evaluation comparison to pre-season evaluation ● Functional fitness test familiarisation.

5) Club training integration Club training should be constructed through consultation with the club technical and conditioning coach so that entry strategies and progression criteria can be formulated for integrated return to training and playing. 1. Ball skills 2. Game skills 3. Tactics 4. Controlled game. On completion of Phase 4, the player can then return to the training programme ready for phase 5 of the rehabilitation.

Rehabilitation Phase 5 Design and administer an appropriate fitness test for: 1. The injury The site of injury, nature, severity, tissue types involved, recovery time and presence of associated or existing injuries should be assessed and evaluated before designing the test for that particular lesion.

Number of repetitions

8 8 8 Rest

between setsb’tween Sets 45 sec

45 se46 +3 45 sec 45 sec Table 4: Open kinetic chain resistance exercise (3 minutes recovery between exercises) for phase 3 of rehabilitation 14 SportEX Load

RPE 14-16 +3 progression

RPE 14-16 +3 progression

RPE 14-16 +3 progression

Speed 3-1-3-1 3-1-3-1 3-1-3-1

TIP