Yudu - sportEX medicine - 1999-2010

PATIENT ADVICE Flexibilty exercises for hamstring injuries

Your injury The hamstring muscle group is found at the back of the thigh and consists of three muscles. The muscles cross both the hip and the knee joints and are therefore known as bi-articular (two joint) muscles. This makes them particu- larly vulnerable to injury.

Importance of flexibility Flexibility training and stretching is

Phase 1 (5 days) Initially the flexibility programme consists of gentle stretches to regain the full range of movement of the hamstrings. They should be performed gently and under con- trol held in a stable position and using only the weight of the leg. In this phase the muscles are only stretched across one joint at a time and the other joint is kept in a neutral position to prevent further injury or over-stretching:

1) Hamstring stretch (lying down) Lie on your back and bend your hip with the knee bent. Gently and slowly straight- en your knee until a stretch is felt at the

Phase 2 (5 days - 2 weeks ) The flexibility aspect of the programme is progressed to involve both the hip and knee once the above stretches can be completed without pain.

3) Seated hamstring stretch Sit on a chair and extend your leg (straighten your knee)

until you feel a stretch in your hamstrings. Repeat this stretch 6-8 times holding each stretch for 20 seconds and resting for 30 seconds. Repeat on the other leg.

4) Supported hamstring stretch Lie on your back through an open door, hips just in front of the door frame. Slide your leg up the frame with your knee bent

Phase 3 (1-6 weeks) 5) Seated hamstring stretch Continue with the seated hamstring stretch in Phase 2 above.

6) Standing hamstring stretch Stand upright and place one foot forward in front of the other. Bend the knee of the rear leg and bend forward to rest your hands on the thigh of this bent leg. Bend forward until you feel a stretch in the hamstrings of your straight leg. To progress this stretch raise your toes on the straight leg. Repeat this 6-8 times holding for 20 seconds and resting for 30 seconds. Repeat on the other leg.

until you feel a stretch. Progress by gradu- ally straightening the knee. Repeat this stretch 6-8 times holding each stretch for 20 seconds and resting for 30 seconds. Repeat on the other leg.

important for a number of reasons. After

an injury it is vital that the muscle regains its full range of movement as any limita- tion can lead to muscle weakness or imbal- ances. Regular stretching programmes have also been attributed to injury prevention.

Progression It is important to avoid over-stretching as provoking pain will trigger a natural pro- tective response in the muscle. Repeated

back of your leg. Do not straighten the knee so much that feel any pain. The stretch can be progressed by slowly straightening the knee a bit more but at no time should it feel painful. Hold each stretch for 15 seconds and rest for 30 sec- onds. Repeat 10-12 times. It may be help- ful to flex (bend) the knee between repeti- tions. Repeat on the other leg.

over-stretching may then damage the muscle fibres due to the body accommo- dating this response. Stretching after a hamstring injury should be progressed as outlined below. Do not move onto the next phase until the current stretches can be performed comfortably and with- out pain. The time specifications are also an approximate guide and it may take longer to progress between phases than indicated.

2) Hamstring stretch prone Lie on your front and straighten your leg so that the hamstrings are stretched. If the knee can not comfortably remain in full extension then a block can be placed under the ankle to provide some knee flexion. The height of block can then be reduced. Hold each stretch for 20 seconds and rest for 30 seconds. Repeat this stretch 10-12 times. Flex (bend) the knee between repetitions. Progress this stretch by lying on a plinth so the hip is flexed (see diagram).

Phase 4 (2 weeks - 6 months) During this phase if you play a particular sport, your therapist may give you some sports-specific exercises. It is important that before you start, you complete a warm-up. This should include general aerobic activity such as 10 minutes of gentle jogging, to increase the heart and respiration rate and the blood flow to the muscles. The warmer the muscles become the more flexible they will get. You can then carry out all the stretches above. Each stretch should be held for at least 20 seconds and repeated 6-8 times. Ask your therapist to provide you with some stretches that are specific to your sport and where appropriate, the position you play. Note: it is very important to avoid all explosive acceleration and deceleration movements during the warm-up phase.

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.