Hamstring rehabilitation running program

Isometric exercise is defined as a muscular contraction where the muscle length is not changing. In other words, the muscle is being flexed, but it is not creating any movement. An example of an isometric exercise is showing off your arm muscles or flexing your abs as hard as you can.

Isometrics have been shown to help with pain and are an effective initial way to start exercising after injury. The bridge position is a good place to start with isometric hamstring exercise. Isometrics have numerous applications in strength training as well as rehab.

They are an effective way to warm-up and prime muscles for movement as well as decrease sensitivity and pain after injury. Isometric contractions allow the athlete to recruit a maximal amount of muscle fibers and can help to optimize the nervous system for efficient muscular contraction. In addition to activation, isometric strength training develops strength that is extremely specific to the range of motion trained.

This can be helpful in training weak points. For example, isometric holds in the bottom of a squat pause squats , or isometric deadlift holds just above or below your sticking point can help bust plateaus. In addition to the physiological benefits of pain relief, the increased neuromuscular recruitment efficiency, and the practical strength training application of isometrics, they can be extremely helpful in teaching exercise progression and introducing new movement.

For example, in the bridge progression chart below, you must complete an isometric hold of each new challenging position before you do it for reps. During rehab, there might be a session where you do the dynamic movement of one position, and the isometric holds from the next most challenging position. This is how you can slowly advance the difficulty of rehab.

They are a useful method of self-limiting progression to ensure we do not push ourselves too much and take a step back as well. Isometrics builds the initial strength and comfort in each new range of motion. Start all new positions with isometric holds, then progress to reps and movement. Build from 2 sets x reps to 3 x before entering each new phase. Use pain and form as your guide for progression.

If the phase 0 bridge is painful with your hamstring strain, there are a few ways to modify the exercise and experiment with finding pain free movement.

The range of motion can be altered to reduce the strength of the contraction. Introducing extra isometric resistance in other planes of movement can help to recruit varied musculature and significantly alter pain sensation. Additionally, there are pelvic and core positioning cues and considerations that can be used to find pain free movement.

A posteriorly tilted pelvis and flexed spine positioning can effectively shorten the length of the hamstrings and increase contraction strength. This is one cue that can help to decrease sensitivity during the initial phase and also train the core to prepare for proper positioning under load later on.

One very common misconception is that tight feeling muscles need to be stretched. Muscles can feel tight for a variety of reasons, and it is not always necessary or even beneficial to stretch a muscle.

Sometimes, it can even be detrimental to its recovery. During most muscle injuries, the fibers or microscopic cells are slightly torn.

In extreme cases where bleeding is excessive, this can be seen in the form of bruising, swelling, and highly sensitized painful tissue. Insulted tissue responds much better to gentle exercise and movement than it does vigorous stretching. If this has been your method of relieving pain or rehabbing a hamstring strain, you are in for a rude awakening.

Stretching a muscle can create a temporary inhibitory effect on its fibers, causing the tone of the muscle to relax and thus allowing for more range of motion. If pain worsens either reported by the player or the length of pain on palpation reduce the amount of load in that session.

Keeping the hip in maximal flexion with the elbows locked, the player is instructed to actively extend the knee until reaching the point of maximal tolerable stretch of the hamstring muscle.

The contralateral leg is fixed by the clinician. The absolute knee extension angle is measured as the endpoint of maximal tolerable stretch with the hand-held inclinometer placed on the anterior tibial border mid shin. We have found the MHFAKE test to be a better measure of flexibility than the traditional straight leg raise test, or other "usual" hamstring tests.

Standing behind the player, holding the hand-held dynamometer HHD with both arms against the posterior heel in a comfortable position, the clinician resists an isometric maximum voluntary contraction from the player against the HHD for three seconds, before performing break movement.

The player is positioned in supine with a fixating belt over the pelvis in line with the anterior superior iliac spine ASIS. Asking the patient about pain during their daily activities such as a numeric pain rating scale , measuring strength in the outer range position, the maximal hip flexion active knee extension flexibility test, as well as length of pain on palpation were the most useful daily examinations to inform the progression during different stages of rehabilitation through to return to participation Box 1.

There is still lack of consensus regarding which clinical measurements are useful to predict time to RTS. A combination of clinical findings at the day 7 follow up clinical examination could provide some reasonable predictive ability in the duration of RTS 9. Careful attention to these measurements might provide the clinician with greater insights into the duration of RTS for an injured football player.

In the literature, several different rehabilitation protocols have been described; these approaches have been valuable in growing our knowledge and understanding of what constitutes an appropriate rehabilitation protocol. The difficulty remains in understanding how and when they will benefit an individual player. We have presented our rehabilitation protocol for a football player with a typical running related hamstring injury, where criteria-based progression is followed throughout the rehabilitation process.

If we integrate objective measures as well as subjective measures into the clinical reasoning process, we can provide a rehabilitation program that is aligned with our RTS goals. At Aspetar, we value of a multi-disciplinary team approach, and shared decision making as described in the literature, has been a valuable feature in our experience 2, During the rehabilitation process, the communication with the player, the team doctor, and especially the coaching, is critical if we want to achieve successful outcomes for our players.

Contact: rodney. PDF Version. Sports Rehab. Stage 1 The main aim is to promote healing and simultaneously avoid any provocative activities which might delay the RTS process. Stage 2 Exercises are performed with increased load. Stage 3 Further progression of strengthening- and lengthening exercises 4 are now included.

Stage On-field rehabilitation After completion of stage 3, the player progress to the on-field phase of the rehabilitation protocol. Isokinetic Assessment Knee flexion and extension muscle strength were tested using an isokinetic dynamometer Biodex Multi-joint System 3. Askling H-test The patient is in supine with the contralateral leg and the upper body fixed. Outer-range strength Figure 8 The player is positioned in supine with a fixating belt over the pelvis in line with the anterior superior iliac spine ASIS.

The important subjective features associated with RTS time were: Maximum pain VAS scale reported at the time of injury A delay in starting physiotherapy Time taken to walk pain free. The physical findings that were found useful were strength testing related variables: Change in pain on the mid-range strength test over the first week Pain during the outer range strength test and single leg bridge at day 7 Outer range strength at day 7 expressed as a percentage of the uninjured leg, Peak isokinetic strength of knee flexion of the uninjured leg.

SUMMARY In the literature, several different rehabilitation protocols have been described; these approaches have been valuable in growing our knowledge and understanding of what constitutes an appropriate rehabilitation protocol. Rod Whiteley Ph. Like this: Like Loading Leave a Reply Cancel reply Enter your comment here Fill in your details below or click an icon to log in:. Email required Address never made public. Name required.

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Grades of hamstring strain: There are three levels of hamstring strain. Grade1 : Mild muscle strain. Grade2: Partial muscle strain. Grade3: Complete muscle strain. Grade 2 injury : Grade 2 injury requires a minimum period of 4 to 8 weeks for recovery.

Sub acute phase: Day 5 - 3weeks Stretching 3- 4 times per day Deep Tissue massage Daily Strengthening exercises Daily Pain free sub maximal isometric exercises are encouraged. Exercises are initiated to develop neuromuscular control of trunk and pelvis. Isometrics of the limb pelvic musculature.

Single -limb balance exercises. Short stride frontal plane stepping drills. Remodeling phase: weeks Stretching progression: progress to frequent stretching advanced. Strengthening progression Progress to concentric strengthening. Standing hamstring curls. Prone leg dropping. Hamstring ball rolls.