Hamstring Strain: Prevention & Rehabilitation (Part 5)

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Guest blog by Paul Head

Paul holds a BSc Sports Therapy degree from University of Central Lancashire (UCLAN) and is a pre reg physiotherapy student. He received first Class Honours Classification (78% average) and  an award for Academic Excellence in the field of sports therapy / physiotherapy from DJO UK. Find out more about Paul here…

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‘The Glider’. The exercise is started from a position with upright trunk, one hand holding on to a support and legs slightly split. All the body weight should be on the heel of the injured leg with approximately 10–20° flexion in the knee. The motion is started by gliding backward on the other leg and stopped before pain is reached. The movement back to the starting position should be performed by the help of both arms, not using the injured leg. Once every third day, three sets with four repetitions       slider 3

‘The Glider’. The exercise is started from a position with
upright trunk, one hand holding on to a support and legs slightly split.
All the body weight should be on the heel of the injured leg
with approximately 10–20° flexion in the knee. The motion is started
by gliding backward on the other leg and stopped before pain is reached. The movement back to the starting position should be performed by the help of both arms, not using the
injured leg. Once every third day, three sets
with four repetitions

Hamstring curl on swiss ball  hamstring curl 2

Hamstring curl on swiss ball

Single leg glute bridge bridge 2

 Single leg glute bridge

 

bridge towel 2Eccentric knee extensions

Eccentric knee extensions

Brughelli and Cronin (2007) suggest alternative eccentric exercises to the Nordic hamstring exercise due it being an open chain exercise that is bilateral which could cause one leg to take more the strain than the other leading to asymmetries. Also that it is a single joint exercise whereas the hamstrings are bi-articulate that is stretched over the hip flexion and knee extension. It would be more specific to perform multi-joint eccentric exercises that involve more muscle groups working together. Brughelli et al (2009) showed the functional eccentric exercises below to be effective in returning an Australian rules football player who had three previous muscle strain injuries confirmed by MRI (grade II and III muscle strain injuries) to his right hamstring (long head of the biceps femoris) over the previous four years. Playing every game in the subsequent season injury free and the exercises also altered the optimum angle of peak torque of the knee flexors and extensors.

Malliaropoulos et al (2012) also recommend exercises that also incorporate both hip and knee concentric and eccentric actions due to the bi articular nature of the hamstring muscle group. Also active lengthening of the hamstring muscles may occur both in the late swing phase (open kinetic chain) and during late stance phase (closed kinetic chain) of sprinting. This suggests that open and closed kinetic chain exercise should be included in prevention programmes. The hamstrings lengthen under load from 45% to 90% of the gait cycle (swing) absorbing imposed mechanical energy, and then shorten under load from late swing through stance to reuse this energy. Therefore, they strongly advise to use of Stretch Shorten Cycle exercises and combine them with isolated eccentric exercises in open or closed kinetic chain in order to replicate hamstring function.

Eccentric Backward Box Drops   Eccentric loaded lunge drops: The trainee rises up onto his or her toes while taking a lunge stance, with or without resistance. He or she then quickly drops onto the ground with his or her feet landing flat and balanced. Then he or she will resist the downward forces into a deep lunge position while maintaining good posture

Single leg RDL with alternating toe touches

 Other exercises include double and single leg dead lifts and Romanian dead lifts, Eccentric split stance zerchers and eccentric leg curls.
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