Hamstring Rehabilitation Resource Guide
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This hamstring resource guide is by no means an exhaustive list of the quality content available on hamstring management out there. These resources were used in reference for a hamstring presentation that intentionally did not cover anatomy, structure & function of the hamstring, prognosis & imaging in any great detail.
Furthermore, this is not a review or statement to the quality and methodology of these research papers. As always, it is up to the clinician to review the quality of the paper and apply findings to their clinical population.
RISK FACTORS
Resource
Key Takeaways
Lower measured FH0 values were significantly associated with a high risk of sustaining a hamstring injury within the weeks following sprint measurement.
Low horizontal force production capacities at low velocity during early sprint accelera tion (FH0) may be considered as a potential additional factor associated with HI risk in a comprehensive, multifactorial & individualized approach
Basis behind the benchmark target of 30+ single leg hamstring bridges
An important systematic Review of Risk factors for HSI.
IMAGING
Findings suggest 89% of the clinically recovered hamstring injuries showed intramuscular increased signal intensity on fluid sensitive sequences on MRI.
This is suggestive that normalisation of this increased signal intensity is not required for a successful RTP
In some contract to the study above, authors report there is a high risk of reinjury when 2 of these 5 radiological findings are present:
- Connective tissue gap
- Loss of tendon tension
- Intramuscular oedema
- Callus gap
- Interstitial feather
MUSCLE INJURY CLASSIFICATION & PROGNOSIS
Influential work from this team on muscle injury classification and the follow up on how this can guide prognosis on return to training timelines
One limitation of the BAMIS is it does not account for pathology such as the T Junction region of the short and long head of Biceps Femoris.
Be sure to listen to this podcast from Fearghal Kerin on T Junction injuries and keep an eye out for his Masterclass coming soon to the SportsMAP Platform
HAMSTRING APONEUROSIS
A very detailed look at the Aponeurosis of the Bicep Femoris long head. It will take some focused reading yet helps to gain a better understanding on this structure and function related to injury.
A systematic review finding âCâ type injuries did not result in a higher recurrence rate
TESTING
This paper found testing the posterior chain in a more knee extended 90:20 position may provide greater sensitivity to fatigue at 48 h post competition than testing in the 90:90 position.
An excellent guide to monitoring a hamstring during the rehabilitation program and associated clinical testing from the team at Aspetar.
EXERCISE SELECTION
Eccentrically, the largest BF/MH nEMG ratio occurred in the 45° hip extension exercise; the lowest was in the Nordic Hamstring.
These findings have implications for strategies to prevent hamstring injury as well as potentially for clinicians targeting specific hamstring components for treatment
Early study on lengthened state eccentrics reported failing to increase an athleteâs eccentric strength in a lengthened position after a hamstring injury may predispose an athlete to subsequent reinjury.
Incorporating lengthened state eccentric training may help reduce the rate of reinjury
Comparing lengthened state eccentrics (seated) vs Nordic Hamstring Training for muscle adaptations found:
- LSET is more effective for muscles involved in knee flexion + hip extension (BFlh)
- NHT better targets muscles not involved with hip extension (BFsh & sartorius)
HAMSTRING REHABILITAION
Important and quality early research about using the PATS program as part of the rehabilitation process.
Use lateral based movements (side to side drills) to get the athlete moving early in rehab and ensure you are addressing rotational and core / trunk stability within the rehabilitation.
A low dose Nordic exposure is as successful as a high-volume dose for muscle strength and architectural changes. However, architectural changes are lost after only two weeks of de-training.
Dean Benton takes this to the next level in his Sports MAP Masterclass with his coaching of speed drills that can be commenced early in hamstring rehabilitation.
A comprehensive take on hamstring injury rehabilitation covering the extra details that may be often overlooked in hamstring injury management programs.
This paper is highlighted in Byran Heiderscheitâs upcoming Sports MAP Masterclass.
It is critical to get the prescription right for top end speed running (80%+).
Knowing the athleteâs max speed is paramount.
A really nice clear criteria-based rehabilitation pathway to follow with your athlete outlined in this paper. Further emphasised in the Bryan Heiderscheit Sports MAP Masterclass.
Addressing âstrainâ in your rehabilitation via running mechanics. This is an opinion piece yet the authors are very well credentialed.
Highlights the disproportionate relationship between running speed and hamstring workload. Eg running at 85% speed is approximately only 70% hamstring workload
Discussed a potential sweet spot of 5-8 exposures of high-speed running at >85% within a 4-week period in the AFL to reduce HS risk.
The SMAS (spring mechanics assessment score) is an extension on the above providing clinicianâs a framework to analyse and interpret running mechanics.
Martin McIntyre talks more to the concept of hamstring âstrainâ in this Sports MAP Podcast
Research supporting the concept of training and improving lumbopelvic control to reduce hamstring strain and therefore risk of injury.
One of the authors in the above paper, Jonas Dodoo goes into greater detail here in his Sport MAP Masterclass. He also highlights the importance of creating âbig shapesâ for thigh angle separation. Something we can create early in the rehab via mobility and training drills.
Jurdan Mendiguchia was a key author in the above papers and he covers this and much more in this very comprehensive and must view Sports MAP Masterclass on Hamstring Strain Rehabilitation.
A quality hamstring rehabilitation paper looking at a 4 week staged program from Ben Macdonald and the British Athletics team.
A straightforward paper however a key takeaway is treating what you see in front of you.
If there is a neural restriction impacting mobility, you should address it.
A recent paper highlighting some athletes' hamstrings takes up to 72 hours to recover from a match.
Clinical implications: schedule sufficient rest days between high eccentric demands when returning from a hamstring.
Two + days between training and match play when returning to sport? + Two days between high sprint exposures?
One of many papers highlighting the importance of maintaining and rebuilding the athleteâs chronic load for a RTP.
High speed running is clearly more specific to hamstring injuries yet there still needs to be load behind the athlete required for their sports (volume, sports specific, change of direction etc.)
Albeit a case study, a nice and informative power on some of the respected authors utilise ramping isometrics in their hamstring rehabilitation.
RECURRENT HAMSTRING ISSUES
The balance between the hamstring muscles may be an important factor and fits with our earlier references around selective activation pending what you see in your athlete.
Craig Purdam talks further about recurrent issues mainly around T junction injuries in this Sports MAP Masterclass.
Nick & Joss dissect some of the latest findings and learnings around the recurrent hamstring string injuries.
Fearghal provides some great detail in how he navigates a recurrent hamstring injury with a specific focus on the management of T junction and IMT injuries.
RECURRENT HAMSTRING ISSUES
Looking to delve further into hamstring strain assessment and rehabilitation?
Donât miss these high-quality resources coming soon from SportsMAP
NICK COURT Masterclass
- Data informed hamstring strain rehabilitation
FEARGHAL KERIN Masterclass
- T junction Injuries
