HamstringStrain/TearNon-OperativeRehabilitationProtocolDr.JeffreyWitty,M.D. GeneralNotes:
- Theprotocolhastwocomponents:o AsklingExercises
§ ThisrehabilitationprogramisoutlinedinAsklingetalBritishJournalSportsMedicine2013.Thisconsistsofhamstringloadingduringperiodsoflengtheningmainlyduringeccentricmuscleactions,andeventuallyloadingatmaximumdynamiclengthening.
§ Bestifstartedwithin5daysofinjury,butnotnecessary.§ Speedandloadingincreasedovertimeandadjustedsothat
thereisnopainprovocationduringtheexercise§ Incorporatedintophasesoutlinedbelow
o PhasesIthroughV
§ Firstdetermineextentofinjury• Minor
o Suggestedbyminimalpain,fullROM,abilitytogeneratenormalpoweragainstresistance
o Proximalextentoftheinjury§ Moreproximal=moretimeneededfor
rehabo CanoftenbeprogressedquicklyfromPhaseIto
IIorevenIIIdependingonsymptoms• Major
o Markedpain,decreasedROM,limp,weakness,inabilitytoresistextensioninproneposition
- Musthavenopaintomovetonextphase.
o Anypainmandatesneedtodroptopreviousphaseorlowerspeed,resistance,etctogettopainfreemotion.
Modalities:- Ice
o 20minutesonandoffasneeded2–4x/day§ Duringinitial48–72hrsfrominjuryperformuptoevery2hrs
tominimizeedema/swellingandhemorrhage- Compression
o Foottomid-thighhighcompressionsleeve
HamstringStrain/TearNon-OperativeRehabilitationProtocolDr.JeffreyWitty,M.D. Phases: Weightbearing ROM ExercisePhaseI
CrutchesandPWBifneededforpainandlimpandprogressgaittraininguntilathlete/patientcanwalkwithoutantalgicgait.
Startgentle,earlycontrolledmobilizationandstretchingofmusclemassguidedbypaintoleranceAAROMorPROMiftoopainful
Start“TheExtender”exercise
PhaseII
ProgresstoWBAT FullROMhipandknee ContinuePhaseIOnceWBATwithoutpainorlimpadd“TheDiver”and“TheGlider”exercises-Ifunabletodo“TheGlider”inthisphase,STOPandaddittoPhaseIIIStartsubmaximalproneisometricsEstimaslongasnotpainfulPain-freepooltherapyforROMbutnoaddedresistanceaslongaspainfreeMaintaincardiovascularfitness:Examples
- Upperbodyexercise- Onelegbike- Swimmingwithpull
buoys(nolegs)PhaseIII
WBAT FullROM ContinuePhaseIIAddisotoniclowerextremityexerciseAddheatformusclestretch
PhaseIV
WBAT FullROM PhaseIIIasaboveStartlighteccentricisokineticsStartlightjogandprogresstosprintAddsportspecificmovementsProgressisolatedhamstringstrengthandflexibilityastolerated
HamstringStrain/TearNon-OperativeRehabilitationProtocolDr.JeffreyWitty,M.D.
Modalities:
- Iceo 20minutesonandoffasneeded2–4x/day
§ Duringinitial48–72hrsfrominjuryperformuptoevery2hrstominimizeedema/swellingandhemorrhage
- Compressiono Foottomid-thighhighcompressionsleeve
AsklingExercises:
The“Extender”
- Hipflexedto90degrees- Stabilizeandholdthighasshown- Performslowkneeextensionstopointjustbeforepainisfelt- Twotimeseveryday,3sets,12reps
PhaseV
WBAT FullROM RTPCriteria:MustpassAskling“H”testIsokineticswithin15%oppositeside30yardsprintx3andfigure8’sdonepainfree
HamstringStrain/TearNon-OperativeRehabilitationProtocolDr.JeffreyWitty,M.D.
The“Diver”
- Standoninjuredlegasshown- Handstogetherlikedivingintoapool- Trunkupright- Bendoverathipsothathipbendsat90degrees- Atsametimestretcharmsforward- Attemptmaximalhipextensionoftheliftedlegandkeeppelvishorizontal- Standinglegkneemaintainedat10–20degrees- Liftedlegkneeat90degrees- Startveryslowlyatfirstandprogressmotionasstrength,balance,andpain
allows.Donotpushthroughanypain.Motionshouldbepain-freeforinjuredleg.
- Performonce,everyotherday,3sets,6reps
The“Glider”
- Startuprightwithonehandholdingsupportasshown- Non-injuredside’sfoothasasockforlowfrictiononfloor- Allbodyweightshouldbeoninjuredside(showwithoutbluesockinfigure)- Injuredsidekneeshouldbeinabout10–20degreesflexion
HamstringStrain/TearNon-OperativeRehabilitationProtocolDr.JeffreyWitty,M.D.
- Inacontrolledmanner,glidebackwardontheotherleg(bluesock)o Goaslowaspossiblebutbeforepainisreached.o Motionshouldbeslowandsteady
- Returntostartpositionbypullingupwithbotharmsonthesupporttoreturntostartposition,NOTtheinjuredleg.
- Progressbyincreasingtheglidingdistanceandspeedoftheexercise.- Performonceevery3days,3setswithreps
Adaptedfrom:LevineetalAmericanJournalofSportsMedicine2000AsklingetalBritishJournalofSportsMedicine2013DeLeeandDrez’sOrthopaedicSportsMedicine3rdEditionAsklingetalKneeSurgSportsTraumatolArthrosc2010
