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