aspetar hamstring protocol - drbrendanricciardo.com.au · hamstring protocol. scan to watch the...
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Orthopaedic & Sports Medicine Hospital
www.aspetar.com
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Aspetar
HamstringProtocol
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The central tenet of the rehabilitation protocol is a requirement for set criteria (specific physical testing) to be proven prior to allowing progression to the next stage. Daily measurements of subjective pain, pain with palpation, range of movement or flexibility, and strength allows the clinician to adapt the protocol for the athlete on that particular day depending on the presentation of the individual, as well as identify the response to the previous day’s treatment. Although we suggest specific exercises and progressions within each stage, clinical reasoning is continuously required from the clinician to execute the protocol optimally for each session.
Arbitrarily the rehabilitation protocol consists of 6 stages, three “physiotherapy” stages and 3 sport specific stages. An overlap of exercises between the stages is allowed, recognizing the fluidity of the rehabilitation process and reflecting an integrated protocol with set criteria for progression. The main feature of the protocol repeated in each stage is the early but safe resumption of repeated high speed running and direction change movements.
CRITERIA BASED PROGRESSION PROTOCOL
Physio
Stage 1
Painless single leg squatPainless bike 150W, 5mins
Run > 70%ROM SLR & HS O >75%
Heavy Football TrainingSession
100% runningPainless direction change
In-between FootballTraining Session
Light Football TrainingSession
Stage 2 Stage 3 Stage 4 Stage 5 Stage 6
On-field
Introduction
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ASSESSMENT
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In general:
• All exercises should be performed close to pain free limit. If the exercise/movement provokes pain (≥ 2 VAS) from the injured area, the exercise is immediately adjusted or terminated.
• The patients should be instructed to perform the exercises with adequate control/stabilization of the hip and trunk.
Variations:
• Depending on the localization of the injury (medial/lateral), tibial IR or ER is applied when appropriate during exercises with knee flexion movements appropriate.
GOALS:
• STAGE I: PROMOTE HEALING OF THE INJURED TISSUE 1) Protect scar tissue development (promote neuromuscular control within protected ROM) 2) Minimize muscle atrophy 3) Minimize pain
• STAGE II-III: REGAIN FULL MUSCLE FUNCTION AND NEUROMUSCULAR CONTROL 1) Regain full voluntary neuromuscular control over the injured muscle 2) Regain pain-free hamstring strength, from mid-range progressing to longer hamstring lengths 3) Develop neuromuscular control of trunk and pelvis with progressive movement speed 4) Pain free running up to maximal speed and with changing directions
• STAGE IV-VI: INTEGRATE FULL SPORTS SPECIFIC PARTICIPATION 1) Symptom-free during all activities 2) Complete 3 progressive sports specific sessions with no pain and full
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GAIT–WALKING The use of crutches and the ability to walk and jog without pain and/or antalgic pattern is noted as normal, antalgic, not able, or has not tried.
FUNCTIONGAIT – WALKING
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7 I Assessment and Exercises
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STANDINGTRUNK FLEXION
Start in upright position.
Stand Straight
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9 I Assessment and Exercises
Trunk flexion is performed with hands touching the legs until pain from injured area or a general “stretching pain” is felt.
Level is noted as finger touch level:knees, mid-shins, ankles or floor
StretchingPain
Knees
Mid - Shins
Ankles
Floor
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DOUBLELEG SQUATg 90°
Standing with hands on hips with feet shoulder-width apart, examination table at height similar to the knee joint line.
Bench hight equalto the knee joint
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The athlete is asked to lower his body by bending his knees until he touches the examination table.
Maintain upright position.
Knee joint aligned over 2nd toe.
11 I Assessment and Exercises
Touchesthe bench
Knees over toes
90° Bend
Heelson the ground
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1 leg squat - bench
position close up
SINGLE LEG SQUAT - 45°
Bench hight equalto the mid-thigh
The patient is asked to lower his body by bending his knees until he touches the bench, keeping the knees directly in line above the feet (2nd toe).
The upper body is maintained in an upright position.
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13 I Assessment and Exercises
1 leg squat - starting
position
1 leg squat - end
position
Heelon the ground
Touchesthe bench
45° Bend
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The athlete indicates the most painful area.
Palpation of the uninjured leg is used as reference to the athlete to identify the known pain.
PALPATION
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15 I Assessment and Exercises
The clinician palpates the full length of the medial and lateral hamstrings to localize painful area.
The painful area borders are marked cranially, caudally, medially and laterally.
The distance from the ischial tuberosity is noted.
The total length, width and the distance between ischial tuberosity and the area with maximal
pain are measured in centemeters
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RANGE OF MOTION
PASSIVE STRAIGHTLEG RAISE (SLR) TEST
Theta Angle Hand-heldinclinometer
The maximal degreesof hip flexion ROMand pain registerd asyes/no
Full KneeExtension
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17 I Assessment and Exercises
The athlete is lying supine while the clinician is fixating the untested leg.
The clinician passively raises the leg, ensuring full knee extension or to the point where the athlete reports pain/onset of discomfort.
Range of motion (i.e. the hip flexion angle from the horizontal plane) is measured by a hand held inclinometer.
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The athlete is lying supine with hip flexed to 90° while the clinician is fixating the untested leg.
The clinician gradually extends the knee to the point of resistance or the onset of pain/discomfort.
PAIN FREE PASSIVE KNEE EXTENSION TEST (PKET)
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19 I Assessment and Exercises
Range of motion (i.e. the knee extension angle) is measured by a hand held inclinometer.
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The athlete is lying supine with hip towards the maximal flexion using the arms to pull the thigh to the chest.
The contralateral leg is fixated with a belt.
MAXIMAL HIP FLEXIONACTIVE KNEE EXTENSION (MHFAKE) TEST
Arms pulling his thigh to the
chest
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21 I Assessment and Exercises
The athlete performs active knee extension until reaching maximal tolerable stretch or the onset of pain/discomfort.
Range of motion (i.e. knee extension angle) is measured by hand held inclinometer.
Maximal tolarablestretch in the
Hamstring muscle
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STRENGTHMEASUREMENTS
ISOMETRIC INNER-RANGE STRENGTH TEST
The athlete is prone with 90°knee flexion of the tested leg.
The clinician holds the HHD horizontally with both arms against the athlete’s posterior heel.
The athlete performs 3 isometric knee flexion for 3 seconds. (Maximal effort–hard as possible)
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Standard instructions:“Ready - GO! - Push-push-push-push”
HHD – Hand Held Dynamometer
90° FLEXED
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The athlete is lying prone.
The clinician raises the heel one foot length above the examination table holding the HHD vertically against the athlete’s posterior heel.
The athlete performs 3 isometric knee flexion for 3 seconds. (Maximal effort–hard as possible)
ECCENTRIC MID-RANGE STRENGTH TEST
Maximal tolarablestretch in the
Hamstring muscle
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25 I Assessment and Exercises
The clinician applies an eccentric brake test.
Standard instructions:“Ready - GO! - Push-push-push-push”
HHD – Hand Held Dynamometer
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The athlete is lying supine while ASIS/pelvis and the contralateral leg fixated with a belt.
The clinician passively flexes the player’s leg to 90° knee flexion, holding the HHD vertically against the athlete’s posterior heel.
The athlete performs 3 isometric knee flexion for 3 seconds. (Maximal effort – hard as possible)
The clinician applies an eccentric brake test.
Standard instructions:“Ready - GO! - Push-push-push-push”
HHD – Hand Held Dynamometer
ECCENTRIC OUTER-RANGESTRENGTH TEST
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27 I Assessment and Exercises
90° KNEE FLEXION
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Lift buttocks into hip extension with:
Stage 1-3
Two legs(knees flexed to ±90°)
Stage 4
Single leg(knee flexed to ±90 °)
Stage 5
Injured leg positioned on a bench or the clinicians shoulder
DOUBLE TO SINGLE LEG BRIDGE
1
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29 I Assessment and Exercises
2 3
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RETURN TO SPORT (RTS)(All assessments repeated)
+
Askling H-testNordic Hamstring ExerciseIsokinetic Strength Test
DYNAMIC FLEXIBILITY H-TEST BY ASKLING
The athlete is lying supine with the contralateral leg and the upper body fixed with a belt.
A knee braces ensures full extension of the tested knee (0°).No warm-up exercises!
Passive flexibility test where the clinician slowly raises the testing leg towards maximal hip flexion. Strong, but tolerable stretching in the hamstring muscle.
The active flexibility test consists of 1 practice trial (submaximal effort)3 consecutive test trials:The athlete performs a straight leg raise as fast as possible to the highest point without taking any risk.
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The athlete is asked to estimate experience of insecurity and pain on a VAS-scale from 0 to 100.
(Askling et al 2010)
31 I Assessment and Exercises
Fixed with a Strap
°0 Full KneeExtension
No Warm-upExercises
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The athlete is kneeling on either the Norbord with ankles fixed in the stirrups.
The athlete is then instructed to fall forward, and resist the fall to the ground for as long as possible using his hamstring muscle.
NORDIC HAMSTRING EXERCISE WITH NORDBORD
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33 I Assessment and Exercises
Hip and lumbo-pelvic control alignment good control throughout the movement
1 set of 3 repetitions
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The athlete is seated upright on the dynamometer and fixated with straps
Instructed to grip the chair handles throughout the test.
The axis of knee rotation is aligned collinear to the lateral femoral condyle and gravitational correction is performed at 30° of knee flexion.
During the test, the athlete is given vigorous verbal encouragement to exert maximal effort throughout the test.
Quadriceps and Hamstrings Concentric 60°/s
(5 trials)Concentric 300°/s (10 trials)
Hamstrings Eccentric 60°/s (5 trials)
ISOKINETIC STRENGTHTESTING
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35 I Assessment and Exercises
EXERCISES
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Instructions:
The athlete is asked to lower his body by bending his knees until he reaches 45°-90° (or pain is felt).
The upper body is supposed to be as straight as possible.
*Knees over toes, heels on the ground.
3 x 15
2 LEG SQUATEXERCISE
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37 I Assessment and Exercises
Progression:
The exercise is performed with weights
3 x 8
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1st session: start at 50 Watt for 30 sec.
Increase the load/intensity with 25 W every 30 seconds until it reaches the highest level of cycling continuously for 5 minutes.
EXERCISE BIKE
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39 I Assessment and Exercises
Aim:
2 X Bodyweight = Power output (W)
5min warm up, 5min hard!
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Starting position
One knee is flexed and placed beside medial knee joint line of the other leg, which is then placed similarly, leaving both knees flexed approximately 90°.
Instructions
The athlete is instructed to perform 3 repetitions of hip extension, where he pushes down through the heels and lifts the hips off the ground towards full hip extension.
3 X 12
SUPINE 2 LEG BRIDGE
Good qualityKeep pelvis horizontally
Both feets areplaced flat
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41 I Assessment and Exercises
Hips extended until 0°i.e. straight line shoulder-hip-knees
*Good quality, i.e.: ASIS/pelvis horizontally throughout the whole movement
*Hips extended until 0°, i.e. straight line
shoulder – hips - knees
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Starting position
The athlete is lying supine or sitting on the bench with the knees flexed at an angle of approximately 90°.
Instructions
The athlete is instructed to push down through the heel by activating the hamstrings and hold the position for approximately 5 seconds.
3 X 12
SUPINE ISOMETRIC HEEL DIGS
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43 I Assessment and Exercises
Isometric contractions in different angles towards end ROM; 90° - 60° - 30°
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Starting position
The athlete is standing with the uninjured leg slightly bent with hands on hips.
SINGLE LEG SQUATEXERCISE
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45 I Assessment and Exercises
Instructions
The athlete is asked to lower the body in a squatting position by bending his knees while the knee in the standing leg is directly in a line above the feet (2nd toe).
3 X 8
Progression:
The exercise is performed with weights
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Starting position
The athlete is lying in prone position with knees flexed. The therapist applies isometric resistance in varying angles..
Instructions
The athlete is instructed to push against the therapist’s hand, which is placed on the posterior calcaneus.
3 X 12
MANUAL RESISTEDHAMSTRINGS
Progressionthrough
range resistanceeccentric
Push against theclinician's hand
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47 I Assessment and Exercises
Progression:
In supine position with hip flexed: resistance towards the end ROM (eccentric)
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Starting position
The athlete is lying in prone position. Effleurages/lymphatic drainage is performed distal and proximal to injury site.
Instructions
The athlete is instructed to be relaxed and report if he feels pain or any kind of discomfort during the treatment.
5-10 minutes
Progression:
Massage of the injured area allowed in Stage 2
MANUAL RESISTEDSoft tissue mobilization
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49 I Assessment and Exercises
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Starting position
Athlete is lying in prone position with both legs extended.
Instructions
The athlete is instructed to actively bend the knee of the injured leg until the heel touches the buttock and then slowly extend the knee towards a straight leg position again.
3 X 8
ACTIVE RANGEOF MOTION (ROM)
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51 I Assessment and Exercises
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Starting position
The athlete is lying supine, holding and stabilize the thigh of the injured leg with the hip flexed approximately 90°.
THE EXTENDER(Askling et al)
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53 I Assessment and Exercises
Instructions
The athlete is instructed to perform slow knee extensions to a point just before pain is felt.
3x12) x 2
Progression:
Increase speed.
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Starting position
The athlete is standing with full weight on his injured leg and the opposite knee slightly flexed backwards.
THE DIVER
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55 I Assessment and Exercises
Instructions
The athlete is asked to perform the exercise as a simulated dive (hip flexion from an upright trunk position) of the injured, standing leg and simultaneous stretching arms forward and attempting maximal hip extension.
3 X 6
*Good quality, ASIS/pelvis horizontally throughout the whole movement
*Maintain 10–20° knee flexion in the standing leg.
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Starting position
The exercise is started with the patient positioned 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° knee flexion.
THE GLIDER
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57 I Assessment and Exercises
Instructions
The athlete is instructed to perform a gliding backward movement on the other leg and stop the movement 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.
3 X 6
Progression is achieved by increasing the gliding distance and performing the exercise faster.
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Starting position
The athlete is lying supine with arms placed in a comfortable position with knees flexed.
Instructions
The athlete is instructed to raise his untested leg off the examination table and then perform repetitions of hip extension, where he pushes down through the heel of the tested leg and lifts the hips off the ground towards full hip extension.
4 X 15
Progression
Exercise performed on a step/clinician’s shoulder
SUPINE 1 LEGBRIDGE
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59 I Assessment and Exercises
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The athlete is instructed to relax and the therapist perform a gentle stretch with the leg in:
1) Straight leg raise (SLR) position
STRETCHING
SLR position
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61 I Assessment and Exercises
2) Maximal hip flexion + knee extension
(MHFAKE position).
Towards the end ROM where the athlete either reports a stretch or onset of pain, 5 isometric contractions are performed (hold-release), before a gentle passive stretch is applied further.
3 x 30 seconds
MHFAKE position
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Starting position:
The athlete is lying prone in the leg curl machine. Make sure the length of the lever arms are adjusted to the patients leg length.
Instructions:
The athlete is instructed to perform slow continuous knee flexions and knee extensions with the injured leg, only, starting with a load that is acceptable and pain free.
RESISTED HAMSTRING CURL EXERCISE
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63 I Assessment and Exercises
Progression:
I: Increasing load (kg)
II: Increasing load in eccentric phase
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Starting position:
The athlete is kneeling on either the Nordbord with ankles fixed or on a mat with the therapist fixating the ankles.
Instructions:
The athlete is then instructed to fall forwards, and resist the fall to the ground as long for as possible using their hamstring muscle.
ECCENTRIC NORDICHAMSTRING EXERCISE
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65 I Assessment and Exercises
*That the loading of the injured leg is similar to the uninjured leg (without pain)
3 times per week
1) 2x 5 reps, drop only
2) 2(3)x 5 – 8, drop only
3) 2(3)x 8 – 12 , d rop only
4) Repeat sessions 1-3 with drop AND curl
Complete 2 painfree sessions before progression to next level
Complete all 3 sessions, drop only, then progress through session again with drop and curl
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“A” Drill
High knee with “Kicks”
(Each lap = 25-50m x2)
RUNNING PROGRAMA DRILL-HIGH KNEEWITH KICKS
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67 I Assessment and Exercises
Instructions
The athlete is instructed to lift his knee as high as possible and extend the knee down in a circular motion “sweeping” the floor.
3 X 4 laps
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Triple Extension Walk
High knee only
(Each lap = 25-50m x2)
Instructions:
The athlete is instructed to lift the knee as high as possible in a jumping motion, and repeat on the other side.
3 X 4 laps
RUNNING PROGRAMTRIPLE EXTENSION WALK HIGH KNEES
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69 I Assessment and Exercises
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The running progression programme includes volume, intensity and running mechanics. It is performed under supervision to facilitate these components are executed well
When the athlete starts with the running progression, he is asked to rate the running from the very first lap.
Both the % rated by the athlete, as well as the timed run/sprint is recorded to allow for gradual progression of the running.
3 X 4 laps
Progression
0 – 100%
RUNNINGPROGRESSION
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71 I Assessment and Exercises
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3 reps12s Æ3s60% Æ100%
1
4
23
5
Modified T-drill where the run starts at 1 and follows the numbers sequentially running around cones (indicated byΔ).
The athlete is asked to run (from a standing start) and touch each of the cones, continuously in a forward motion while changing direction without any side stepping or backwards running
% linear scale where the athlete is asked to indicate the speed at which he/she is running
0 10 20 30 40 50 60 70 80 90 100
Inju
red le
g:
LE
FT
RIG
HT N
o =
no p
ain
, P =
pain
, NA
= n
ot a
ble
, SLR
= s
traig
ht
leg r
ais
e, M
HFA
KE =
maxim
al hip
fle
xio
n a
ctiv
e knee
exte
nsi
on, °
= d
egre
es, kg =
kilo
gra
ms
/
/
201
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
INJU
RED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
Se
lf-r
ep
ort
ed
re
ad
ine
ss
A
ve
rag
e p
ain
to
day
V
AS
/
10
VA
S
/
10
VA
S
/
10
V
AS
/
10
VA
S
/
10
Wa
lkin
g
No
P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
Jog
gin
g
No
P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
2 le
g s
qu
at
x 3
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
1 le
g s
qu
at
x 3
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
Tru
nk
fle
xio
n
No
P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
To
tal p
alp
. le
ng
th:
cm P
cm P
cm P
cm P
cm P
Mid
ra
ng
e
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
Ou
ter
ran
ge
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
SL
R
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
MH
FA
KE
°
P |
no
°
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
Be
nt
leg
bri
dg
e 3
x
No
P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
S
tra
igh
t le
g b
rid
ge
3x
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
C
om
men
ts:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
INJU
RED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
Se
lf-r
ep
ort
ed
re
ad
ine
ss
A
ve
rag
e p
ain
to
day
V
AS
/
10
VA
S
/
10
V
AS
/
10
VA
S
/
10
VA
S
/
10
Wa
lkin
g
No
P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
Jo
gg
ing
N
o P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
2 le
g s
qu
at
x 3
N
o P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
1 le
g s
qu
at
x 3
N
o P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
Tru
nk
fle
xio
n
No
P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
To
tal p
alp
. le
ng
th:
cm P
cm P
cm P
cm
P
cm
P
Mid
ra
ng
e
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
Ou
ter
ran
ge
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
SL
R
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
MH
FA
KE
°
P |
no
°
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
Be
nt
leg
bri
dg
e 3
x
No
P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
Str
aig
ht
leg
bri
dg
e 3
x
No
P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
Co
mm
ents
:
Pat
ient
label
HA
MST
RIN
G P
RO
TO
CO
L
Dai
ly a
ssess
ments
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Inju
red le
g:
LE
FT
RIG
HT N
o =
no p
ain
, P =
pain
, NA
= n
ot a
ble
, SLR
= s
traig
ht
leg r
ais
e, M
HFA
KE =
maxim
al hip
fle
xio
n a
ctiv
e knee
exte
nsi
on, °
= d
egre
es, kg =
kilo
gra
ms
/
/
201
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
INJU
RED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
Se
lf-r
ep
ort
ed
re
ad
ine
ss
A
ve
rag
e p
ain
to
day
V
AS
/
10
VA
S
/
10
VA
S
/
10
V
AS
/
10
VA
S
/
10
Wa
lkin
g
No
P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
Jog
gin
g
No
P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
2 le
g s
qu
at
x 3
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
1 le
g s
qu
at
x 3
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
Tru
nk
fle
xio
n
No
P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
To
tal p
alp
. le
ng
th:
cm P
cm P
cm P
cm P
cm P
Mid
ra
ng
e
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
Ou
ter
ran
ge
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
SL
R
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
MH
FA
KE
°
P |
no
°
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
Be
nt
leg
bri
dg
e 3
x
No
P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
S
tra
igh
t le
g b
rid
ge
3x
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
C
om
men
ts:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
/
/ 2
01
_
Days
Post
:
S
ign
:
INJU
RED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
IN
JUR
ED
U
NIN
JUR
ED
Se
lf-r
ep
ort
ed
re
ad
ine
ss
A
ve
rag
e p
ain
to
day
V
AS
/
10
VA
S
/
10
V
AS
/
10
VA
S
/
10
VA
S
/
10
Wa
lkin
g
No
P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
Jo
gg
ing
N
o P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
2 le
g s
qu
at
x 3
N
o P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
1 le
g s
qu
at
x 3
N
o P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
Tru
nk
fle
xio
n
No
P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
To
tal p
alp
. le
ng
th:
cm P
cm P
cm P
cm
P
cm
P
Mid
ra
ng
e
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
Ou
ter
ran
ge
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
kg
P |
no
kg
SL
R
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
MH
FA
KE
°
P |
no
°
° P
| no
°
° P
| no
°
° P
| no
°
° P
| no
°
Be
nt
leg
bri
dg
e 3
x
No
P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
N
o P
N
A
Str
aig
ht
leg
bri
dg
e 3
x
No
P
N
A
N
o P
N
A
N
o P
N
A
No
P
N
A
N
o P
N
A
Co
mm
ents
:
Pat
ient
label
HA
MST
RIN
G P
RO
TO
CO
L
Dai
ly a
ssess
ments
![Page 74: Aspetar Hamstring Protocol - drbrendanricciardo.com.au · Hamstring Protocol. Scan to watch the video The central tenet of the rehabilitation protocol is a requirement for set criteria](https://reader033.vdocuments.us/reader033/viewer/2022053000/5f0450e77e708231d40d5fb6/html5/thumbnails/74.jpg)
Pati
en
t la
bel
HA
MST
RIN
G P
RO
TO
CO
L
Wei
ght:
L
eg inju
red:
LEFT
RIG
HT
WEE
K:
/
/
201
_
Sign
:
/
/ 2
01_
Si
gn:
/
/
201
_
Sign
:
/
/ 2
01_
Si
gn:
/
/ 2
01_
Si
gn:
/
/ 201
_
/
/
201
_
Sign
: ST
AGE
and
Volu
me
diffi
culty
TR
EATM
ENT
SETS
/ RE
PS
Sets
Re
ps
Load
Se
ts
Reps
Lo
ad
Sets
Re
ps
Load
Se
ts
Reps
Lo
ad
Sets
Re
ps
Load
Se
ts
Reps
Lo
ad
Sets
Re
ps
Load
1
2
LEG
SQUA
T Pr
og: w
ith w
eigh
ts
3 x 1
5
3 X
8
1
EX
ERCI
SE B
IKE
(W
att:
2x B
W) 5
min
+ 5
min
5
min
s
1
2
SUPI
NE B
RIDG
E 2
LEGS
3
X 12
1
2SU
PINE
ISOM
ETRI
C HE
EL
DIGS
3
X 12
1
2SI
NGLE
LEG
SQUA
T →
45°
Pr
og: w
ith w
eigh
ts
3 X
8 3
x 15
1
2M
ANUA
L RES
ISTE
D HA
MST
RING
S 3
X 12
1
2SO
FT T
ISSU
E 5
min
s
1
2AC
TIVE
ROM
3
x 8
1
2 3
“T
HE E
XTEN
DER”
Da
ily
(3 x
12)
x 2
1
2 3
“ARA
BESQ
UE/D
IVER
” Ev
ery
2nd d
ay
3 x 6
1
2 3
“THE
GLI
DER”
Ev
ery
3rd d
ay
3 x 6
2 3
SUPI
NE B
RIDG
E 1
LEG
2
sec u
p/2
sec d
own
2sec
up/
1 se
c dow
n O
n st
ep
On
exer
cise
ball
4 x 1
5
2 3
STRE
TCHI
NG
(SLR
and
PKE
T)
3 X
30 s
2 3
RESI
STED
HAM
STRI
NGS
1. P
rone
leg
curl
2. P
rone
leg
curl
ecce
ntric
3.
Hea
vy S
quat
s
4 x 1
5 4
x 8
4 x 8
3
ECCE
NTRI
C ST
RENG
THEN
ING
Nord
ic ha
mst
ring
2 x 5
/3 x
6
Crite
ria fo
r pro
gres
sion
from
Sta
ge 1
to S
tage
2:
1.Pa
inle
ss S
ingl
e Le
g Sq
uat
2.Pa
inle
ss B
ike,
W: 2
x Bod
y W
eigh
t, 5
min
utes
(lev
el 6
-7)
Crite
ria fo
r pro
gres
sion
from
Sta
ge 2
to S
tage
3:
1.Ru
n ≥
70%
Pat
ient
-rate
d2.
Pain
mid
-rang
e te
st ≤
VAS
2
Crite
ria fo
r pro
gres
sion
from
Sta
ge 3
to S
port
s Spe
c Reh
ab:
1.10
0% ru
nnin
g sp
eed
2.Pa
inle
ss h
igh
spee
d di
rect
ion
chan
ges
3.M
ust d
emon
stra
te a
bilit
y to
acc
eler
atio
n/de
cele
rate
with
out a
ny d
iscom
fort
dur
ing
high
spee
d ru
nnin
g
HA
MST
RIN
G P
RO
TO
CO
L
Runnin
g P
rogr
ess
ion
P
ati
en
t la
bel
Leg
inju
red:
LEFT
RIG
HT
W
EEK:
Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: ST
AGE
PREP
ARAT
ION
EXER
CISE
S SE
TS/
LAPS
Se
ts/
Laps
Sets
/ La
ps
Se
ts/
Laps
Be
st T
ime
% m
ax
Sets
/ La
ps
Se
ts/
Laps
Sets
/ La
ps
Se
ts/
Laps
2+3
Trip
le E
xten
sion
Wal
k Hi
gh k
nee
only
(E
ach
lap
= 10
0m x
2
3 x 1
2+3
“A” D
rill
High
kne
e w
ith “K
icks”
(E
ach
lap
= 10
0m x
2)
3 X
1
RU
NNIN
G RO
GRES
SIO
N SE
TS/
LAPS
Se
ts/
Laps
Be
st
Tim
e %
m
ax
Sets
/ La
ps
Best
Ti
me
%
max
Se
ts/
Laps
Be
st
Tim
e %
m
ax
Sets
/ La
ps
Best
Ti
me
%
max
Se
ts/
Laps
Be
st
Tim
e %
m
ax
Sets
/ La
ps
Best
Ti
me
%
max
Se
ts/
Laps
Be
st
Tim
e %
m
ax
2+3
Wal
k –
Jog
(1
0 -7
0%)
Jog
–Run
(7
0 - 1
00%
)
3 x 4
3 Ti
min
g
Se
t I:
Set I
I: Se
t III:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
3 M
odifi
ed T
-Dril
l (7
0 –
100%
) (≤
11
sec.
)
3 x 1
Ti
min
g
Se
t I:
Set I
I: Se
t III:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Co
mm
ents
PR
OGRE
SSIO
N W
alk
– Jo
g: B
egin
runn
ing
at 1
0-25
% (p
atie
nt-r
ated
), pr
ogre
ssio
n by
10%
step
to m
ax.7
0%.
Jo
g –
Run
and
Mod
ified
T-D
rills:
Beg
in ru
nnin
g at
70%
(pat
ient
-rat
ed),
prog
ress
as a
ble
by 1
0%. A
t 90%
, pro
gres
s by
5%.
![Page 75: Aspetar Hamstring Protocol - drbrendanricciardo.com.au · Hamstring Protocol. Scan to watch the video The central tenet of the rehabilitation protocol is a requirement for set criteria](https://reader033.vdocuments.us/reader033/viewer/2022053000/5f0450e77e708231d40d5fb6/html5/thumbnails/75.jpg)
Scan to watch the video
HA
MST
RIN
G P
RO
TO
CO
L
Runnin
g P
rogr
ess
ion
P
ati
en
t la
bel
Leg
inju
red:
LEFT
RIG
HT
W
EEK:
Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: Da
te
/
/ 2
01_
Sign
: ST
AGE
PREP
ARAT
ION
EXER
CISE
S SE
TS/
LAPS
Se
ts/
Laps
Sets
/ La
ps
Se
ts/
Laps
Be
st T
ime
% m
ax
Sets
/ La
ps
Se
ts/
Laps
Sets
/ La
ps
Se
ts/
Laps
2+3
Trip
le E
xten
sion
Wal
k Hi
gh k
nee
only
(E
ach
lap
= 10
0m x
2
3 x 1
2+3
“A” D
rill
High
kne
e w
ith “K
icks”
(E
ach
lap
= 10
0m x
2)
3 X
1
RU
NNIN
G RO
GRES
SIO
N SE
TS/
LAPS
Se
ts/
Laps
Be
st
Tim
e %
m
ax
Sets
/ La
ps
Best
Ti
me
%
max
Se
ts/
Laps
Be
st
Tim
e %
m
ax
Sets
/ La
ps
Best
Ti
me
%
max
Se
ts/
Laps
Be
st
Tim
e %
m
ax
Sets
/ La
ps
Best
Ti
me
%
max
Se
ts/
Laps
Be
st
Tim
e %
m
ax
2+3
Wal
k –
Jog
(1
0 -7
0%)
Jog
–Run
(7
0 - 1
00%
)
3 x 4
3 Ti
min
g
Se
t I:
Set I
I: Se
t III:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
3 M
odifi
ed T
-Dril
l (7
0 –
100%
) (≤
11
sec.
)
3 x 1
Ti
min
g
Se
t I:
Set I
I: Se
t III:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Set I
: Se
t II:
Set I
II:
Co
mm
ents
PR
OGRE
SSIO
N W
alk
– Jo
g: B
egin
runn
ing
at 1
0-25
% (p
atie
nt-r
ated
), pr
ogre
ssio
n by
10%
step
to m
ax.7
0%.
Jo
g –
Run
and
Mod
ified
T-D
rills:
Beg
in ru
nnin
g at
70%
(pat
ient
-rat
ed),
prog
ress
as a
ble
by 1
0%. A
t 90%
, pro
gres
s by
5%.
![Page 76: Aspetar Hamstring Protocol - drbrendanricciardo.com.au · Hamstring Protocol. Scan to watch the video The central tenet of the rehabilitation protocol is a requirement for set criteria](https://reader033.vdocuments.us/reader033/viewer/2022053000/5f0450e77e708231d40d5fb6/html5/thumbnails/76.jpg)
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