hamstring rehab - mayo clinic · ©2014 mfmer | slide-2 case presentation • 42 year old female...

©2014 MFMER | slide-1

Hamstring rehab Jeff Strauss, PT, DPT, SCS, CSCS


Case presentation • 42 year old female • Married, mother of 3 • Works as secretary • Water skiing accident • Acute proximal hamstring tear • Orthopedic consultation • Surgery next week


Rehab considerations • Principles of rehab

• Assistance at home • Brace/immobilizer use • Weight bearing

• Exercise progression • Desire to return to sport and which sport


Initial Concepts (4-6 weeks) • Hip flexed= knee flexed

• Brace on except for showering

• Must avoid tensioning muscle


Initial phase of rehab

Protected weight bearing

• Non-weight bearing • 4-6 weeks *Acute patients ~4 weeks *Chronic ~6 weeks

• Brace use • Locked at 60-90

degrees of knee flexion

*Acute patients 60 degrees *Chronic patients 90 degrees


Concepts (6-12 weeks) • Restore normal daily mechanics (stairs,

walking, return to work) • Initiate co-contraction when appropriate • Avoid overstressing repair (stretch or

strengthen)


Progressions • Weight bearing

-Progress to weight bearing as tolerated +/- crutches until gait normalizes (4-6 weeks)

• Motion • Work to restore normal

knee/hip motion • Knee

• Flexion • Extension

• Hip • Flexion • Extension • Abduction • Rotation

• Co-contraction - 6-8 weeks post

operative - Examples: Bridging,

step ups, etc.

- No isolated contraction of hamstrings until 10-12 weeks post operative

- Conditioning via bike or elliptical


Special consideration • Scar tissue

• Sitting tolerance • Soft tissue mobilization • Graston • Ultrasound • Dry needling

• Paresthesias • Desensitization exercises


Concepts (12+ weeks) • Return to running

• ReturnToRunning.pdf

• Isolated hamstring strengthening • Isometric > Concentric> Eccentric


Deadlift progression


Skipping progression

A-Skip B-Skip


Eccentric ball curl


Nordic Curl


Return to play • Goal of symmetry

• Range of motion • Strength • Plyometrics

• Surgeon/Therapist/Patient • Realistic timeframe


Non-operative management • Reduce fluid/edema

• Restore motion

• Restore normal gait mechanics


Bridge progression

March out Slide out


Hamstring Isolation


Single leg

Con/Ecc Eccentric


Dry needling


Return to play • Remember

• Predictor of hamstring strain is previous hamstring strain

• Athletes often return to sport with asymmetric strength deficits

• Simulation> Competition

• Goal of symmetry • Range of motion • Strength • Plyometrics


Thank you!

hamstring rehab - mayo clinic · ©2014 mfmer | slide-2 case presentation • 42 year old female...

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