Physical Therapy Exercises for Hamstring Muscle Strain

1. Physical Therapy Exercises for Hamstring Muscle Strain By Alisha Johnson

2. Common Muscles Strained of the Hip Hip Adductors Gracilis Pectineus Adductor Longus Adductor Brevis Adductor Magnus Hip Flexors Iliopsoas Quadriceps group –More common of the group is Rectus Femoris Hip Extensors Hamstrings group –Most common

3. General Info The most commonly sprained muscles of the hip is the Hamstring group The Hamstring muscle group consists of the Biceps Femoris, Semitendinosus and Semimembranosus Running sports poses an increased risk for a sprain A strain results from a rapid contraction of the muscle during an explosive action After a Hamstring, there is an increased risk of reinjury Injury disrupts normal gait mechanics because of pain and weakness Full recovery is necessary before continuing on with sport activity and even normal mobility

4. Hamstring Muscle Group

5. Causes of Injury Prior hamstring injury Lumbar DJD Biomechanical inadequacies such as: anterior pelvic tilt, leg length discrepancies, anatomical arrangement Poor posture Muscle imbalance Decreased flexibility Hamstring strength Fatigue

6. Cause of Injury Prior Hamstring Strain Due to loss of extensibility and eccentric strength Lumbar DJD Decreased ROM and hamstring extensibility. LBP has been shown to decrease proprioception & neuromuscular control of the LE’s Fatigue From overtraining or overexertion is easily damaged Posture Adaptive shortening of hip flexors place hamstrings in a lengthened position Decreased Flexibility Primary cause of injury

7. Cause of Injury Biomechanical Inadequacies Anterior pelvic tilt: innonimate bone in injured side increases tension on hamstrings and cause lengthened position of O&I Leg Length Inequality: The shorter leg develops overly tight hamstrings Anatomical: The hamstrings are a biarticular muscle (cross two joints) group which are more susceptible to shortening Muscle Imbalance Agonist/Antagonist muscle groups  The hamstrings are antagonistic to the quadriceps group Eccentric to concentric rations Hamstring to trunk stabilizer ratios

8. Conservative Treatment Phase I (Acute) RICE—Rest, Ice, Compression, Elevation Modalities such as Ultrasound, Cryotherapy and Electric Stimulation AROM-Knee flexion and extension Manual therapy such as massage Aquatic therapy Phase II (Subacute) When patient has full ROM w/o pain, mild concentric strengthening such as hamstring sets and curls, heel slides, hip extension can be introduced For cardiovascular fitness: stationary bike or swimming can be initiated

9. Treatment cont. Phase III (Remodeling) Begin Hamstring stretching Eccentric Strengthening can be initiated Concentric strengthening is introduced first because eccentric causes a greater force than concentric Phase IV (Functional) Prepare patient’s to return to sport Continue and progress strengthening and flexibility Introduce running activities: a light jog increasing to a sprint Phase V (Return to Sport) Goal is to avoid re-injury

10. Hip Strengthening Program Quadruped Hip Extension Knee Bent  Bring knee in toward chest, while keeping your knee bent extend hip and reach foot toward the ceiling. Keep buttocks tight. Do not arch back. Quadruped Crossover  While keeping knee bent, extend hip and reach foot toward the ceiling while keeping buttocks tight. Lower knee over opposite leg. Touch knee to the floor and reach foot toward the ceiling and repeat. Bridges with Ball Squeeze  Lift hips up while squeezing the ball between legs. Keep buttocks tight. *Progress by lifting one leg, hold for 5 seconds and switch legs. Bridges with Hamstring Ball Curl  With legs and feet on the exercise ball, lift hips up while squeezing your buttocks. Roll ball toward you then underneath buttocks while maintaining a bridge.

11. Hip Strengthening Program Sidelying Adductor Strengthening Lie on your side, bend the knee of your top leg, set the foot flat on the floor behind your opposite leg. Keep bottom leg straight. Lift & lower in a straight plane then clockwise/counter clockwise circles. Hip IR/ER with Ball Sitting with band around ankles and ball between ankles. Squeeze ball and hold 5 sec. Push out into band and hold 5 sec. Keep knees close together throughout exercise. Supine Straight Leg Raise Lie on your back with band around ankles. Hold one leg on the floor while slowly lifting opposite leg off floor while keeping the band tight. Repeat with other leg. Keep your back flat on the floor. Clamshells with Band  Lie on your side with both knees bent with band around knees. Keep ankles together. Lift & lower top knee slowly while keeping pelvis still and back straight.

12. Hip Strengthening Program Butt Busters Use support surface to keep balance if necessary. Take side steps by lifting one foot, then the other. Keep toes pointed forward & upper body vertical. Monster Walks  Walk forward, stepping as far as possible. Keep feet 18'' apart. Return to starting point by walking Backward with the above instructions. Keep toes fwd 5 Way Hip  Place band around ankles. Stand on one leg with the other leg pushing forward 3x, pushing to the side 3x, pushing back 3x, clockwise circles 3x and counterclockwise circles 3x. Repeat with other leg. Use support surface to maintain balance if necessary.

13. Works Cited Opar D, Williams M, Shield A. Hamstring Strain Injuries: Factors that Lead to Injury and Re-Injury. Sports Medicine [serial online]. March 2012;42(3):209-226. Available from: Academic Search Premier, Ipswich, MA. Accessed November 20, 2012. Proske U, Morgan D, Brockett C, Percival P. IDENTIFYING ATHLETES AT RISK OF HAMSTRING STRAINS AND HOW TO PROTECT THEM. Clinical & Experimental Pharmacology & Physiology [serial online]. August 2004;31(8):546-550. Available from: Academic Search Premier, Ipswich, MA. Accessed November 20, 2012. Gokaraju K, Garikipati S, Ashwood N. Hamstring injuries. Trauma [serial online]. October 2008;10(4):271-279. Available from: Academic Search Premier, Ipswich, MA. Accessed November 20, 2012. Petersen J, Hölmich P. Evidence based prevention of hamstring injuries in sport. British Journal Of Sports Medicine [serial online]. June 2005;39(6):319-323. Available from: Academic Search Premier, Ipswich, MA. Accessed November 20, 2012.

14. Questions?