Hamstring rehabilitation challenges -10 Tips for Clinical Assessment

Hamstring strains are the “Achilles Heel” of many sports participants (couldn’t resist the pun!). The tendency for recurrence is legendary and the myriad of available treatments indicating  limited understanding of the etiology

Acute management is not difficult but the clinical challenge is defining the mechanism of breakdown and planning appropriate treatments to prevent recurrence.

Recalling the hamstring’s role during gait…..

• They demonstrate peak activity during the terminal portion of swing phase, during which they decelerate the forward motion of the extending leg (eccentric activity).

• They contract through most of the contact period where they assist gluteus  maximus with decelerating flexion (eccentric activity) and initiating extension of the hip joint (concentric activity).

• A burst of activity during late propulsion may act to assist gastrocnemius with flexing the knee.

Recalling the hamstring’s anatomy…..

The hamstrings are composed of:

• Biceps femoris
• Semitendinosus
• Semimembranosis

The Biceps femoris originates on the inner medial ischial tuberosity and sacrotuberous ligament, and inserts onto the head of the fibula and lateral condyle of the tibia. Since it acts posterior to the hip, it extends the femur. Since it acts posterior to the knee, it flexes the leg.

The Semitendinosis originates from the lower medial ischial tuberosity and inserts into the medial body of the tibia. Like biceps femoris it extends the femur and flexes the knee.

The Semimembranosis originates from the upper outer ischial tuberosity and inserts into the posterior medial aspect of the tibial condyle. Its actions are the same as the other two hamstrings.

Clinical Hypotheses – 10 Tips for Clinical Assessment

The following list provides framework to assess contributory factors to injury. Some are easier to explore with more definitive test interpretation while others fit more into the category of hypotheses to push through rehabilitation bottlenecks.

1 Hamstring Flexibility deficits

2. Gastrocnemius /Soleus flexibility deficits

3. Hamstring / Quadriceps strength  Imbalance

4. Quadriceps recruitment deficit

5. Excessive Hamstrings /quadriceps co-contraction

6. Hamstrings / Gastrocnemius paradox

7. Hip Extensor flexibility deficit

8. Hip extensor power deficit

9. Trunk stability deficit

10. Rotational control deficit

PS

11. Foot alignment

We will explore each of these components in subsequent posts.

Rise to the clinical challenge.
David

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