{"id":2452,"date":"2019-03-11T12:19:19","date_gmt":"2019-03-11T12:19:19","guid":{"rendered":"https:\/\/andreasphysioblog.com\/?p=2452"},"modified":"2021-06-17T04:10:59","modified_gmt":"2021-06-17T04:10:59","slug":"tyler-t-f-schmitt-b-m-nicholas-s-j-mchugh-m-p-2017-rehabilitation-after-hamstring-strain-injury-emphasizing-eccentric-strengthening-at-long-muscle-lengths-results-of-long-term-fol","status":"publish","type":"post","link":"https:\/\/andreasphysioblog.com\/?p=2452","title":{"rendered":"Tyler, T. F., Schmitt, B. M., Nicholas, S. J., & McHugh, M. P. (2017). Rehabilitation After Hamstring-Strain Injury Emphasizing Eccentric Strengthening at Long Muscle Lengths: Results of Long-Term Follow-Up. Journal of Sport Rehabilitation"},"content":{"rendered":"
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Tyler, T. F., Schmitt, B. M., Nicholas, S. J., & McHugh, M. P. (2017). Rehabilitation After Hamstring-Strain Injury Emphasizing Eccentric Strengthening at Long Muscle Lengths: Results of Long-Term Follow-Up. Journal of Sport\u00a0Rehabilitation<\/h1>\n<\/header>\n
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Tyler, T. F., Schmitt, B. M., Nicholas, S. J., & McHugh, M. P. (2017). Rehabilitation After Hamstring-Strain Injury Emphasizing Eccentric Strengthening at Long Muscle Lengths: Results of Long-Term Follow-Up. Journal of Sport Rehabilitation<\/em><\/p>\n

Progressive criteria based rehabilitation protocol emphasising eccentric exercises at long hamstring muscle length is effective in reducing injury recurrence.<\/p>\n

50 athletes who enrolled in the study, those who completed the structured strengthening programme and met return to sport criteria (N42) remained pain free to years after return to play, whereas athletes who was non compliant with the exercises suffered a re injury in the following 3-12 month,<\/p>\n

Phase 1 <\/strong><\/p>\n

Goals <\/strong><\/p>\n

\u2022 Protect healing tissue.<\/p>\n

\u2022 Minimize atrophy and strength loss.<\/p>\n

\u2022 Prevent motion loss. Protection<\/p>\n

\u2022 Avoid excessive active or passive lengthening of the hamstrings.<\/p>\n

\u2022 Avoid antalgic gait pattern.<\/p>\n

Ice<\/p>\n

\u2022 2\u20133 times daily Therapeutic Exercise (3 d\/wk, Isometric Exercise Performed Daily at Home)<\/p>\n

\u2022 Stationary bike (10\u201320 min)<\/p>\n

\u2022 Submaximal isometric at 3 angles (100\u00b0, 45\u00b0, 20\u00b0), 3 sets of 12 repetitions with 3-second hold \u2022 Single-leg balance 30\u2033 to 90\u2033, adding unstable surface as tolerated<\/p>\n

\u2022 Balance Board 30\u2033 to 90\u2033<\/p>\n

\u2022 Soft-tissue mobilization (STM)\/instrument-assisted STM<\/p>\n

\u2022 Progressive hip strengthening consisting of sidelying hip abduction, prone hip extension, straight-leg raise 3 sets of 12<\/p>\n

\u2022 Pain-free isotonic knee flexion in seated using cable column 3 sets of 12<\/p>\n

\u2022 Sciatic nerve flossing in seated (extend knee, dorsiflex foot, flex spine, the reverse steps) \u2022 Ice with sensory electrical stimulation using premodulated current 10 to 15 minutes Criteria for Progression to Next Phase<\/p>\n

\u2022 Normal walking stride without pain<\/p>\n

\u2022 Pain-free isometric contraction against submaximal (50\u201370%) resistance during prone knee flexion (90\u00b0) manual strength test<\/p>\n

 <\/p>\n

Phase 2 <\/strong><\/p>\n

Goals <\/strong><\/p>\n

\u2022 Regain pain-free hamstring strength, progressing through full range. \u2022 Develop neuromuscular control of trunk and pelvis with progressive increase in movement speed, preparing for functional movements. Protection<\/p>\n

\u2022 Avoid end-range lengthening of hamstrings if painful. Ice<\/p>\n

\u2022 Postexercise, 10 to 15 min Therapeutic Exercise (Performed 3 d\/wk)<\/p>\n

\u2022 Stationary bike 10 to 15 min<\/p>\n

\u2022 Treadmill at moderate to high intensity (progressive increasing intervals), pain-free speed and stride<\/p>\n

\u2022 Isokinetic eccentrics in nonlengthened state using Biodex isokinetic dynamometer at 0.5 rad\/s (20\u00b0\/s)<\/p>\n

\u2022 Single-limb-balance windmill touches without weight, 3 sets of 12<\/p>\n

\u2022 Single-leg stance with perturbation (eg, ball toss, reaches)<\/p>\n

\u2022 Supine hamstring curls on Swiss ball, sets of 12<\/p>\n

\u2022 STM\/instrument-assisted STM<\/p>\n

\u2022 Nordic hamstring lowers, 3 sets of 8 to 12 reps, with therapist stabilizing at ankles<\/p>\n

\u2022 Shuttle jumps, 3 sets of 12<\/p>\n

\u2022 Prone leg drops (therapist holds bent knee in hip extension and drops leg with patient attempting to \u201ccatch\u201d leg before it touches table), 10 to 15 repetitions<\/p>\n

\u2022 Lateral and retro band walks 60 to 120 feet, rest as needed<\/p>\n

\u2022 Sciatic nerve flossing as in phase 1 Criteria for Progression to Next Phase<\/p>\n

\u2022 Full strength (5\/5) without pain during prone knee flexion (90\u00b0) manual strength test<\/p>\n

\u2022 Pain-free forward and backward jog, moderate intensity<\/p>\n

\u2022 Pain-free maximal eccentric in shortened state<\/p>\n

 <\/p>\n

Phase 3 <\/strong><\/p>\n

Goals <\/strong><\/p>\n

\u2022 Symptom-free (eg, pain and tightness) during all activities.<\/p>\n

\u2022 Improve neuromuscular control of trunk and pelvis.<\/p>\n

\u2022 Integrate postural control into sport-specific movements. Protection<\/p>\n

\u2022 Train within symptom-free intensity.<\/p>\n

Ice<\/p>\n

\u2022 Postexercise, 10 to 15 minutes, as needed Therapeutic Exercise (Performed 3 d\/wk)<\/p>\n

\u2022 Treadmill moderate to high intensity as tolerated<\/p>\n

\u2022 Hamstring dynamic stretching in standing, kicking leg straight up (eg, Rockette-style kick) \u2022 Isokinetic eccentric training at end range of motion, begin with 3 sets of 10 reps and progress to 15 reps performed at 0.35 rad\/s (20\u00b0\/s)<\/p>\n

STM\/instrument-assisted STM<\/p>\n

\u2022 Plyometric jump training (double-leg hops progressing to single-leg hops, progressing to single-leg hops in multiple directions)<\/p>\n

\u2022 5- to 10-yard accelerations\/decelerations<\/p>\n

\u2022 Single-limb-balance windmill touches with weight on unstable surface 3, sets of 12<\/p>\n

\u2022 Sport-specific drills that incorporate postural control and progressive speed<\/p>\n

 <\/p>\n

Criteria for Return to Sport<\/p>\n

\u2022 Lengthened-state eccentric training pain free at 0.35 rad\/s (20\u00b0\/s) throughout available range of motion while resisting with maximal effort<\/p>\n

\u2022 Replication of sport-specific movements at competition speed without symptoms<\/p>\n

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<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Tyler, T. F., Schmitt, B. M., Nicholas, S. J., & McHugh, M. P. (2017). Rehabilitation After Hamstring-Strain Injury Emphasizing Eccentric Strengthening at Long Muscle Lengths: Results of Long-Term Follow-Up. Journal of Sport\u00a0Rehabilitation Tyler, T. F., Schmitt, B. M., Nicholas, S. J., & McHugh, M. P. (2017). Rehabilitation After Hamstring-Strain Injury Emphasizing Eccentric Strengthening at Long […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[7,190],"tags":[42],"class_list":["post-2452","post","type-post","status-publish","format-standard","hentry","category-hamstring","category-publications","tag-hamstring"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":7}},"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t