There are 4 components of a proper hamstring prevention program. These are aimed to incorporate the many ways that the hamstring is used in sport where it is most commonly injured; the muscle has the ability to stretch statically and dynamically, contract concentrically and eccentrically and also performs in rapid changes between the concentric and eccentric motions as in plyometric activity. **Before any activity, including stretching, it is important to warm up properly to increase blood flow to the muscles for effective stretching and to reduce the risk of injury. Examples of proper warm up include jogging, biking, jump rope, jumping jacks, etc.**

Static stretching; should be performed for 30 seconds each with no ballistic movement at end range.

1. Pike
2. Hurdles left and right
3. Straddle o Supine Hamstring stretch with belt
4. Standing Hamstring stretch with anterior pelvic tilt
5. Splits (gymnasts, cheerleaders, figure skaters, dancers, etc)

Dynamic stretching; walking dynamic stretches should be performed for as many stretches as possible within approximately 10 yards. Walking quad stretch Walking knee to chest Frankensteins Side Lunges

1. Inch Worms
2. Walking hamstring stretch Helicoptors
3. Stepping Backwards

Leg swings – these are performed stationary with one hand supported for balance. Swing straight leg forward until stretch is felt and then repeat into hip extension, progressively increasing the range.

Plyometrics: These are important exercises for the prevention of hamstring strain due to their ability to use the hamstring muscle at its greatest length and highest force. Please see plyometric program embedded in this rehabilitative program.

Progressive Resistive Exercises are also required to increase the strength of the hamstring to further prevent injury. Standing Hamstring curls Prone hamstring curls Concentric hamstring curls

Eccentric Hamstring curls Romanian Dead Lifts :

REHABILITATION AND EXERCISE PROGRESSION AFTER GRADE II HAMSTRING STRAIN

Notes:

1. Muscle most commonly affected is long head of the biceps femoris, usually just proximal to the musculotendinous junction 6-16 cm proximal to the knee joint.
2. Immobilization if required should be in the lengthened position and should not last longer than 1 week
3. The use of NSAIDS is controversial in the first few days because of the potential for impeding healing; evidence suggests that NSAIDs have no additive effect on the healing rate. Acute Phase (3-4 times a day)
4. Rest (immobilization in a lengthened position for no longer than 1 week, then relative rest)
No antalgia with gait: if antalgic, supplement with assistive device o Gentle stretching (pain less than 3/10)
5. Ice in lengthened position (in long sitting with as much active pain free knee flexion and extension as possible)
6. Compression and elevation until thigh girth stabilizes
7. NSAIDS no sooner than 2-4 days after injury
8. Retrograde massage may be implemented for swelling control. DTM may begin when girth is stabilized
9. Modalities- sensory Estim can be used

Criteria for progression: No increase in thigh girth measured 8 cm proximal to the patella; SLR to 80 ̊ with an estimation of 3 or less on a numeric rating scale where 0 = no pain and 10 = maximal pain Test: The foot is plantar flexed and the examiner slowly (about 30 ̊/s) raises the leg Subacute Phase: day 3 to >3 weeks

1. Stretching (3-4 times/day)
Progressively increase stretch to full ROM (stretched across hip and knee)exercises. Self stretching
2. Begin with standing technique with anterior pelvic tilt
3. Progress to aggressive self-stretching and partner stretches
4. Strengthening progression (daily)
Isometric knee flexion
5. begin with sub-maximal isometric holds at multiple joint angles (0 ̊, 30 ̊, 60 ̊, 90 ̊) and progress to maximal holds

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