This season, a soccer coach sent in one of his high school athletes to the clinic who had a re-occurring hamstring injury that had plagued the better part of his 2015-2016 season. The coach mentioned that this particular athlete had 3 NCAA Division 1 offers on the table and that these NCAA coaches were getting worried about this nagging condition and might pull the offers off the table.
We brought in the athlete for an assessment and this soccer player was one of the strongest/fittest athletes of his age group that we had seen. However, he also failed a plethora of functional tests, that one would assume he would pass with flying colors. Without going deep into the assessment; our working diagnosis was that of a Grade 2 Proximal Bicep Femoris (hamstring) Strain.
A proximal hamstring strain is quite common in sports that involve high speeds and the risk of re-injury is quite high at over 60%. The injury usually occurs to the Bicep Femoris (Hamstring) muscle during sudden eccentric loading (swing phase) when the hamstring is lengthened and absorbing energy from the descending limb that is getting ready for foot contact with the ground. Usually improper training, adaptive changes in biomechanics and motor patterns, and early return to sport can cause these injuries to re-occur.
We like to use a comprehensive approach to therapeutic management of these injuries at Performance Sports Therapy that include: soft tissue therapy, joint mobilizations, and neurofunctional acupuncture to help speed up healing and prevent re-occurrence. But the most important aspect is the rehabilitation.
We use advanced rehab protocols from Integrated Therapeutics to ensure that we decrease the risk of re-injury and return the athlete to sport safely.
No pain with isometric and concentric movements through different degrees of movement.
Start with low to moderate sidestepping and basic movement drills. Through all three phases of rehab we will to work on proper mobility and movement specific strategies tailored to the athlete based on their limitations.
Progressive lumbopelvic stability and proprioceptive program, that includes simple exercises like glute bridges and single leg stance.
Include moderate to high intensity movement drills.
Progressive neuromuscular control exercises, that include using a physio or bosu ball.
Begin simple eccentric hamstring exercises, such as supine bent knee bridge walk outs.
Start to incorporate speed-strength training exercises, for example dead lifts and eccentric box drops.
Progressive neuromuscular training to include single limb balance windmill touches with dumbbells.
Begin the Nordik hamstring eccentric strengthening protocol.
It is important that we progress properly before moving on, and there is no clear cut timeframe for this as everyone will be at different stages in their recovery and might not come into the clinic right away. For example, this particular athlete took 12 weeks to progress through this protocol while refraining from any in-game activity. However, working with this athlete and coach we were on the same page the entire time and we all worked together to progress what this athlete was able to do in practice along the way. At the end of the day there was short term sacrifice for long term gain.
Feel free to contact us at Performance Sports Therapy with any questions you may have about your injury, or if you are interested in an injury prevention training program.
Dr. Devin Chohan