First of all, to all the people who attended, I hope you enjoyed the seminar as much as I did. Fearghal gave a great overview of all things related to Hamstring Injuries. It’s a complicated area and while we have made large strides in the past few years, I do think from the research that we are only beginning to really understand the issue.
Normally when we go to these Seminars, we often don’t reflect and learn from them as much as we should (I have been guilty of this). So I would encourage you all to give yourself an hour or two and review the slides over the next few weeks, notebook by your hand and scribble your learning points down. Practice some of the exercises that we did, review the methods of assessment and reflect on how you can upgrade your clinical management of these injuries. The easiest way to re-inforce the information and learn is to chat to people about this and discuss some of the main points.
A few things I took away from the seminar I will outline below.
Don’t be afraid to load the hamstrings as soon as the athlete can tolerate the load. This is helpful, not harmful.The traditional conservative approach is not going to help in the long term. The research has shown that having hamstrings long and strong is really important to protect against injury. Fearghal touched on how they use Nordics and other very high load hamstring exercises early in their program, and there will be more research published later this year on this early stage intensive loading. Watch the space!
Always start from the end. What do you want your athlete to be able to do before returning to play in order for you and the athlete to have full confidence in their hamstring?
Most don’t have access to Nordbord, so maybe a certain number of repetitions of Nordic Hamstring Exercise? Certain amount of strength measured using a Dynamometer.
Minimal amount of loading through a range of exercises e.g. RDL, SLDL, TRx Rollouts etc.
Minimal number of training sessions completed?
Hitting certain speed markers?
Assess, re-assess, re-assess… As you progress through the rehab programme, are you actually getting better? Fearghal spoke about re-assessing the assessables. Unless the markers you have used during the initial assessment are improving, how do you know that your rehabilitation programme is working?
Is the site of palpation smaller?
Is their pain during rehab? During specific exercises?
Has their passive knee extension improved?
Has their outer range knee flexion strength improved?
Know the running demands of the sport. This is extremely important. Are you giving out a generic rehab programme or preparing that individual for their sporting demands?
What sport does that person play?
What are the positional demands of that sports? Defender vs Midfielder?
What is the overall running volume of that sport?
How many max speed runs will that person be potentially exposed to during a game situation?
Is that person ready for the worst case scenario or minimal demands?
How can you replicate those demands in rehabilitation?
Always be on the watch out for the unexpected.
Know your mechanism of injury. This can give you a better idea of the potential area of injury and also give you a better prognosis in the timeline to return to play (Askling, 2013).
Sprinting? Probably the Biceps Femoris Long head
Stretch? Potential for more proximal tears of the hamstring group. Time to return to play will be longer, median 50 days.
Position of knee and hip during injury?
Be aware of pop and loss of function that may suggest an avulsion.