Acute Hamstring Strain Rehabilitation Article Review

A physical therapy review and thoughts on "A Comparison of 2 Rehabilitation Programs in the Treatment of Acute Hamstring Strains" by Marc Sherry, PT and Thomas Best, MD, PhD.  Originally published in the Journal of Orthopaedic & Sports Physical Therapy.  This study was performed by researchers from the University of Wisconsin.  Volunteers with acute hamstring injuries were recruited from multiple sport backgrounds and randomized into groups.

The discussion here is based on the time to return to sport after acute injury (<10 days old) to the hamstring muscle complex.  Additionally, the rate of re-injury both at initial return and within a year after return were reported.  All of the volunteers had Grade 1, small or non-existant tearing, or Grade 2, partial tear, injuries.  Two separate programs for the athletes with recent hamstring strains were evaluated.  They were not separated by degree of injury and each group used athletes with both Grade 1 and 2 injuries.  The first group underwent static stretching, isolated progressive hamstring resistance exercise, and icing (from here will be referred to as SS group).  The second group performed progressive agility and trunk stabilization exercise combined with icing (PA group).

This study showed what we have seen as a increasing trend in rehabilitation in all levels of rehab.  More research and belief in "Full ROM and full range exercise" for stretching and return of pain free motion continues to compile.  The SS group is what many people would commonly do.  They rest it, stretch it lightly to tolerance, ice it, take pain meds, then slowly return to exercise and ramp it up as they feel better.  Can this work?  Of course it can!  Is it the best?  Research often will point to no for most individuals.  In this study, 54.5% of the individuals in the SS group re-injured their hamstring in 2 weeks, and 70% were re-injured within a year.  Comparatively, the PA group performing dynamic active range of motion (AROM) and full range exercise/plyometrics/agility training without further provocation of the injury showed a 0% re-injury rate within 2 weeks and a 7.7% re-injury rate within 1 year.  Additionally, the researchers reported the average return to sport for the SS group was 37.4 days compared to 22.2 days for the PA group.

Here is the program of the PA group divided into Phase 1 and Phase 2.  Patients were progressed when they were able to walk normally as well as march their symptomatic leg without pain.

The following information is from the article referenced at the top of this review and can be found in Table 5 of the original article.

PHASE ONE

• low-to-moderate intensity sidestepping 3 x 1 minute
• low-to-moderate intensity grapevine stepping in both directions 3 x 1 min
• low-to-modeate intensity steps forward and backward over tapeline moving sideways 2 x 1 min
• single leg stance 4 x 20 seconds progressing from eyes open to eyes closed
• planking 4 x 20 seconds
• supine extension bridging 4 x 20 seconds
• side bridging 4 x 20 seconds on each side
• Icing performed in long sitting x 20 minutes

PHASE TWO

• moderate-to-high intensity sidestepping 3 x 1 minute
• moderate-to-high intensity grapevine stepping in both directions 3 x 1 min
• modeate-to-high intensity steps forward and backward while moving sideways 2 x 1 min
• single leg stance windmill touches alternating sides 4 x 20 seconds
• push up position into trunk rotation and upward reach with one hand, rotate sides 2 x 15
• fast feet in place (running in place with quick steps) 4 x 20 seconds
• PNF trunk pulldowns with thera-band, 2 x 15 each side
• Practice of high speed activity including sprinting/cutting only performed if symptom-free
• Continue ice if symptoms present

In summary, progressive pain free active range of motion, stabilization, dynamic stretching, and dynamic strengthening were shown to help return an athlete to sport sooner as well as reduce their future risk of re-injury.  If you would like some videos or pictures of these exercises please comment below.  In a future physical therapy review we will be posting that information as well.

Thanks for stopping by!

-Nick