AFL Hamstring

Hi, this is my first post- thanks for helping!
I am a physiotherapist working at an Australian Rules Football Club; I am currently dealing with a 23 year old player with a 5 week old hamstring injury.

He initially injured it 5 weeks ago whilst kicking the football- he did not think it was much at the time, just a bit of tightening on follow through. He presented to me the next day with mid-belly hamstring pain. I could not palpate a specific tender spot, he reported it just felt a bit tight. Strength tests were good, he had Gr 4+/5 strength on both concentric and eccentric tests- it was slightly more painful when biasing semimem/tend. Hamstring length was about -15 degrees of knee ext bilaterally in supine with hip at 90 degrees. No pain on stretch.

I estimated about a 2 week time frame (miss one game). On fitness testing 2 weeks after the initial injury he got through a 3km run and a shuttle test (sprinting, run throughs at different speeds and over different distances) without problem. When he started kicking the ball he could kick approx 30m from a stationary position and also around the body, but a longer kick on the run reproduced pain. It is now 3 weeks later and he still hasn't been able to play. He is running really well and doing sprinting, agility work no problems- it is still the long kick on the run.

Lumbar spine assessment was ok, slump was good as well. Gluts also do not seem to be contributing. He is doing strength exercises in standing with a theratube and mimicking kicking. I cannot produce his pain during assessment and deep palpation/massage (with elbow!) cannot seem to hit the spot.

Any ideas?? Am I missing something or being impatient? I am relatively new to the footy scene.

Thanks heaps for your help!

Hi kristy,
Out of curosity how is his Hip internal rotation on the side of the tear compared to the non-injured side. Sometimes with football players the quadratus femoris can become adhered to the hamstring thus the pain on running with the greater degree of flexion in the hips whilst kicking.
With hamstrings it is always wothwhile checking the hips.
C

You have not written about the physiotherapy management of your patient. What management plan have you adopted so far?

A hamstrings strain is may be caused by a sudden high velocity movement seen in sprinters, hurdlers and high jumpers. Associated causative factors include poor flexibility, inadequate warm up, fatigue, and quadriceps/hamstring muscle imbalance.

It is treated with Ice and wrap and with ice and ultrasound. Once soreness is gone, progression is made to hamstring curls, high speed cycling and stretching ( including dural stretching ).

Hamstring Strain Rehabilitation Exercises

You can begin gently stretching your hamstring right away by doing standing hamstring stretch. Make sure you do not feel any sharp pain, only a mild discomfort in the back of your thigh when you are doing this stretch.
• Standing hamstring stretch: Place the heel of your leg on a stool about 15 inches high. Keep your knee straight. Lean forward, bending at the hips until you feel a mild stretch in the back of your thigh. Make sure you do not roll your shoulders and bend at the waist when doing this or you will stretch your lower back instead. Hold the stretch for 15 to 30 seconds. Repeat 3 times.
After the standing hamstring stretch has become easier, you can do the hamstring stretch on a wall. You should also stretch your calf muscle because it attaches near where your hamstring ends using the standing calf stretch.
• Hamstring stretch on wall: Lie on your back with your buttocks close to a doorway, and extend your legs straight out in front of you along the floor. Raise the injured leg and rest it against the wall next to the door frame. Your other leg should extend through the doorway. You should feel a stretch in the back of your thigh. Hold this position for 15 to 30 seconds. Repeat 3 times.
• Standing calf stretch: Facing a wall, put your hands against the wall at about eye level. Keep the injured leg back, the uninjured leg forward, and the heel of your injured leg on the floor. Turn your injured foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times. Do this exercise several times each day.
When the pain is gone, start strengthening your hamstrings using the next 3 exercises.
• Prone knee bends: Lie on your stomach with your legs straight out behind you. Bend your knee so that your heel comes toward your buttocks. Hold 5 seconds. Relax and return your foot to the floor. Do 3 sets of 10. As this becomes easier you can add weights to your ankle.
• Prone hip extension: Lie on your stomach with your legs straight out behind you. Tighten up your buttocks muscles and lift one leg off the floor about 8 inches. Keep your knee straight. Hold for 5 seconds. Then lower your leg and relax. Do 3 sets of 10.
• Elastic tubing hamstring curls: Sit in a chair facing a door (about 3 feet from the door). Loop and tie one end of the tubing around the ankle of your injured leg. Tie a knot in the other end of the tubing and shut the knot in the door. Bend your knee so that your foot slides along the floor and moves back underneath the chair, stretching the tubing. Slowly let your foot slide forward again. Do 3 sets of 10.
You can challenge yourself by moving the chair farther away from the door and increasing the resistance of the tubing.
• Chair lifts: Lie on your back with your heels resting on the top of the a chair. Slowly raise both hips off the floor. Hold for 2 seconds and lower slowly. Do 3 sets of 15.
You can challenge yourself by standing only on your injured leg and lifting your heel off the floor. Do 3 sets of 10.
After your hamstrings have become stronger and you feel your leg is stable, you can begin strengthening the quadriceps (the muscles in the front of the thigh) by doing lunges.
• Lunges: Stand and take a large step forward with your right leg. Dip your left knee down toward the floor and bend your right leg. Return to the starting position. Repeat the exercise, this time stepping forward with the left leg and dipping the leg on your right side down. Do 3 sets of 10 on each side.