STUDY DESIGN: Case report. BACKGROUND: After 2 attempts at conservative care for a diagnosis of hamstring strain, the patient had a surgical hamstring allograft reconstruction. The purpose of this report is to describe the physical therapy approach to postoperative management of a hamstring reconstruction. CASE DESCRIPTION: A 24-year-old female coach who sustained a complete avulsion of the proximal hamstring tendon while playing softball had a surgical hamstring reconstruction using an Achilles tendon allograft. Precautions concerning range of motion and stretching, weight-bearing status, and brace were followed to protect the surgical graft. Treatment incorporated cardiovascular, strength and proprioception exercises, and progressed with the focus on correct movement patterns and eccentric muscle control during functional movements. OUTCOMES: The patient attended 25 physical therapy sessions over 7 months. Muscle strength improved from 4/5 to 5/5. Straight-leg raise range of motion decreased from 145 degrees to 90 degrees . Lower Extremity Functional Scale (LEFS) scores improved from 15/80 to 70/80. DISCUSSION: A complete avulsion of the proximal insertion is rare. Conservative management of hamstring tears has traditionally focused on end-range passive stretching, modalities, and direct hamstring strengthening. New evidence recommends a program that is more protective of the injured tissue and includes exercises such as core stabilization; indirect hamstring strengthening may be beneficial in the treatment of hamstring injuries. This concept was taken into account when considering the rehabilitation protocol and progression for this patient. LEVEL OF EVIDENCE: Therapy, level 4.
STUDY DESIGN: Case report. BACKGROUND: After 2 attempts at conservative care for a diagnosis of hamstring strain, the patient had a surgical hamstring allograft reconstruction. The purpose of this report is to describe the physical therapy approach to postoperative management of a hamstring reconstruction. CASE DESCRIPTION: A 24-year-old female coach who sustained a complete avulsion of the proximal hamstring tendon while playing softball had a surgical hamstring reconstruction using an Achilles tendon allograft. Precautions concerning range of motion and stretching, weight-bearing status, and brace were followed to protect the surgical graft. Treatment incorporated cardiovascular, strength and proprioception exercises, and progressed with the focus on correct movement patterns and eccentric muscle control during functional movements. OUTCOMES: The patient attended 25 physical therapy sessions over 7 months. Muscle strength improved from 4/5 to 5/5. Straight-leg raise range of motion decreased from 145 degrees to 90 degrees . Lower Extremity Functional Scale (LEFS) scores improved from 15/80 to 70/80. DISCUSSION: A complete avulsion of the proximal insertion is rare. Conservative management of hamstring tears has traditionally focused on end-range passive stretching, modalities, and direct hamstring strengthening. New evidence recommends a program that is more protective of the injured tissue and includes exercises such as core stabilization; indirect hamstring strengthening may be beneficial in the treatment of hamstring injuries. This concept was taken into account when considering the rehabilitation protocol and progression for this patient. LEVEL OF EVIDENCE: Therapy, level 4.
Authors: Carl M Askling; George Koulouris; Tönu Saartok; Suzanne Werner; Thomas M Best Journal: Knee Surg Sports Traumatol Arthrosc Date: 2012-12-11 Impact factor: 4.342
Authors: Bryan C Heiderscheit; Marc A Sherry; Amy Silder; Elizabeth S Chumanov; Darryl G Thelen Journal: J Orthop Sports Phys Ther Date: 2010-02 Impact factor: 4.751
Authors: Harry M Lightsey; David E Kantrowitz; Hasani W Swindell; David P Trofa; Christopher S Ahmad; T Sean Lynch Journal: Orthop J Sports Med Date: 2018-02-23