Chronic Hamstring Pain: Gymnastics Case Study

In this case study you’ll see how I blend take The Eclectic Approachand throw in a little yoga as to treat a youth athlete. 
History: Pt is a high-level gymnast with a h/o acute hamstring injury 8 months ago. She was treated in a traditional outpatient PT setting and is now pain free with ADLs. She still has pain during running, tumbling, and vaulting preventing her from competing at her highest level. Alleviating factors include rest, activity avoidance, over the counter pain medication.  
Objective:
  • R SLR PROM lacking 20 degrees from opposite side 
  • FADDIR decrease and painful pinch with overpressure
  • Unable to maintain transverse abdominis (TA) contraction and breathing with hook lying knee lifts, significantly more ASIS movement on R
  • Bridge with increased activation of hip flexors on R
  • Palpable soreness of proximal R HS near ischial tuberosity 
  • Test/retest of gymnastics skills complicated by concurrent UE injury (different mechanism of injury but could be another case study on its own) that limited UE weight bearing during the first 1-4 visits. 
1st Visit:
2nd Visit:
  • SFMA Rolling – patient had the most difficulty going supine-prone
  • IASTM proximal hamstring 
  • Posterior chain activation exercise including single leg bridge, double leg bridge with single leg lift
  • Yoga poses: Warrior I, II, III series for challenging hamstring response to stress and concentric/eccentric loads
  • By the end of treatment session pt lacking only 5 degree PROM test by SLR compared to unaffected side. Also able to perform splits and cartwheel pain free. 
3rd and 4th visit: 
  • Completing practice pain free (with the exception of vaulting – separate wrist issue) 
  • Strength deficit on R – unable to perform single leg squat to the floor 
  • Worked on retraining of landing mechanics with 2 footed and single leg jumping to improve force distribution during gymnastics. 
  • Continuing posterior chain activation exercises from above with additional of single leg squat.
  • Yoga poses to focus on pelvic control and neutral spine in quadruped with extension of arms and legs. Progressing difficulty of core rotational stability. 
  • Added chair pose with emphasis on seating femoral head in acetabulum through tactile cueing of hip ERs prior to starting pose. Pt seeing immediate improvement in squat by being able to lower down farther and with decreased pain. 
  • Instructed on how to use yoga strap to perform a self-inferior glide/hip corkscrew for R hip (will post a video of this soon!) 
  • By 4th visit had equal HS PROM for the first time in 8 months. 
Final Thoughts:
  • Sciatic neurodynamics was very important for regaining full hamstring motion needed for gymnastics 
  • Activation of posterior chain and hip external rotators crucial to retraining squatting 
  • This may be obvious…but your rehab needs to be SPORT specific. Too many times I see gymnasts who are “discharged” from PT, however still have deficits that either severely limit their gymnastics or put them at high risk for re-injury. 
Christine Walker owns her own PT practice inside in Charlotte, NC where she helps active adults and athletes get back to the activities and sports they love without painkillers, injections, or multiple trips to the doctor’s office. To learn more visit her website or connect with her on Twitter.
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic…

#mc_embed_signup{background:#fff; clear:left; font:14px Helvetica,Arial,sans-serif; } /* Add your own MailChimp form style overrides in your site stylesheet or in this style block. We recommend moving this block and the preceding CSS link to the HEAD of your HTML file. */

Advertisements

Published by

bettydroche

My interest in health and fitness started at a young age. Even though I had been educated and trained as an engineer in Europe I always want to follow my passion. I have made some guest appearances on a health educational program TV in Europe and, this experience, has made me follow my passion of sharing wellness information with others.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s