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Physiotherapy Examination of Acute Hamstring Strain Injuries: Pain and Palpation

Written by Shane Pongho (Physiotherapist) – RAD Centre, Ballarat VIC

My pain has improved – am I ready to play? A common question with a tricky answer!

Both the area of soreness (on palpation) and pain during daily tasks will improve early during your rehab.  

Whiteley et al. 2018 encourage clinicians to carefully palpate the injured hamstring and measure (in cm) the maximal length of tenderness. 

As a rule of thumb the maximum length of tenderness should reduce by 50% approximately one third of the way through rehab.   

Pain during daily tasks should also resolve early – which means it is less helpful in the second half of rehab unless there is an increase in pain (ie awareness during progressive running or return to training).

This can be a frustrating process as you have likely returned to sub-maximal running and are pain free during the day.

Unfortunately returning to play is not yet recommended. Take the extra time (sometimes weeks) to return to performance, and reduce your risk of re-injury. 

Do you have a return to play checklist?   

Take Home: 

  • Pain with daily tasks improves early
  • Your area of soreness on palpation improves early 

References:

  • Whiteley, R., et al. (2018). Clinical implications from daily physiotherapy examination of 131 acute hamstring injuries and their association with running speed and rehabilitation progression. British Journal of Sports Medicine. 52(5): 303-310. 

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Physiotherapy Examination of Acute Hamstring Strain Injuries: Strength

Written by Shane Pongho (Physiotherapist) – RAD Centre, Ballarat VIC

Why do we measure strength after a hamstring strain injury?

Strength testing is a useful clinical tool in the first half of your rehab when performed in long-lever positions. 

After injury we prefer to assess hamstring strength with a hand-held dynamometer (HHD) in outer range positions.

Whiteley et al. 2018 identified that testing strength in an outer range position offered more relevant information than mid-range and inner-range positions. 

As a rule of thumb we expect your outer range strength to approach 75% of the un-injured leg during the first half of your rehab. 

Outer range strength testing appears consistent across the literature. 

Wollin et al. 2016 assessed isometric hamstring strength at 30 degrees of knee flexion (and 45 degrees on hip flexion) using an externally fixed device. 

This position is difficult to replicate in private practice – however we try to replicate 30 degrees of knee flexion when assessing hamstring strength using the Force Decks.  

Crema et al. 2017 used isometric knee flexion force in their clinical examination to try and identify acute injuries involving the intramuscular tendon. 

Another clue in identifying these injuries may be a reduction in isometric strength at 15 degrees of knee flexion.

Take Home: 

  • Strength testing is important – but so is the position you assess hamstring strength
  • Outer range strength appears the best strength measure to guide/progress rehab
  • Similar to flexibility – we see greater strength improvements in the first half of rehab

 

Do you have a Hamstring injury that needs to be assessed in Ballarat? Click through to our Physiotherapy page to find an appointment time:

https://radcentre.com.au/physio-ballarat/

 

 

References: 

  • Whiteley, R., et al. (2018). Clinical implications from daily physiotherapy examination of 131 acute hamstring injuries and their association with running speed and rehabilitation progression. British Journal of Sports Medicine. 52(5): 303-310. 
  • Wollin, M., et al. (2016). Reliability of externally fixed dynamometry hamstring strength testing in elite youth football players. Journal of Science and Medicine in Sport. 19(1): 93-96.
  • Crema, M. D., et al. (2017). Can a Clinical Examination Demonstrate Intramuscular Tendon Involvement in Acute Hamstring Injuries? Orthopaedic Journal of Sports Medicine. 5(10): 1-8.
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Physiotherapy Examination of Acute Hamstring Strain Injuries: Flexibility

Physio Ballarat

Written by Shane Pongho (Physiotherapist) – RAD Centre, Ballarat VIC

Why do we measure flexibility after a hamstring strain injury?

Assessing flexibility via the maximum hip flexion active knee extension test (MHFAKE Test) is a nice way to guide your rehab in the early stages. 

Whiteley, et al. 2018 found the MHFAKE Test the most useful flexibility measure to track rehabilitation progress. 

As a rule of thumb we expect the flexibility of your injured leg to return to normal during the first half of your rehab. 

For example – if your flexibility is normal two-weeks after injury this may indicate a four-week injury.   

The Active Knee Extension Test is another way to measure flexibility after hamstring injury. 

We find this particularly useful with more severe injuries as some do not tolerate maximal hip flexion positions. 

Crema et al. 2017 highlighted deficits in this position as a potential clue for intramuscular tendon involvement. 

Take Home: 

  • Flexibility is a useful outcome measure early after hamstring strain injury 
  • Your flexibility should return to normal in the first half of your rehab  
  • As you get closer to return to play – flexibility measures become less relevant 

Do you have a Hamstring injury that needs to be assessed in Ballarat? Click through to our Physiotherapy page to find an appointment time:

References: 

  • Whiteley, R., et al. (2018). Clinical implications from daily physiotherapy examination of 131 acute hamstring injuries and their association with running speed and rehabilitation progression. British Journal of Sports Medicine. 52(5): 303-310. 
  • Crema, M. D., et al. (2017). Can a Clinical Examination Demonstrate Intramuscular Tendon Involvement in Acute Hamstring Injuries? Orthop J Sports Med. 5(10): 1-8.