STRENGTH and CONDITIONING PROGRAMMING after HAMSTRING INJURY.

Disclaimer

Also this manual will not cover back related hamstring problems or gluteal ( piriformis) problems and tendinopathies. Back problems ( example dics

prolapses at L4/L5 and/or L5/S1) are often likely reasons to cause hamstring issues and scans ( MRI Scans) can show muscle strains as a result of the back

problem or no strains but ongoing hamstring signs .

Every hamstring is different. The approach is multifactorial and requires individual assessment and programming.

Is the inner core or “transverse abdominus” dysfunctioning?

Is there a problem with how the athlete runs?

Is there a muscle balance problem?

The list is endless and no cookbook will ever exist.

The fitness guru can be a real worry when trying weird and wonderful exercises or reading the internet and looking for the magic exercise. Another concern is

often the masseur or “magic healer” who lives around the corner and lurks in the shadows with “cure alls” for everything. Even clinicians can be a problem, given

sometimes they know little about rehabilitation, running and strength and conditioning.

And the biggest hurdle is often the athlete who wants to get back the moment

that hamstring feels pain free.

That is the reality of managing a hamstring rehabilitation.

If you have injured a hamstring or suspect an injury, you must see a qualified medical person to get an accurate diagnosis immediately. Any programs and

phases in this book must to be assessed as suitable by a qualified practitioner after they have diagnosed an injury. This information is provided to give you more information on how to plan strength and conditioning programs after

hamstring injury but the process and duration must be decided upon by qualified medical people. I will not be discussing treatment and specific rehabilitation

processes in this document. That is for the clinician

HAMSTRING RECURRENCE RATES IN SPORT

SOCCER STUDY DONE OVER 2 YEARS ( PREMIER LEAGUE ENGLAND)

What % of injuries were hamstrings? 12%

What was the re-injury rate? 12%

What muscle group was most involved Biceps Femoris 53%

How many hamstrings per club per season 5

How many matches missed per season 15

When did they occur more often In matches and second half

Who got them? Old players, premiership players, outfield players and black ethnic

players The Football Association Medical Research Programme: an audit of injuries in professional.football.. Woods et al. Br J Sports Med.2004; 38: 36-41

AUSTRALIAN RULES FOOTBALL AFL Injury Report: : Season 2006 Dr John Orchard, Dr Hugh Seward, AFLMOA . May 2, 2007

Recurrence rates for hamstrings were over 30% in the late 1990’s. This was 16% in 2006 which was the lowest on record. The average recurrence rate is still in the high 20’s.

Monday, 24 September, 2001

Owen 'distraught' after hamstring blow Michael Owen has been ruled out of England's final World Cup

game against Greece with a torn hamstring.

The Liverpool striker, a hat-trick hero against Germany, would

have been a definite starter for England's last group match at Old

Trafford on 6 October.

Liverpool manager Gerard Houllier revealed that Owen was

inconsolable after sustaining the injury against Tottenham on

Saturday.

"I thought we had seen the last of these problems with Michael,

and he is distraught at the moment," said Houllier.

WHY LESS RECURRENCES IN 2006 IN THE AUSTRALIAN STUDY? Longer rehab? The decrease in recurrences in Australian Rules Football has been paralleled by longer rehabilitation periods in the past few years ( more towards 28 days) and more time for healing and rehabilitation.

The table below shows that in Australian Rules you are have a real odds of injuring a hamstring again after rehabilitation, and the odds show that in this study, 12.6% recurred the week back and that 30.6% recurred in that season.

WEEKS AFTER RETURN FROM INITIAL INJURY

858 Hamstring Injuries AFL 1992 to 1998

1 12.6

2 8.1

3 6.8

4-5 4.7

6-8 3.1

9-14 2.7

15-22 1.4

Risk of recurrence 30.6% This is part of a table adapted from:

The Management of Muscle Strain Injuries: An Early Return Versus the Risk of Recurrence

Clinical Journal of Sport Medicine, 12:3–5 Best and Orchard

Professional Rugby Union Hamstring Statistics

Am J Sports Med. 2006 Aug; 34(8):1297-306. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union

Average Time Lost 17 days

Average time lost in recurrent injuries 25 days

Average time lost in new injuries 14 days

Hamstrings ( Running Injuries) 68%

Hamstrings ( Kicking Injuries) 36 days lost

TAKE HOME MESSAGE: ADD A WEEK TO RECURRENCES

Simply this study suggests that a week must be added if there is a recurrence in games or

even training.

IS IT WORTH FAST TRACKING REHABILITATION?

An OZ study suggests maybe yes, because it all averages out in the end as games lost!

“In numerical terms, it is preferable to have the average hamstring strain in a football player return at 3 weeks with a 90% success rate (in the first match back)

than for the average injury to take 8 weeks to recover with a 95% to 100% success rate”.

Return to Play Following Muscle Strains. Orchard, Best & Verrall . (Clin J Sport Med Volume 15, Number 6, November 2005)

Maybe in a team sport one can gamble with players using the above statistics which even out in the end. But for an athlete in with an individual sport, having one hamstring is bad enough, but having a recurrence means you may be heading towards a hamstring history. And the best predictor of getting an injury is having had it before, so beware. Get the first one fixed properly. TAKE HOME MESSAGE: As an individual don’t gamble! HEALING My opinion also is that almost the most important phase of a rehabilitation is the healing phase. Compromise this and you may pay later if nature deals you a bad hand. Adding a day or 2 to the acute ( immobilization) phase and one or two days to the sub acute ( or mobilization) phase might make all the difference. And more importantly don’t go out on the pitch and try it out at day 5. TAKE HOME MESSAGE: Let the thing heal! IS FITNESS TESTING A HAMSTRING DANGEROUS? Functional testing is often discussed when relating to criteria or reasons for return to sport, and I believe testing can sometimes lead to recurrences in games and training if done too early or too fast. So if one tests at 100% with a maximal speed test on Day 17 of a 21 day hamstring program, there is every chance that on Day 21, the player might go into the game in a stage of adaptation to the stress of eccentric exercise as described. ( or read tired hammies ) Q1: Can you safely go 100% speed at Day 17 of a rehab.? Q2: With 3 extra days would that player have improved and be able to go 100%?

TAKE HOME MESSAGE: Don’t’ risk everything in a fitness test. EDUCATED JUDGEMENTS and HAMSTRINGS With short rehabilitations ( 14 to 28 days maybe I short? ) I believe educated judgements have to be made at 90/95% of maximal speed and then at least 48 hour rest if possible is needed from those sub-maximal tests. Obviously if one gets time in a rehab, a 100% test is invaluable from a re-assurance point of view and also a specific conditioning perspective. But adaptation and recovery can take up to 7 days for maximal eccentric ( or fast explosive) exercise as many studies have shown.

TAKE HOME MESSAGE: Make sure you have adapted to training sessions before going 100%. DIFFICULT FOOTBALL REHABS: Personal Case Studies. After a recurrence we decided to do a 5 week ( 35 day) program. At day 27 I did maximal speed and agility tests on an athletics track for flying 20m and the player had DOMS ( Delayed Onset Muscle Soreness) for 4 days. He played 8 days later ( Day 35). He may have survived if he had played at day 28, but would have been sore ( DOMS) for days after the game, or he might have recurred due to fatigue from repeating maximum sprints in a game. Who knows! I remember another player who kept running 90% for a speed test and insisted his hamstring was ok. I knew his maximum time. Thus he was operating at 90% of his maximum speed and he was ruled out even though he looked ok to the media and staff and said he was ok. He then admitted later he still had some minor awareness! That’s how fine this is at the elite levels.

The game is either the blue dot or the red dot. The blue dot is 6 days after the test

and the red dot is 4 days after.You fitness test the athlete at 95/100 % on the training

day. Maybe 8 fast strides and 2 agilities and then 30 mins of sports specific training at 90%. Accelerated recovery means you get all your treatment and training and eat well and so on. So if you do that you will be ok for the blue dot. . But if the game

was the red dot then you would be in big risk of recurrence

Fitness Test

95/100%

Possible Game

Days

ANATOMY

BICEPS FEMORIS

Long Head Biceps

From Ischial Tuberosity

Flexes the knee and extends the knee

Short Head Biceps From femur

Flexes the knee and rotates

the knee laterally.

SEMI TENDINOSUS From Ischial Tuberosity

To medial side tibia

Extends the Hips

Flexes the Knee

Rotates the tibia inwards & more when the knee is

flexed.

SEMI MEMBRANOSUS From Ischial Tuberosity

To postero medial side tibia

Extends the Hips

Flexes the Knee

Rotates the tibia inwards &

more when the knee is flexed.

HAMSTRING ACTIONS

1. Concentrically flex or bend the knee, extend the hip & rotate the tibia 2. Eccentrically decelerate knee extension, hip flexion & tibial rotation: As the lower leg extends out the hamstrings stop overstriding and “brake” the shin so it comes back and under the centre of gravity. 3. Work synergistically with the Anterior Cruciate Ligament to stabilize tibial translation.

The hamstrings produce & control forces in multiple planes.

HIP FLEXORS AMD HAMSTRINGS

Tight hip flexors can cause anterior ( forward) pelvic tilt which puts hamstrings on stretch.

WHAT DO THESE 2 MUSCLES DO?

Work with back muscles and abdominals ( erector spinae, multifidus &

deep abdominal wall ) to balance and stabilize the trunk and pelvis.

Can switch off the gluteus maximus and deep back and abdominal

muscles when the hip flexors are tight and in spasm and thus cause a lack

of drive or hip extension.

When the athlete has hit full stride the hip flexors are on stretch and then

they contract eccentrically and start the next hip drive.

HIP FLEXORS Psoas

Iliacus

WHERE THEY COME FROM AND ATTACH TO?

PSOAS: This attaches ( or has it origin at) to the transverse

processes of L1 to L 5 and to the bodies and discs of T12 to L5. It

flexes ( or bends) the hip and also rotates it laterally. It also bends

or flexes the spine.

ILIACUS: This attaches ( or has it origin at) on the hip bone ( or

ilium ) and also to the sacrum and a few ligaments ( sacroiliac &

iliolumbar).

It flexes ( or bends) the hip and also rotates it laterally

Both these muscles attach to the lesser trochanter of the femur.

ILIOPSOAS

( Hip Flexors)

MUSCLE IMBALANCES Given the hamstrings arise on the ischial tuberosity (pelvis), all these impbalances can have a dramatic effect on hamstring functioning. So sometimes just getting muscles stronger may actually cause more problems.

ANTERIOR ( forward) TILT OF THE PELVIS AND TIRED HAMSTRINGS

Anterior ( or forward) tilt is seen in injured athletes, correlating with over-striding and a lack of ability to maintain trunk stability and tired overworked hamstrings.

Often the athlete has poor mechanics and hip flexor activation and so needs to work on running drills and technique.

Or an athlete may have poor trunk stabilization and lose control of the pelvis and thus overstride causing a cascade of other symptoms.

Assess dynamic posture and take a video of the athlete running and jumping at high speed in the preseason if possible.

NEED 1: Get some strength and control in the abdominal muscles, obliques and transverse abdominus. NEED 2: Hip flexors ( psoas and iliacus) may need to be stretched as with quadriceps. * The back muscles in my opinion are better off strong and tight and with most athletes aggressive flexion should be avoided.

Muscle Imbalances that may cause Posterior ( rear) Pelvic Tilt.

NEED 1: Strength and control in the hip flexors ( psoas and iliacus) and the back muscles.

NEED 2: Control issues should still be addressed in the abdominal muscles and obliques ( and especially transverse abdominus!) but also stretching of the abdominal area ( through extension exercises)

NEED 3: Gluteal muscles and hamstring muscles may need to be stretched when in posterior tilt.

*I have seen these conditions respond very well to classic Pilates training

Hamstrings may be tight due to a number of reasons such as

1) Genetic, and in general women and children are more supple than men.

2) Not enough stretching after exercise when muscles are warm and receptive to stretching.

3) Problems in the lower back can put pressure on the sciatic nerve which runs down the legs and cause muscles to tighten.

FRONTAL INSTABILITY

Core stability issues may need to be addressed and then specific back tightness and weakness problems worked on

Then gluteus medius strength work is needed here:

Side lying leg raises ( or Clamshells)

Hitch lifts

One leg squats

Dynamic hops and

drills

MUSCLE BALANCE, STRENGTH and RANGE of MOTION If the hip flexors and quadriceps are shorter or tighter than normal, then hip extensors and the hamstrings have to work harder to stretch out in a stride which might make hamstrings prone to injury by fatigue.. In a study on risk factors on OZ football screening and other variables were assessed to determine risk factors. Musculo-skeletal tests performed were as below in this table. The two main predictors form this study were age ( >23) and also decreased quadriceps flexibility.

RECTUS FEMORIS

( Middle Quad)

From iliac bone to base of patella.

Extends or straightens knee Flexes the hips

Risk factors for hamstring injuries in community level Australian football B J Gabbe, C F Finch, K L Bennell, H Wajswelner Br J Sports Med 2005;39:106–110.

THE SIMPLEST THING IS OFTEN TO CHECK MUSCLE DEVELOPMENT ( Especially hams and Glutes).

Simply looking at muscle girths or even specific deficiencies in hamstrings can also assist in decisions of where to head in the strength and conditioning of the hamstring complex.

Lack of gluteal and

hamstring development

EXAMPLES OF RUNNING TECHNIQUES THAT MAKE HAMSTRINGS WORK HARDER

Classic Overstrider

This athlete has gone into anterior pelvic tilt.

Thus he overstrides due to the pelvic position.

Hamstrings have to work hard in stance phase since the foot has landed

in front of the centre of gravity and so the gluteals and hams have to pull

the leg through .

Lack of frontal stability

This athlete has lack of control over his hips.

Thus he tilts to the side due to the pelvic position and weakness in

muscles like gluteus medius and other core muscles.

Hamstrings have to work hard here simply due to the lack of pelvic and

trunk stabilization that occurs..

HAMSTRING INJURIES and OTHER FACTORS

Leg Lengths Discrepancies ?

PRONATION

The ankle bone is connected to the shin bone which is connected to the thigh bone which is connected to the hip bone which is connected to the spine IE: The Kinetic Chain!

DEHYDRATION AND DOMS IN RUNNERS

Lumbar

sidebending and

thoracic

compensation

Leg length differences

and excessive pronation

may cause problems all

the way up the kinetic

chain at the hip and

thus hamstring

function.

OVERSTRIDING AND HAMSTRING INJURY

Studies have analysed elite sprinters and by comparing elite athletes with slower sprinters they found that world class sprinters can pull their leg through the back swing faster than other sprinters

The faster the leg is pulled through in the back swing the more efficient is the touchdown, Thus by eliminating overstriding , braking forces and contact times can be reduced. Braking force means an athlete has landed in front of their centre of gravity and has to overcome that and then work back through the stride. Which is why this drill is important in hamstring rehabilitation. Skip, then extend the leg fully, then paw back actively using the glutes under the centre of gravity.

If the athlete doesn’t pull the leg under the centre of gravity they have to work harder by using the gluteals and hamstrings to pull their body over their leg during the stance phase. The gluteals are critical in the back swing and the first half of the stance. Thus the straight leg running drill is good for training hip extension.

LATE SWING PHASE THE CULPRIT They found that the peak hamstring stretch occurred during the late swing phase of sprinting just before foot contact and EMG study showed more activity at late swing phase thus demonstrating lengthening and eccentric contraction. Biceps femoris was also stretched more in this phase and as we know more injuries occur in this hamstring. Biceps femoris can account for up 80% of hamstring injuries.

HIP FLEXORS NEED SWITCHING ON Hip flexors are critical in the second half of the stance phase and the early swing phase. If the hip flexors are weak or inactive, there is less drive in stance phase and the hamstrings and hip extensors have to compensate.

Some important factors that must be addressed in a hamstring rehabilitation with running drills and technique were outlined in a review by Heynen. 1. Practice specific running drills throughout the year that correspond with the recorded EMG muscle activity during sprinting. 2. Correct technical faults in their sprinting action. 3. Focus their sprinting technique on minimising vertical ground reaction force and sweeping through with the back swing to maximise horizontal acceleration. 4. Clearly separate training periods of high volume and lower intensity from low volume, high intensity training. 5. Perform mental rehearsal of the movement to improve their internal representation of the sprinting movement.

OVERSTRIDING AND HAMSTRING INJURIES Michael Heynen wrote an article on Hamstring Injuries. ( NEW STUDIES IN ATHLETICS 2001 Vol. 16 No 3).

Hip Flexors contract

eccentrically and initiate hip

drive for the next stride.

Hip Flexors contract

concentrically. ( Hip up/ knee

up/toe up ).

SPEED EFFECTS ON STRETCH and FORCE of BICEPS FEMORIS AT END

RANGE STRIDE

This table that I have approximated from the study

At 80% maximum speed the eccentric or “speed” force is approx 55%. This eccentric force is the hamstring working hard to decelerate the lower leg in the

late swing phase just before touchdown. But the stretch at 80% eccentric force is almost 100% on the lower limb. The eccentric or “speed” force rises dramatically from 90 to 100% maximum speed. These are the subtle changes that occur at

end range of swing just before touchdown

But in the picture below the table one can see that at 80% maximum speed the hip is less advanced but the lower leg compensated creating a similar angle at

the knee from 80 to 100% maximum speed.

This change in hip drive is related to hip flexor activity which increases dramatically at high speeds.

Table and diagram adapted from : (Neuromusculoskeletal Models Provide Insights into the Mechanisms and Rehabilitation of Hamstring

Strains. Sherry (Exerc. Sport Sci. Rev., Vol. 34, No. 3, 2006.)

% MAXIMUM SPEED PEAK STRETCH approx values

ECCENTRIC FORCE approx values

100 95 to 100 100% force

95 95 to 100 80% force

90 95 to 100 75% force

85 95 to 100 65% force

80 95 to 100 55% force

So one has to be very careful when the decidion is made to go 100% and if in a situation where stride patterns vary from 80 to 100% then more risk is taken.

Black line is the leg at 80% maximum speed. The

thigh is less advanced. Note that the stretch at the

ground is almost the same which is what the above

table says.

100% Max Speed

80% Max Speed

NEW STUDIES IMPLICATE THE CORE IN HAMSTRING INJURIES

TRUNK STABILIZATION

Neuromusculoskeletal Models Provide Insights into the Mechanisms and Rehabilitation of Hamstring Strains Sherry (Exerc. Sport Sci. Rev., Vol. 34, No. 3, 2006.)

BETTER CORE STABILITY or NEUROMUSCULAR CONTROL ( brain to muscle) of the LUMBOPELVIC ( lower back/hips) area reduces the risk of hamstring injury according to this and other new studies.

HIP FLEXORS and HAMSTRINGS and TRUNK STABILITY TRAINING The opposite hip flexor ( iliopsoas) also has a big say in hamstring stretch. This is because the hip flexor can tilt the pelvis ( anterior pelvic tilt) and further put the opposite hamstring on stretch. Also oblique abdominals and erector spinae can also cause pelvic changes. Running Drills and Core Stability and Hip Flexors Work on core stability of the trunk and pelvic muscles and technical work with running drills when hip flexor activation is concerned.

CORE STABILITY AND HAMSTRINGS

We have seen the evolution of the core stability and pilates studies and pelvic floor and transverse abdominus are buzz words. If the inner core is not functioning then the pelvis under load cannot maintain its subtle 3 D actions and the hamstrings have to work hard to assist stabilization which again may cause fatigue and thus injury. Inner core function in athletes is best re-trained using dynamic ultra sound and then integrating core strength exercises. So in some cases a hamstring rehabilitation might start with the pelvic floor!

Picture of Pilates Scooter Exercise and using the inner core

Pilates Reformer Exercise.

Switch on the inner core and

then extend the leg to

strengthen gluteals that assist

hamstrings

Spine

Pelvic

Floor

Muscle

Pubic

Bone

Transverse

Abdominus

“The Hoop” or the

“Corset”

Multifidus

Back Muscles

The inner core and hamstrings? Sometimes the missing link. Transverse Abdominus & Hamstrings

In osteitis we have seen the use of dynamic ultra sound feedback to assess the function of the pelvic floor and transverse abdominus ( corset surrounding our

abdominals) and even multifidus ( small muscles in the back). . Certainly in back pain, TA is often switched off and rewiring the system and then integrating this

with trunk stabilization and back strength can assist the patient in recovery. Control of the pelvis is important to stop hamstrings tiring when control is lost .

Core strength is addressed in these programs but core stability retraining may be the missing link in the whole program. This is outside the scope of this book but inner core function may need to be addressed in a hamstring rehabilitation. TIGHT TENDONS AND SCAR TISSUE? Residual scar tissue in the musculotendinous area ( muscle-tendon area) after a tear can change the biomechanics of the muscle and thus this can cause problems later in rehabilitation program because of changes in how muscles stretch.

OTHER MUSCLES THAT IMPACT ON THE HAMSTRINGS

If the adductor magnus ( groin muscle) is weak and the gluteal muscles are tight then the hamstrings may have to assist in adduction ( pull the leg in)

ADDUCTOR MAGNUS

Adducts ( brings hip in) and laterally rotates hip. Also assists in fexion and extension ( driving phase) of the hip.

GLUTEUS MAXIMUS

Weak glutes and overworked hamstrings If the athlete has weaker gluteals and/or tight groins the hamstrings may be overworked again whilst still acting in hip extension and knee flexion. All these variables may lead to fatigue of the hamstrings and thus injury

GLUTEUS MAXIMUS

Major Extensor of the hip

The first diagram demonstrates the end of the driving phase and the action of the gluteus maximus muscle. It it is weak then the hamstrings have to work in hip

extension which tires them out.

HAMSTRING EXERCISES

Always do the simple things well. Hamstrings are injured at high speed and so slow “contrived” exercises are not the solution. What is indispensable is a progressive running program underpinned by a program that is balanced.

A bit more on how hamstrings work!

The Hamstrings slow the lower leg in the last part of the stride.

Just before contact, maximum stretch and force occurs

Specificity: Running fast replicates running fast!

Lots of these injuries occur with the leg dangling in the air ( open chain) and so some open chain exercises may be needed. That is part of the function of the running drills that emphasise pawing under the centre of gravity. But remember that even running drills do not replicate running. They assist in specific strengthening, but running fast replicates running fast, given the forces are enormous as the lower leg is decelerated and then placed under the athletes body to commence driving.

When ground contact is made and through stance, the hamstrings extend the hip. This is the reason for all the gluteal and core work. . And just at contact is when the hamstrings are stretched over two joints, the knee and hip.

Straight leg bounding is one way to train in a similar stance as is sprint bounding.

Both exercises do not have the same stance times as sprinting but are useful at training hip extension. Reverse Leg Press and the Pilates Scooter Exercise are other ways of working the gluteal muscles in the gym and in a rehabilitation program.

The rear portion of adductor magnus is sometimes known as a hamstring muscle due to its alignment and sometimes is sore after hard running bouts and is confused by athletes with a hamstring but needs to be reconditioned because of some of its similar actions.

Adductor magnus: Aids in Hip Extension but for adduction can be strengthemed in closed chain setup with side lunges.

So lots of things happen in running with hamstrings and so a variety of reconditioning needs often have to be covered.

Co-ordination, Hamstrings, Biceps Femoris and speed.

Now in fatigue or in complex movements coordination between hamstring muscle groups can become impaired. All at high speed and at a maximum stretch when decelerating or accelerating or bending at high speed

Reverse Leg Press for Hip Extension

This was promoted by Charlie Francis as the gluteal strengthener of choice for his sprinters.

Similar to the Pilates exercise but with resistance but again developing the gluteals so the hamstrings don’t have to overwork in hip extension.

The biceps femoris muscle is known to be damaged more often due its two portions being innervated by two separate nerves.

Thus this can lead to a misfiring of nerves resulting in a pulled hamstring.

Add to that the fact that hamstrings are fast twitch so can fatigue early.

STEPUPS AND LUNGES

This is a table derived from a study on muscles in exercises done for 5 repetitions compared to the same muscles during a 1 repetition maximum in a squat. EMG studies are called electromyography studies and measure the use of a muscle in an exercise. So stepups and lunges use the hams more than squats and hip extensions really work them according to this study.

% Use of Hamstrings in spepcific exercises at 80% of

their 5RM relative to 1 RM Squats

0

20

40

60

80

100

120

140

160

180

Squ

ats

Singl

e Le

g Squ

ats

Pro

ne H

ip E

xten

sion

s

Ste

pups

Lung

es

Hip E

xten

sion

s

5 RM of Exercise

% of 1 RM Squats

Hamstrings

Gluteus Maximus

Gluteus Medius

American Council on Exercise (ACE) Blake Ristvedt,M.A., and John P. Porcari, Ph.D.

I prefer to do high bench stepups in a program because I believe there is even more hamstring and gluteus activation at 90 degrees than at 45 or 60 degrees but one must progress to 90 degrees and explosive stepups or stepups with a drive or with resitance behind the athlete an be done on a lower box.

Lunges. I am of the opinion that doing reverse lunges may elicit more gluteus maximus activity and also doing lunges with a reach and many other variations will also spark off lots of hamstring and gluteal activity.

The one leg squat is valuable because it’s job is in stabilizing the hip and not directly working hamstrings. As discussed, if frontal stability is lacking then problems can occur with injury.

Hip extensions and prone extensions seemed to really spark off some activity and are valuable exercises in a rehabilitation.

SQUATS HALF THE HAMSTRING ACTIVITY

And the last bit of science I will use is EMG studies ( Electromyographic) studies of hamstring activity comparing leg curls, squats and stiff leg deadlifts. Leg Curls and Stiff Leg Deadlifts involve the hamstrings to a similar degree; however, the back squat involves only about half as much hamstring integrated EMG activity as LC and SLDL.

The Journal of Strength and Conditioning Research: Vol. 13, No. 2, pp. 168–174.

A great core exercise and this also can be integrated into a program for core strength. And core strength is such a key in hamstring prevention. And bodyweight squats are a great functional way to switch things on early in a rehabilitation.

I have not added squats in my programs but can be integrated into a program if required and there are no back related issues with the injury.

Caterisano et al. (2002) did EMG analysis on experienced lifters on quarter squats, squats to parallel and below parallel. With respect to gluteus maximus it does reflect the importance of doing some light bodyweight squats in a rehabilitation to parallel to engage the gluteals.

Muscle tested ¼ Squat Squat to Parallel Below Parallel

Biceps Femoris 13.37 15.35 15.01

Gluteus Maximus 16.92* 28.00* 35.47*

Vastus Medialis 30.88 18.85 20.23

Adapted from Caterisano et al. J Strength Cond Res 2002.

Are Leg Curls Bad? Is Isolation Bad?

Often in multiple recurrence situations there has been a huge loss in bulk and not just function, in an area of the hamstrings. So for a short time some hypertrophy work and isolation work on a leg curl machine or with ankle weights is warranted. After that eccentric function has to be addressed and exercises such as catches may be necessary after the hypertrophy or bulk phase is over. This type of “bulking” training should not be done when strides are above 80% due to the “confusion” that can occur neurally.

Stanton P and Purdam C (1989):

Hamstring injuries in sprinting the role of eccentric exercise. Journal of Orthopedic and Sports Physical Therapy 10:343-349

This article examined the use of “catch” type exercises to mimic the end range

forces in high speed running. The optimal position was to lie over a bench . This exercise is important in a rehabilitation, but once some eccentric function is returned at low resistances and high speed it is time to move to work on hip related exercises , given that specific end range stride adaptations can be

achieved with running.

Trying to mimic the forces running with very heavy ankle weights done at high speed seems risky.

So when we are talking leg curls and catches, I have added a flow chart of these

exercises designed to work that last bit of the stride when the hamstrings are shunting and slowing the shin bone down to the ground.

1. HEALING: Immobilize 2. RESTORE FUNCTION: Isometric Exercises at varied angles 3. HYPERTROPHY Concentric Leg Curls one leg BW to Weights 4. STRENGTH EXERCISES : Eccentric Leg Curls ( 2 up/1down) 5. ECCENTRIC EXERCISES : Eccentric Catches from BW to Weights at speed 6. FUNCTIONAL EXERCISES : Running Drills with pawing action .. 7. RUNNING PROGRAM : Progressive speed and agility program.

BEFORE CATCHES DO SLOW ECCENTRIC LEG CURLS ( 2 up/1 down)

As a precursor to catches, I often do eccentric leg curls or doing 2 legs up and one down

and controlling the end range. When I get to a moderate weight with leg curls and can

control the end range properly I often start on some eccentric catches with bodyweight

and moderate speed and then build to high speed. I have used up to 2.5 kgs with some

players and I have heard of 4 to 5 kgs being used but in the context of this program , I

would like to not go over 1 to 1.5kg and make sure speed is the aim and catches are used

as an introduction to the forces of late swing phase encountered in fast running.

YoYo Leg Curl Machine and eccentric exercise

A recent ( 2003) study using a YoYo leg curl machine uses open chain exercise. This

machine sets a rotational flywheel when the athlete does a normal leg curl and then has to

decelerate the flywheel eccentrically due to the machines actions.

Players were tested before and after the 10 week study for strength on a kin kom

machine and tested for a flying 30m off a 20m run up. They did 16 sessions , every 5th

day for 4 weeks and every 4th day for 6 weeks.

Throw the lower leg into rapid extension and

then catch it 20 to 30 degrees from the table

and then bounce straight back and repeat

usually 15 times at speed.

Catches can be done standing up but I

prefer doing them over a bench because

these angles are a bit similar to the late

swing phase.

2 Legs up

2 Legs up then release one leg

One leg down controlling to end phase

Control right down to last degree.

Eccentric Leg Curls

2 up /1 down.

The training group improved their strength and speed over 30m against the control group

of elite soccer players. And also the strength group had less injuries.

Players doing the leg curls complained about soreness at the start of the program. ( 11/5

after the first session, 9/15 after the eight session and 7/15 after the last session).

I have recently worked in soccer at one level down from elite in Australia. Some of the

players were fit but lacked strength and speed. If you got them to do some light leg

weights they would be sore for days. But the interesting factor was that I didn’t have a

hamstring all year ( only some quads due to kicking) and I think this is because the speed

of the game drops when one goes down a division.

Hamstring Injury Occurrence in Elite Soccer Players after Preseason Strength Training with Eccentric Overload,”

Scandinavian Journal of Medicine and Science in Sports, Vol. 13, pp. 244-250, 2003

Standing Full Range Leg Extension and Catch ( Bicycle Leg Swings)

Another exercise that can be interchanged for the eccentric catches are bicycle leg swings. Here you stand on one leg ( eg left) and hold a support to maintain balance on the right. Raise your right hip and knee to 90 degrees and then extend knee until the leg is almost straight. Catch it at end of the swing phase and then “paw back” with a straight leg until the leg is behind your body. Keep the hips stable and back posture neutral and then actively lift the knee ( hip up/knee up/ toe up) and then start again. Do this smoothly and with good posture. Build up to 12 swings every 10 seconds. IE Start at 5 swings every 10 seconds and progress. Then the athlete can use a theraband ( start with green ) and attach it to the lower leg formt he front. Extend back into hip extension then complete the cycle as above with an emphasis on catching the lower leg when it straightens atteh end of the swing phase. Build up the resistance but no heavier than allow you to do 10 swings every 10 seconds with good form.

This article is accessible on Vern Gambettas website. It is good reading and there are some interesting exercises on it.

A Systematic Approach to Hamstring Prevention & Rehabilitation:

Vern Gambetta1

Dean Benton2

“Hamstring injury prevention and performance enhancement exercises should be

multiple joint, closed kinetic chain and eccentric in nature. The emphasis should be on exercises that enhance intermuscular coordination.

The training of timing and coordination is essential.

Timing and coordination has not received much emphasis because it is difficult to

measure. Timing and coordination demand a clear understanding of sprint mechanics and the adaptation of those mechanics to multidirectional field sports where the incidence of

hamstring injuries is so high”

EXERCISES Gambetta and Benton split exercises into 3 sections. GENERAL EXERCISES SPECIAL EXERCISES SPECIFIC EXERCISES Double Leg Romanian Deadlifts

Horizontal Bridges from a hang

Straight Leg Bounds

Single Romanian Deadlifts

Cable Hip Extensions

B Mach Drills

Low Stepups with Resistance

Resisted Moonwalks

15 degree hill sprints

Lunge and Reaching in 3 planes

Walking Lunges into a High Knee

Table adapted from A Systematic Approach to Hamstring Prevention & Rehabilitation

Doing exercises such as Swiss Ball Curls and Nordic Hamstrings could “confuse” the muscle according to this review. I agree with this if these exercises are the cornerstone of a program but I also believe that all the exercises such as Swiss Ball Curls and even Nordic Lowers have a place in a program. ( Nordic lowers in my opinion more in the preparation phase of training.) Running is specific to running and to the complex co-ordination needs that exist.

SWISS BALL HAMSTRING CURLS My opinion is this exercise should be done with the hips in an extended position. It is not a functional exercise relative to running as sometimes quoted BUT stresses the hip extensors and also assists the development of lumbar-pelvic needs. I have seen a link with players who have had problems with hamstrings and an inability to maintain good posture in one leg swiss hamstring curls. I did this exercise for a number of seasons and it seemed to work in the context of prevention and rehabilitation. It is of low eccentric demand so seems safe to use inseason as a good core exercise that can assist pelvic functioning. Strong gluteals and an ability to maintain lumbo pelvic stability is essential in running.

Nordic Hamstring Lowers? I would use Nordics early in a pre-season for 3 weeks to dose a bit of general eccentric load and would mix and match with some Romanian Deadlifts or ( machine back raises) to make sure upper hammy activity and hip activity was addressed.

Then I might add a hip extension exercise and finish off with some run drills and even a few run throughs in the same session to get some specific carryover. Seemed to work. The main thrust of a conditioning plan for hamstrings should be closed chain exercises that are compound in nature.

I never felt comfortable doing Nordic Lowers inseason more because they are so intense but that was my preference. The exercise can be done inseason but care must be taken with recovery and the next fast ( 95% and more) running session. Some people have tried to use weights with this exercise. That is ok in some circumstances, but I think in others it could put disproportionate stress on some structures in the hamstring complex. The only exercises that should be really loaded up are multi-joint bilateral compound lifts such as deadlifts and squats and the power lifts. These specific exercises ( such as Nordics) should be done with perfect form and for a specific purpose. Nordic Lowers in a Rehab Setting?

This exercise is an introduction to the Nordic lower. Have some resistance but lower with the ball.

Nordic Eccentric Lowers can be interchanged for the eccentric exercises. A continuum in rehabilitation would be as below and a strength protocol is under that for conditioning in pre-season. Possible pre-season progression for Nordic Hamstrings according to a study. I don’t know about pushing a partner but there it is !

Week 1 1 session only. 2 sets of 5 reps.

Week 2 2 sessions. 2 sets of 6 reps

Week 3 3 sessions: 3 sets of 6 to 8 reps

Week 4 3 sessions: 3 sets of 8 to 10 reps

Week 5 to 10 3 sessions: 3 sets of 12 to 10 reps

As the athlete gets stonger:

1) Try and go further down to the ground 2) Do it a bit faster on the way down. 3) Have a partner push for resistance on the way down.

A 10-Week Randomized Trial Comparing Eccentric vs. Concentric Hamstring Strength Training in Well-Trained Soccer Players,"

Scandinavian Journal of Medicine & Science in Sports, Vol. 14, pp. 1-7, 2004

Many studies discuss the NORDIC HAMSTRING EXERCISE and it’s use in the prevention of hamstring injury.!

One example:

Half the teams in Iceland and Norway entered a study using the Nordic Hamstring Exercise. This was done over 2 years. Some teams did the eccentric exercise whilst others only warm up stretching. Both groups did the warmup stretches. They found that the group that used the Nordic Hamstring Exercise “ appeared to reduce the risk of hamstring strains, whilst no effect was detected from flexibility alone.”

Prevention of hamstring strains in elite soccer: an intervention study. Arnason A, Andersen TE, Holme I, Engebretsen L, Bahr R.

GLUTE HAM RAISES

This was very popular years ago and really are an extension of the Nordic lower.

Of interest the glute ham raise does involve an eccentric contraction or “switch-over” at full extension as against the Nordics. The Nordic Hamstring lower is supposed to copy the forces at the end range of a stride before touchdown. The GHG can do this but is a quicker movement.

I did the GHG ( Gluteal Hamstring Gastrocnemius) exercise in Europe in the 70’s on a pommel horse and wall bars. Then it became quite popular in the 80’s and GHG devices sprung up all over the place.

In the early 90’s I used eccentric leg curls and glute ham raises with most players in preparation phases and it seemed to work. I coupled them with stepups on high benches . One could theorize that the GHG exercise

requires stabilization of the trunk. In this block I would do abdominal exercises such as medicine ball twists. We had a low hamstring rate that year. We also did a lot of fast running in the preparation block and lots of plyometrics. So it is difficult to assess. One player said he hurt his back and hamstrings doing this exercise?

But the GHG exercise was certainly eccentric which I think helped a lot. The players squatted a lot pre-season but concentrated on stepups and

power cleans and pulls inseason and most did glute ham raises.

WHY INJURIES?

SOMETIMES IT IS SIMPLY TRAINING AT THE WRONG TIME AND NOT THE EXERCISES?

One year in the 90’s I did the same exercises at another club but mid year I had an increase in hamstring injuries. The players had been coming in on off nights

and doing extra running and kicking inseason. Once I identified this extra “eccentric” load inseason and had a recovery night instead, the injury glut

ceased. I did not change the exercises.

ALL ECCENTRIC PROGRAM:

PLYOMETRICS and CATCHES the KEY!

And with another player I only got somewhere when we introduced eccentric catches and lots of plyometrics and fast running and avoided all heavy weights. He simply was a genetically gifted fast footballer who had recurred many times and was given slow running in his rehabilitation. Thus he had lost all “speed” or

eccentric qualities and needed to get this back in the gymnasium and then start a speed running program.

NO ECCENTRIC PROGRAM

PILATES and TRANSVERSE ABDOMINUS the KEY!

Another famous player tried everything, but only work with a Pilates Specialist seemed to coincide with recovery from recurrent hamstrings. He simply struggled

to control his pelvis yet had strong legs and also was not an aerobically gifted player so when he was tired and running fast he kept injring himself. He needed

ot get some control of his pelvis and core and also get a bit fitter.

Seems like one has to use the lot!!

CHIROPRACTORS

And now more and more we are hearing about chiropractic treatment for pelvic imbalances that may affect hamstrings.

TRUNK STABILITY AND HAMSTRINGS

THE CORE

Lumbo-pelvic-hip complex (Back-Pelvis-Hip)

Location of center of gravity (CoG) Efficient core allows for normal length-tension relationships and thus muscle balance. Maintenance of normal forces at required times in different muscle groups. Maintenance of good movement patterns. Optimal efficiency in entire kinetic chain during movement Acceleration, deceleration, and stabilization during movement. Provides stability ( or a base) for movement of extremities

TRUNK STABILIZATION Even more removed from traditional programs is the approach by Sherry and Best Sherry MA, Best TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther. 2004 Mar;34(3):116-25

This study compared a traditional program with with a PATS ( Progressive agilty and trunk stabilization ) program and got better results than with a traditional weights program. Stabilizing the hips and thus assisting the function of the hamstring was important. And the use of agility movements to gain fitness and condition eccentric components and also adductor needs without overloading the hamstrings was thought provoking and changed the way I did things a bit.. THEY HAD TWO PHASES IN THEIR PROGRAMS PHASE 1 This phase on average started 3.4 days after injury ( 1 to 10 days range) IE After the acute phase. Side to side steps and grapevines or carioca movements done for 3 * 1 min each form low to moderate intensity. Balance work on one leg with eyes open and closed Prone Bridges or what is known as the plank sets 20 secs Double leg Bridges Side bridges or planks Emphasised ice in this phase PHASE 2 Side to side steps and grapevines or carioca movements done for 3 * 1 min each from moderate to high intensity. Doing small steps backwards and forwards ( like in speed ladder) and moving sideways. Single leg bent over windmill touches 4*20 sec Rotation Pushup. 2*15 reps Small fast feet movements Trunk pull downs with a theraband And practicing at speed sports specifically. And repeat ice if required

BACK RAISES and FOOTBALLERS Again the back raise to parallel ( and not into an arch) on a bench is not mentioned a lot in hamstring rehabilitation but I use it. It can be interchanged with romanian deadlifts ( 1 and 2 legs ) especially if the athlete has some flexion ( bending over) back issues. If one has a strong spinal erectors and good trunk stabilization then the gluteus maximus can work hard at hip extension and not at stabilizing the trunk and hips ,thus giving the hamstrings a rest in the extension phase.

IT CAN TAKE A WEEK TO PLAN A HAMMY REHAB! One just has to be very careful in the acute phase and sub acute phase. Usually

7 days after an incident.

Often the actual injury often doesn’t declare itself until day 3 to 10 in my experience.

SPRINTERS, HAMSTRINGS and MRI

“There was an association between the time to return to pre-injury level (median, 16; range, 6-50 weeks) and the extent of the injury.”

This study used MRI scans to predict the time it took not only to rehabilitate a

100m sprinter’s hamstring, but also to get their form back.

Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings.

(Askling The American Journal of Sports Medicine)

18 sprinters were injured running in competition. They had MRI scans ( magnetic resonance imaging scans) 4 times after injury. ( Day 2/4/10/21 and 42). The

follow up was 2 years. They found a link between the time to pre-injury level and the extent of the injury on MRI. If the injury was more on the tendon and also

near the hip ( ischial tuberosity) then it took longer. They concluded that careful palpation ( touch) during the first 3 weeks after injury and MRI during the first 6 weeks after injury both assisted the predictions to return to pre injury level of

performance for 100m sprinters.

YES IT TAKES SPRINTERS 16 weeks on average to get back to form after a hamstring injury!

DANCERS CAN TAKE EVEN LONGER THAN SPRINTERS AFTER A HAMMY!

But the real time to return back to pre-injury level was staggering. Average of 16 weeks for sprinters and 50 weeks for dancers.!

Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level C Askling, T Saartok, A Thorstensson

Br. J. Sports Med. 2006;40;40-44

The study found little correlation between tests at 2 days and return to injury 18 sprinters and 16 dancers were used in this 5 year study. The sprinters were injured at 100% speed whilst the dancers doing slow stretches such as splits.

They were excluded if they had a prior hamstring injury. All these injuries were diagnosed clinically and confirmed later by MRI. Tests were done at 2,10, 21 and 42 days after injury. After 6 weeks athletes and dancers reported back to tell when they could sprint 100% again or dance without restriction. On the first test 15 of the 18 sprinters used crutches and none could walk without pain. Seven of the dancers could walk pain free 2 days after injury. Both groups had huge strength loss at Day 2. At the next test this difference decreased for both but in the last 2 tests ( Day 21 & 42) the sprinters had bigger strength deficits. At 10 days strength and flexibility on the tests was back to 70 to 92 % of the uninjured leg. After 6 weeks or 42 days both groups were at at an average of 90% of the uninjured side but still apprehensive about letting go functionally. MRI scans of the dancers showed damage closer to the hip and more in the tendinous area. Sprinters tended to involve more muscular tissue. This correlated with the locations on palpation after injury. Thus there may be a link to location and recovery time. Both groups estimated their return back to pre-injury level. Sprinters thought they would be OK in an average of 4 weeks and dancers thought they would be ok in 1 week. But the real time to return back to pre-injury level was staggering. Average of 16 weeks for sprinters and 50 weeks for dancers.! The opposite! At six weeks post injury no dancers and only 2 sprinters were back to form. The sprinters had regained 96% of their strength back at six weeks . The study found little correlation between tests at 2 days and return to injury. 3 of the 18 sprinters re-injured at 8,9 and 20 months.

WHY IS 21 DAYS OFTEN THE NORM IN TEAM SPORTS? DO THEY PLAY AGAIN AT LOWER INTENSITY? This is a quote from this study! “In team sports it has been reported that players recover, on average, far quicker than either of the two current groups, but potentially they may be competing again without being fully recovered to their pre-injury level, whereas dancers and sprinters probably need much closer to full function”

Vicious cycle and hamstrings I found so often when things were going bad they got worse because injured players would play as soon as possible and not play as well. Then losses and/or recurrences or both. A vicious cycle. When things go ok and teams are winning there is usually less hurry with rehabilitation programs. Thus more wins and less injuries. A virtuous cycle! HA. All very predictable in sports teams sorry to say. With hamstrings in team sports players can come back and shorten their stride a bit and just miss “warp” speed. They might even play ok. Tough decision but in my opinion you don’t want to have good players running around with multiple tears and scar tissue and thus histories. Get the first one right!

DO YOU NEED AN MRI or an ULTRA SOUND?

This study compared the use of MRI scans and only a clinical diagnosis on hamstring injuries. The result was that clinical diagnosis is good enough to

predict rehabilitation times. But make sure you see a qualified person to get the injury diagnosed not the club masseur!

A Comparison Between Clinical Assessment and Magnetic Resonance Imaging of Acute Hamstring Injuries

The American Journal of Sports Medicine 34:1008-1015 (2006) Schneider-Kolsky, Hoving, Price Warren, David A. Connell,

WHAT IF YOU GET A SCAN AND IT SHOWS NOTHING BUT YOU ARE SURE YOU HURT YOURSELF?

When an MRI is negative but there has been an incident and a clinical diagnosis at Day 3 for example, plus awareness for a few days then it must be assumed that there is a problem and a rehabilitation must take place. Often only a small “tweak” doesn’t show up in scans but if not rehabilitated properly causes problems 2 or 3 weeks later. So make sure you treat every possible tear with care in the first 3 days after injury and immobilize and ice, elevate and compress until a clearer diagnosis is done. If diagnosis is 100% clear after 3 to 4 days and you do an MRI and then that is clear and you are symptom free then you might be OK.

SO WHAT DO YOU DO IF YOU HURT YOUR HAMSTRING?

ACUTE PHASE:

Acute (Immobilisation) Phase can last -3 to 10 Days.

A qualified clinician must determine when this phase has ended given initial healing is so

critical in managing soft tissue injuries.

Some of the factors that need to be addressed.

Reduce local tissue temperature & energy needs by resting & elevating.

Manage pain

Minimise inflammation and swelling

Protect damaged tissue from more injury. ( Stop & maybe use crutches).

Prevent disruption of the newly-formed fibrin bonds by not stretching or stressing or testing the injury.

PRICE

P=PROTECTION: Protection Usually involves immobilizing the injury to reduce

pain and prevent disruption of the healing process. Stop playing the activity ASAP and don’t test it too much if you think you have injured your hamstring. Crutches can support weight bearing if it is very painful.

R=REST: Rest is to avoid further injury and disruption of the forming fibrin but also

to reduce increased blood flow.

I=ICE: Apply Ice following injury to minimise swelling, and prevent pain. The easiest

way is to use crushed ice, a bag of frozen peas, or an ice compress. If crushed ice, wrap it in a damp towel before applying it to the skin. Unwrapped ice can lead to ice burn. Hold the ice in place for 10 to 20 mins and repeat this every two hours until the swelling and/or ‘heat’ from the injury has gone away. Do every 2 hours on the first day and then every 4 hours for example on the second and at least for 3 days after injury.

C=COMPRESSION: Compression is to reduce oedema. Compression (a form of

pressure) helps lessen swelling and increases the effectiveness of the muscle pump in aiding venous return and should be applied as soon as possible following the injury . Be careful using compression – it must be removed at night and be sure that it doesn’t prevent proper blood flow to the ends of limbs [check pressure is not

greater at the end of the limb that is closest to the body]. Always check the areas furthest from the body (eg toes) for signs of reduced blood supply (lack of colour or numbness). If you are worried, take the compression off. If you are elevating a limb, don’t also compress it.

E=ELEVATION: Elevation is to allow gravity to reduce oedema. As far as possible

elevate the injured area above the level of the heart in the first 72 hours and have it comfortably supported. Avoid compression and elevation at the same time..

NO HARM PROTOCOL!

The No HARM protocol should also be applied – no heat, no alcohol, no running or activity, and no massage.

All these will lead to increased swelling and bleeding in the injured area.

HOW INJURIES ARE GRADED DOMS Delayed Onset Muscle Soreness: pain, swelling, and loss of strength and

ROM after eccentric exercise, increase in intensity during first 24 h after exercise, peak intensity after 24 to 72 h. So often this can be confused with a strain so that testing at 96 hours will confirm that it was DOMS as suspected.

FIRST DEGREE STRAIN First-degree strain is the result of stretching of the musculotendinous unit and involves tearing of only a few muscle or tendon fibers. Some pain usually. Maybe a minor limp, maybe not soon after the incident. Only a few muscle fibers, minor swelling and discomfort, and only minimal loss of strength and restriction of the movements. There is only a low-grade inflammatory response

SECOND DEGREE STRAIN

Second-degree injury refers to a more severe muscle tear without complete disruption of the musculotendinous unit. Actual tissue damage occurs that reduces the strength of the musculotendinous unit.There is some residual function loss. or a clear loss in function (ability to contract). Noticeable pain, and often a limp to a pronounced limp

THIRD DEGREE STRAIN This refers to a complete tear of the musculotendinous unit. Severe and often leaves victim unable to stand or walk, and with heavy bruising on back of thigh Complete disruption of the musculotendinous unit is seen and loss of function. If this is suspected then the athlete must see a Doctor immediately.

HOW HAMSTRINGS ARE DIAGNOSED

Often at sporting contests there are no medical people at all. More often than not unless it is an elite sports setting. So if you are the trainer and have first aid

qualifications the number one thing to do is PRICE. But some simple diagnostic tools can help. Only progress if pain allows. Remember never go above 3 (

moderate awareness) on the One to Ten Awareness Scale.

Then send them ASAP to a sports medicine expert.

SOME GUIDELINES TO ASSESSING A HAMSTRING INJURY

1. Test uninjured leg first. 2. Test flexibility before strength. 3. Do not aggravate the injury at all in the tests. 4. Allow the subject to determine the range of movement and also

the strength of contraction according to pain.

5. Do not ever go above moderate pain in a test.

SCALE of AWARENESS

0 No awareness

1 Very slight awareness

2 Some awareness

3 Moderate awareness

4 Somewhat aware

5 Aware

6

7 Very Aware

8

9 Very Very Painful ( almost max)

10 Maximal Pain

DIAGNOSIS IS A JOB FOR QUALIFIED MEDICAL PEOPLE

Diagnosing an injury is a job for a professional. I will simply outline a few methods and rationales for diagnosis.

Where is the injury?

1. Origin of the muscle? At the hip?

2. Musculotendinous junction? Where the tendons merge into muscle?

3.Muscle belly? In the middle?

4. Insertion of the muscle? At the knee.?

5. Is tenderness over the injury

6. Bruise?

In severe strains a mass may be felt but normally in the acute phase swelling and area of the injury make this difficult to assess.

• Often muscle is checked for a defect with the patient lying prone or with the knee flexed to 90°.

• Often the muscle is palpated and the person is made to tense the muscle slightly in both positions.

• Assess pain with passive extension of the knee and the hip flexed at 90°, as compared with the noninjured side, which stretches the muscle

• Assess pain with resisted knee flexion, which activates the muscle

STRAIGHT LEG RAISE (SLR)

• Keep the leg straight • Keep the hips of pelvis neutral. Don’t let it tilt either way. • If you dorsiflex the ankle at the end range then one can assess whether this is a

muscle injury or if the nervous system is the cause or even the fascia. Again these complexities always lead us back to a qualified person making the diagnosis.

STRENGTH ASSESSMENTS

1. Simply assess range of active movements by lying down and doing leg curls movements.

2. Lying prone lift leg up and reisist Note pain and strength 3. Do resisted knee flexion tests where 3 angles can be assessed and also different

psotiions of tiibial rotations can be assessed to assess medial or lateral hamstrings. Assess any awareness at all and stop the tests if pain is elicitied.

4. If this is ok then do eccentric leg curls where in prone position one resists the push of the assessor

* Bridges and variations of bridges also can be used in a diagnosis.

HEALING TIMES AND REHABILITATION

YOU HAVE HAD YOUR HAMSTRING DIAGNOSED.

Lets have a look at a few studies on healing of muscle.

STUDY 1 HEALING

“Immobilization for longer than 1 week resulted in marked atrophy of the injured gastrocnemius. Mobilization instituted immediately after injury

resulted in dense scar formation and interfered with muscle regeneration.”

LAYMANS TERMS!

Make sure you rest until Phase 1 is over. ( 3 to 10 days) If you rest totally for longer than 7 days you will lose too much muscle. If you move too soon straight

after injury you will cause too much scar and also interfere with muscle regeneration.

Immobilization or Early Mobilization After an Acute Soft-Tissue Injury?

Pekka Kannus, MD, PhD THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 3 - MARCH 2000

Phases of Healing after an Acute Soft Tissue Injury according to this study:

Phase 1: Inflammation: 7 days Phase 2: Proliferation: 7 to 21 days Phase 3: Maturation and Remodelling: > 21 days Phase 1: Acute inflammatory phase. Swelling, redness of the skin temperature, pain, and loss of function. The process culminating in tissue repair and sometimes scar (adhesion) formation. Phase 2: Proliferative phase. Fibrin clotting and the spread of fibroblasts, and capillaries.. Damaged tissue is removed by phagocytosis, Production of collagen (initially, the weaker, type 3 collagen, later type 1. Phase 3: Maturation and remodeling phase. Type 1 collagen fibers start to assume a normal orientation. Approximately 6 to 8 weeks postinjury, the new collagen fibers can withstand near-normal stress

STUDY 2 HEALING

Muscle Injuries: Biology and Treatment: Järvinen The American Journal of Sports Medicine, Vol. 33, No. 5

This study emphasizes the need to immobilize in the acute phase which as minimum from healing studies should be 3 days.

REST IS CRITICAL IN THE ACUTE PHASE

Even slight use of the injured muscle in this Acute Phase needs to be avoided according to Jarvinen. He also talks about reruptures at the same site if mobilization is too soon. By resting in this phase less scar is put down.

WHAT HAPPENS AFTER THIS IMMOBILIZATION PHASE ?

PARADOX: Use it or lose it!

The rest in the immobilization phase allows the scar to get some strength. In fact after 10 days the scar is quite strong After the immobilization phase is over then active mobilization enhances the penetration of muscle fibres into the scar tissue, limits the size of the scar and aligns the regenerating muscle tissue.

“If immobilization is continued past the acute phase (first few days) of muscle regeneration, the deleterious effects become particularly evident

during the remodeling phase of muscle healing”

STUDY 3 HEALING

LET IT HEAL IN THE FIRST FEW DAYS!

COLLAGEN AND FIBRONECTIN IN A HEALING SKELETAL MUSCLE INJURY Journal of Bone and Joint Surgery Lehto

. In a group that had 5 days of immobilization before mobilization (IM5-MO) scar tissue was almost totally gone after eight weeks. But in the group that only was immobilized for 2 days there was an area of “fatty necrosis” in the centre of theinjured area 3 weeks after and 8 weeks after there was a lot more scar tissue.

STUDY 4 HEALING

EVIDENCE BASED PREVENTION OF HAMSTRING INJURIES IN SPORT

Petersen and Holmich Br J Sports Med 2005

I will use the terminology in this study in my programs BUT these phases are difficult to predict accurately and simply describe a process that can be followed.

Phase 1 (acute): 1–7 days

Phase 2 (subacute):

day 3 to .3 weeks

Phase 3 (remodeling); 1–6 weeks

Phase 4 (functional): 2 weeks to 6 months

Phase 5 (return to comp): 3 weeks to 6 mths

The aim is to

control haemorrhaging , inflammation and

pain.

PRICE

Ice in lengthened position.

Do not stretch.

Only test if

necessary and don’t go over

moderate awareness.

This phase begins when the signs of

inflammation (swelling, heat,

redness, and pain) begin to resolve.

Muscle action must start to prevent

atrophy and hasten healing. Concentric strength exercises can begin in this phase when the

athlete has achieved full range of motion

without pain

Hamstring stretching can begin in the third phase. DO concentric

exercise before eccentric exercise because eccentric contraction causes greater force than

concentric contraction. Thus good concentric strength must be

achieved before any eccentric training is

done.

Strength and

flexibility levels need to be back to normal values for pre injury.

Jogging progresses

to strides then sprints and then sports

specific activities.

All these boxes must be ticked.

Assess all factors

from the mechanism of the injury to the

diagnosis and scans if any. Also how long did it take ofr acute

and sub acute phases?

Test at 90 to 100% in functional means but allow recovery after

tests before competition.

HOW TO PLAN A REHABILITATION

TWO VARIATIONS FOR 21 DAY REHABILITATIONS

Once you have gone over 4 days for immobilization you should take 28 days for your rehabilitation. That seems to be a safer option. Better safe than sorry. 21

day rehabilitations are used for athletes that have a grade 1 strain and have no history of previous injury. So if pain or awareness persists past day 4 then you

should use the 28 day model and not cut the edges at all. If you are a sprinter or a very fast athlete, I would simply use the 4 week program. This is a sample 21

day plan. Phases are a bit arbitrary apart from a minimum of 3 days immobilization of injury has occurred or is suspected.

Mon Tue Wed Thu Fri Sat Sun

INJURY Immobilize

Immobilize Immobilize Mobilize Mobilize Mobilize Remodel Remodel

Remodel Remodel Remodel Remodel Remodel Functional Functional

Functional Functional Functional Functional Functional PLAY

NO FASTER THAN 70% in REMODELLING PHASE

The fastest I think you should go in the remodeling phase is 70% of your

maximum speed. This should allow for specific adaptations and progressions but not put too much strain on the hamstring and allow remodeling to occur.

SO IF YOU HAVE RUN 12 seconds for 100m then 70% of maximum is 15.6

seconds

NUMBER ONE RULE IN HAMSTRING REHABILITATIONS!

FOLLOW THE PLAN OR RISK A RECUURENCE!

Athlete says: “ I want to play, this hamstring is pain free!” Its Day 10 and I feel nothing!

Clinician replies: “ Ok, lets have a look at this hamstring and go faster each rep,

but he be careful ok, no pain eh”

Athlete goes 60%......70%.......80%..( Feels great mate!) .... Then accelerates to 90%....... Ouch..Recurrence...Back to square one..... Start a 21 day cycle again and maybe might have to go 28 days again.

Predictable stuff!

That is why the statisitics are so high for this injury. With an ankle injury or other similar problems, having a go at fast tracking rarely sends one back to day one. Maybe a step back. But in a hamstring , sure get cocky, but also pay the price for your bravado. The maximum one could squeeze the immobilization phase to in a 21 day rehabilitation is 4 days. After that as suggested you should use a 28 day model.

Mon Tue Wed Thu Fri Sat Sun INJURY Immobilize

Immobilize Immobilize Immobilize Mobilize Mobilize Mobilize Mobilize

Remodel Remodel Remodel Remodel Remodel Remodel Functional

Functional Functional Functional Functional Functional PLAY

And in a practical setting given all the progressions are respected then this is as tight as one would want to do it with a grade 1 strain for I would simply use the 4

week program. WHAT ABOUT SOME OF THOSE 14 DAY REHABILITATIONS YOU HEAR

ABOUT?

In an elite sports setting sometimes athletes injure themselves and are diagnosed with a grade 1 strain after the incident. But by day 1,2 or 3 they feel

pain free on all tests. They have an MRI a few days later and shows no tear. But if the original diagnosis was a strain this suggests there was some micro damage or disruption that has not shown up on scans. Also if the mechanism was done at

reasonable speed this adds further weight to the fact that there may be a small problem. So if you are not a real speedster and have not had a hamstring before

then only in this situation can a14 day rehabilitation be considered. But this must be closely monitored by a clinician and agreed to by all parties after

careful diagnosis and consideration.

Also the program should be different for a 14 day hamstring with less eccentric work and more core work and basic exercises such as lunges and stepups.

The difference here is simply allowing healing of any microtrauma. There is very

little time to strengthen or test.

A key factor here again is the immobilization phase even though you feel 100%. This makes sure that healing has started. Then allowing for 2 more days of

mobilization will ensure that healing is complete.

Also remember that Day 10 is usually a switch over point in healing so even though there is little time here , don’t put your muscle under too much strain until

after day 10.

Again this is only for those hamstrings that clear up almost the next day or have

a negative MRI , and is a rehabilitation decision for a medical person.

Mon Tue Wed Thu Fri Sat Sun INJURY Immobilize

Immobilize Immobilize Mobilize Mobilize Remodel Jog

Remodel 55% Strides

Remodel 65% Strides

Functional 75% Strides

Functional Functional Test 90%

Functional Functional PLAY

SOME GUIDELINES TO PLANNING A REHAB ( Better safe than sorry!).

10% Rule: Never progress faster than 10% in any variable in a rehabilitation. This little rule seems to work.

If in doubt after an incident that seems a hamstring have 3 days of immobilization. You will not lose much fitness and if there was some damage healing won’t be compromised Any Grade 2 injury should do a 28 day or longer rehabilitation program and a minimum of 4 to 5 days of immobilization and PRICE in the acute phase. If you need 5 to 7 days of immobilization, then you should go to a 5 week program or longer. If you need 7 to 10 days of immobilization then use the 6 week program. Any fast sprinters or very fast athletes should add a week. Maybe if you are over 30 and still have some speed you should add a week. Phases change only when symptoms allow. It is a good idea to check with a clinician at the end of each phase to decide whether it is ok to progress to the next phase. Don’t just change phases for the sake of it.

Once jogging an athlete can run every day. But I normally have a stride day followed by a jog day given that agilities and weights are done and require adaptation. Thus jogging and slow running is valuable for fitness, specific to running but low in eccentric demand. Also on the off days the athlete can do high intensity swimming and grinder and any other needs such as Pilates or Upper Body Weights. Bike sessions and pool running should be done on the same day as the strides so that there is no interference when you stride again. Especially when the speed gets above 80%.

SOME POSSIBLE INDICATORS FOR PROGRESS These are just guides. Check with a medically qualified person to assess phases.

Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Acute Phase

(Immobilization) Sub Acute

(Mobilization) Remodelling Functional Return

3 to 10 days long 3 to 21 days long 7 to ? days long 7 to ? days long At Day 14 to ? .

If pain is greater than 3 then use crutches in my

opinion.

The aim is to control haemorrhaging ,

inflammation and pain.

PRICE

Ice in lengthened position.

Do not stretch.

Only test if necessary and don’t go over moderate

awareness.

Begins when the signs of inflammation (swelling,

heat, redness, and pain) begin to resolve and

athlete can walk pain free at normal pace and also

not feel the injury in normal daily activities.

Only pain free walking and

low intensity activities Low Intensity Bike and

Pool. Walk and run.

Only hips and other muscles stretched / not

hamstrings.

Only bodyweight exercises done slowly.

Continue icing after

exercising.

START PHASE WHEN

1. SLR almost back to

normal of uninjured leg.

2. Resisted Hamstring Test minimal to zero

awareness at approx. 60% perceived force of uninjured leg.

3. When walking with a high knee march in place

can be done for 30 seconds

4. Also stride length and

stance time when walking should be the same on both legs

Do not start this phase at less than Day 7 even in short 14 day and 21 day programs to ensure

healing.

START PHASE WHEN

All range of motion tests are almost the same as

non injured leg.

Isometric strength work can be done at 90 to

100% contraction

Bridges at varied angles on a bench can be done

for repetitions,

Concentric weight training can be done at

maximal levels and bodyweight eccentric training has begun.

Jogging phase has

been completed and run at 70% speed

completed.

14 and 21 day plan

Test at 90% 72 hours

before .( IE Wed before a Sat)

Test speed and agility and

test your sport at 90% intensity.

14 and 21 day rehabs are too short to test 100% so you have to make an educated

judgement.

28 days rehab onwards

If you have completed

90% intensity by 21 days then a test 6 days before the event at 95/100% is warranted and will assist the rehab. Then 72 hours before the athlete should perform their skill at 90%

perceived intensity.

GENERAL PLANNER FOR A HAMSTRING REHABILITATION

Mon Tue Wed Thu Fri Sat Sun

INJURY Minimum

Immobilization

Minimum Immobilization

Phase

Minimum Immobilization

Phase

Assess

Immobilization

Assess Immobilization

Assess Immobilization

Assess Immobilization

Assess Immobilization

Assess Immobilization

Assess Immobilization

Day 14 or Week 2

Day 21 or Week 3

Day 28 or Week 4

Day 35 or Week 5

Day 42 or Week 6

All the sessions are outlined in the appendix using abbreviated terms. Check the

programs below and then go to the required program.

Example AG1 L1 = Agility 1 Level 1 R WTS 1 = Remodel Wts 1

SESSIONS AVAILABLE AND CODES

Mobilization Jogging Strides

Agility

Weights

Sports Specific

MOB 1 JOG 1 Flying 20m Ag1 L1 Mob1 Wts Sports Specific

MOB 2 JOG 2 40/20/20 Ag1 L2 Mob2 Wts Sessions

MOB 3 JOG 3 30/20/20 Ag2L1 Mob3 Wts

JOG Extra 20/20/20 Ag2L2 Remodel Wts 100m Ag3L1 RWTS 1

Jog in 5/Run100 Ag3L2 RWTS 2

* 150/200m? AgTests RWTS 3

Sports Specific Functional Wts FWTS 1

FWTS 2

FWTS 3

14 Day Wts 14 Day Wts 1

14 Day Wts 2

These are after the acute phase and include walking.

light bike and varied pool work,

Jog Extra

This is a general session on days between stride

sessions.

All these sessions have progressions

from 50% to 100% of the athletes personal

best.

Sports Specific means that in a

multidirectional sport, specific sessions can

be used for agility tests.

PreCompWts

Sports Specific

Sessions need to be integrated into a

rehabilitation program and

intensities of these sessions must be closely monitored

and kept below that of stride sessions.

ANCILLARY SESSIONS

WARMUP

STRETCHING

Mobility Drills Stretch Mobilization Phase

Done before any running Stretch Remodel Phase

Running Drills Stretch Functional Phase

Once Strides Start

• 150/200m sessions are not included but can be used.

EXAMPLE OF A SESSION ONLY 70% Stride Session at Day 13 for example

of 21 day hamstring program.

Walk

Mobility drills

Jog 1200m

Running Drills

12*40/20/20 ( 70% Maximum Speed)

Ag 2 L2 ( Agility 2 Level 2)

R WTS 3 ( Remodel Wts 1 )

Stretch Remodel Phase

* Cross Training for fitness an option

EXAMPLE OF A SESSION ONLY 90% Stride Session at Day 21 for example

of 28 day hamstring program.

Walk

Mobility drills

Jog 1200m

Running Drills

12*20/20/20 ( 90% Maximum Speed)

Agility Test 90%

Sports Specific Training 20 mins 80% Intensity

FWTS 3

Stretch Functional Phase

PROGRAMS

PHASES If you are having difficulty with awareness then you must change the plan and

create a new plan before you have a recurrence! Thus work closely with a medical professional during the program to assess progress and adjust phases if

necessary.

“Plans are nothing, planning is everything” and

“Plans are useless, planning is indispensable.” Dwight Eisenhowe

FITNESS MAINTENANCE This area is very sports specific. Until the remodeling phase is over this must be addressed by low intensity methods. If bike is used then intense sessions with high resistances must be avoided before stride sessions. Bike should use high revolutions and low resistances and sessions should be done after a running

session to allow for 48 hours before the next stride session. Thus low intensity jogging and swimming and seated grinder work can maintain cardio fitness levels and be done on off days. Low intensity sports specific sessions can be integrated

into the program but always should be 10% less intensity than the controlled running session completed. Versa Climber and stepper work is like the bike. Plan

carefully and don’t work intensely the day before a running session. Pool Running at low intensity after a running session is excellent for recovery and fitness and again don’t do a hard pool running session the day before a stride

session, given hip flexors can take a hammering.

SPORTS SPECIFIC TRAINING

All sports are different. My advice is to add some sports specific training once the functional phase starts for skill and fitness. Verrall demonstrated that by implementing sport specific training drills in a preseason instead of slow running resulted in a reduction in the number of hamstring pathologies. Simply train fast and specific and hamstrings will adapt to what awaits them. Competition.

BE CAREFUL WITH SPORTS SPECIFIC TRAINING. HARD TO MEASURE Thus there is some validity for switching some of the agility drills to sports specific work but the intensity of training has to be closely monitored because it is difficult to monitor intensity in game like situations where instinctive movments can cause recurrences.

The perceived intensity should always be 10% less then the running program on that day. So if you have done a 90% stride intensity session you should do a somewhat hard skills session and not hard. And if you have started with 60% strides then only a very low intensity skills session can be done. In soccer this might mean you only kick a ball 10 metres for example. (Verrall GM, Slavotinek JP, Barnes PG. The effect of sports specific training on reducing the incidence of hamstring injuries in professional Australian Rules football players. Br J Sports Med. 2005;39:363-368.)

What running intensity as a % correlates to in words.

RUNNING or STRIDES INTENSITY AS % TRAINING INTENSITY of RUNNING in WORDS 50% Very Low Intensity

60% Low Intensity

70% Moderate Intensity

80% Somewhat hard and fast

90% Hard and fast

95% Very Hard and fast

100% Maximal

COMBINATIONS IN A REHABILITATION THAT SHOULD BE OK IN A REHABILIATION PROGRAM IN THE SAME SESSION ARE AS FOLLOWS

RUNNING or STRIDES INTENSITY AS % SPORTS SPECIFIC TRAINING INTENSITY

60% Very Low Intensity Sports Specific Training

70% Low Intensity Sports Specific Training

80% Moderate Intensity Sports Specific Training

90% Somewhat hard and fast Sports Specific Training

95% Hard Sports Specific Training

IMPORTANT Monitor Loads and vary training if you have to

If there is a crucial need to do more sports specific training then agility loads and tests and stride loads should be cut a little. I have not provided accurate loadings for sports given the huge differences in different sports. So if you do 10 strides at 80 to 95% and 2 agility tests then the load of the sports specific sessions should

be probably low and the intensity as discussed should be 10% less than the running and agility

STRETCHING

This is to be done after training and combined with recovery methods such as icing and ice baths. But it must be avoided in my opinion in the acute phase and

the muscle should not be “tugged at”. Even in the next 2 phases stretching of hamstrings should be very conservative in a hamstring strain. The intensity of stretching needs to be graded up evenly with the program. There are some

sample programs for each phase in the appendix. Attention to detail with hips, ITB bands, hip flexors and quadriceps is warranted in a hamstring rehabilitation

with stretching and massage.

MASSAGE Just like stretching, enormous care must be taken with massage until late in the functional stage. Treatment and rehabilitation is outside the scope of this book

but avoid aggressive massage until later in the program and follow your clinicians advice.

SAMPLE 14 DAY REHABILITATION Example: Minor strain at speed. Pain free for example 48 hours later. All

diagnostic tests totally clear at day 3. If on MRI no lesion appears. No previous hamstring history. Not a speed freak!. Note 2 different weights sessions here. 14

day Wts 1 and 2

Mon Tue Wed Thu Fri Sat Sun

INJURY

Immobilize PRICE

Immobilize PRICE

Immobilize PRICE

Mobilize MOB 1

MOB 1 WTS

Mobilize MOB 3

MOB 3 WTS

Remodel Jog 1 Ag1 L1

MOB 3 WTS

Remodel Jog 2

55% Strides Ag1 L1

14 DAY WTS 1

Remodel Jog 3

65% Strides Agility 2 L1

Functional 75% Strides Agility 3 L1

14 DAY WTS 2

Jog or off legs

Swim UB

Grinder Pilates

20/20/20 Test 90% only

Agility Test 90% Sports Specific

Functional

Assess

Functional

Low Intensity Sports Specific

PLAY

*A 14 day rehabilitation program is a decision for a medical person, not you if the

diagnosis was a definite but very minor hamstring injury, or if there is back related pathology involved.

SAMPLE 1 21 Day with 3 days Immobolization

Mon Tue Wed Thu Fri Sat Sun

INJURY PRICED

Immobilize PRICED

Immobilize PRICED

Immobilize PRICED

Mobilize MOB 1

MOB 1 WTS Ice

Mobilize MOB 2

MOB 2 WTS Ice

Mobilize MOB 3

MOB 3 WTS Ice

Remodel Jog 1 AG1Li

MOB 3 WTs

Remodel

Jog 2 AG1L2

MOB 3 WTS

Remodel

Jog 3 AG1L2

Remodel 60% Strides

AG2L1 RWTS 1

Jog or off legs Swim UB

Grinder Pilates

Remodel 70% Strides

Ag2 L2 RWTS 2

Jog or off legs Swim UB

Grinder Pilates

Functional

80% Strides Ag3L1

Speciifc Sports 70%

FWTs 1 & 2

Jog or off legs

Swim UB

Grinder Pilates

Functional Strides 90/95%

Ag3L2 Specific Sport 80%

FWTs 2/3

Jog or off legs Swim UB

Grinder Pilates

Ag Test 90% Specific Sport 90/95%

PreComp Wts

Assess

Clinically

Functional Assess

Low Intensity

Sports Specific <75%

PLAY

This is a careful plan. On day 14 a specific sports session can be done but it must be low intensity. Functional weights sessions in this program need to be

mixed and matched given the time frames and the need to avoid high eccentric loads early in the program

Variation of this might be as below if things are going really well early.

SAMPLE 2 21 Day with 3 days Immobolization

Mon Tue Wed Thu Fri Sat Sun

INJURY PRICED

Immobilize PRICED

Immobilize PRICED

Immobilize PRICED

Mobilize MOB 1

MOB 1 WTS Ice

Mobilize MOB 3

MOB 3 WTS Ice

Remodel Jog 1 AG1Li

MOB 3 Wts

Remodel Jog 2

AG1L2 RWTS 1

Remodel

Jog 3 AG1L2

RWTS 2

Remodel

60% Strides AG2L1

Remodel 70% Strides

AG2 L1 RWTS 3

Jog or off legs

Swim UB

Grinder Pilates

Functional

80% Strides AG3L1 FWTS 1

Jog or off legs

Swim UB

Grinder Pilates

Functional 90% Strides

AG3L1 Specific Sport 70%

FWTS 2

Jog or off legs Swim UB

Grinder Pilates

Functional

Strides 95% Max Specific Sport 80%

Ag3L2 FWTS3

Jog or off legs Swim UB

Grinder Pilates

Ag Test 90% Functional

Specific Sport 90% PreComp Wts

Assess Clinically

Functional

Assess

Low Intensity Sports Specific

<75%

PLAY

*This approach means an athlete can get more work in if symptoms allow. But great care has to be taken

SAMPLE 3 21 Day with 4 days Immobilization given symptoms persisted till Day 4 and thus a very slight cram of the phases might be used. Also a day on/day off program can be used in these cases and this also allows for a

day to be pushed out in the functional phase.

Mon Tue Wed Thu Fri Sat Sun

INJURY PRICE

Immobilize

PRICE

Immobilize PRICE

Immobilize

PRICE

Immobilize

PRICE

Mobilize MOB 1

MOB1Wts Ice

Mobilize MOB 3

MOB3WTS Ice

Remodel Jog 1

AG1 L1 MOB 3 WTS

Remodel

Jog 2 AG1L2

RWTS 1

Remodel

Jog 3 AG2L1

RWTS 2

Off Legs Swim UB

Grinder Pilates

Remodel 60% Strides

AG2L2 RWTS 3

Jog or off legs Swim UB

Grinder Pilates

Functional 70% Strides

Ag3 L1 RWTS 3

Jog or off legs Swim UB

Grinder Pilates

Functional 80% Strides

Ag3L2 FWTS 1/2

Jog or off legs Swim UB

Grinder Pilates nal

Functional

Strides 90% Max Specific Sport 80%

Ag Test 90% F WTS 2/3

Assess Clinically

Sports Specific Session

Low Volume 90% to assess.

REST and assess Recovery

PLAY 2

Fitness should be addressed by low intensity jogging and early in the program

with swimming and seated grinder sessions. Bike should be added on the day of a running session otherwise the athlete may not recover if it is done on off-days. Also due to the slightly cramped nature of this program a mix of FWTS 2 and 3

could be done on the Monday for example.

Sample 28 day program 1 These phase must be assessed carefully by the rehabilitation expert and the

rehabilitation progression planned carefully after the immobilization phase.This might be a Grade 1 plus type hamstring or a Grade 1 injury in a player with a

history or who is very fast.

Mon Tue Wed Thu Fri Sat Sun

INJURY PRICE

Immobilize PRICE

Immobilize PRICE

Immobilize PRICE

Immobilize PRICE

Mobilize MOB 1

MOB 1 WTS Ice

Mobilize MOB 1

MOB 1 WTS Ice

Mobilize MOB 2

MOB 2 WTS Ice

Mobilize MOB 3

MOB 3 WTS Ice

Remodel

Jog 1 AG1L1

MOB 3 WTS

Remodel

Jog 2 AG1L2

Remodel

Jog 3 AG1L3

RWTS 1

Off Legs

Swim UB

Grinder Pilates

Remodel

Strides 60% AG2L1

RWTS 2

Jog or off legs

Swim UB

Grinder Pilates

Remodel

Strides 70% AG2L2

RWTS 3

Jog or off legs

Swim UB

Grinder Pilates

Functional

Strides 75% AG2L3 FWTS 1

Jog or off legs

Swim UB

Grinder Pilates

Functional

Strides 80% AG3L1 FWTS 2

Jog or off legs

Swim UB

Grinder Pilates

Functional

Strides 90% AG3L2

PreComp Wts

Jog or off legs

Swim UB

Grinder Pilates

Functional

TEST Strides 95% AGILITY TEST 90% Sports Specific 80%

FWTS 3

Jog or off legs

Swim UB

Grinder Pilates

Functional

Sports Specific Session 80/90%

Possible Test 90% if

not done Monday

Functional

Assess

Functional

Low Intensity Sports Specific

< 75%

PLAY

Note that on Day 21 I have placed a PreComp Wts session given the high intensity session planned on the Monday so as the athlete is recovered from that.

Then the last Functional Weights session ( F WTS3 ) can be done on the Monday and the athlete can assesses specifically on the Wednesday. Also if the progress has been a bit slow and the test was not done on the Monday then a

90% evaluation can be done on the Wednesday.

Sample 28 day program 2 Here symptoms might persist till Day 5 and also given the history of the player and/or the diagnosis a 28 day rehabilitation was planned. These plans are just

guides and phases might be different.

Mon Tue Wed Thu Fri Sat Sun

INJURY

Immobilize PRICED

Immobilize PRICED

Immobilize PRICED

Immobilize PRICED

Immobilize PRICED

Immobilize PRICED

Mobilize MOB 1

MOB 1 WTS Ice

Mobilize MOB 2

MOB 2 WTS Ice

Mobilize MOB 3

MOB 3 WTS Ice

Mobilize MOB 3

MOB 3 WTS Ice

Remodel

Jog 1 AG1L1

MOB 3 WTS

Remodel

Jog 2 AG1L2

RWTS 1

Remodel

Jog 3 AG1L3

Off Legs

Swim UB

Grinder Pilates

Remodel Strides 60%

AG2L1 RWTS 2

Jog or off legs

Swim UB

Grinder Pilates

Remodel Strides 70%

AG2L2 RWTS 3

Jog or off legs

Swim UB

Grinder Pilates

Functional

75% Strides AG3L1 FWTS 1

Jog or off legs Swim UB

Grinder Pilates

Functional 85% Strides

AG3L2 FWTS 2

Jog or off legs Swim UB

Grinder Pilates

Functional

Agility Test 90% Sports Specific

80% PreComp Wts

Jog or off legs Swim UB

Grinder Pilates

Functional

Strides 90/95% Sports Specific

85% FWTS 3

Functional Rest

Assess

Functional

Sports Specific Low Volume

90% Intensity Max

Functional Rest

Assess PLAY

Splitting up assessments is OK also in this example with agility on a Sunday and some testing on a Tuesday. The sports specific session on Day 21 for example needs to be kept at low intensity given the session on the day before. If there is any doubt then an off legs session or an aerobic jog can be done for example. One notes the slow progress in the functional

phase.

Sample 35 day Program ( 5 weeks)

This is an example of simply running one day and not the next in a rehabilitation program. Good idea after a serious hamstring. Also gives some time for more

sports specific fast work a week before competition.

INJURY

Immobilize

Immobilize Immobilize Immobilize Immobilize Immobilize

Mobilize MOB 1

MOB 1 WTS Ice

Mobilize MOB 1

MOB 1 WTS Ice

Mobilize MOB 2

MOB 2 WTS Ice

Mobilize MOB 2

MOB 2 WTS Ice

Mobilize MOB 3

MOB 3 WTS Ice

Remodel

Jog 1 AG1L1

MOB 3 WTS

Off Legs

Swim UB

Grinder Pilates

Remodel Jog 2

AG1L1 RWTS 1

Off Legs Swim UB

Grinder Pilates

Remodel

Jog 3 AG2L1

RWTS 1

Off Legs

Swim UB

Grinder Pilates

Remodel Strides 60%

AG2L2 RWTS 2

Jog or off legs Swim UB

Grinder Pilates

Remodel Strides 70%

AG2L2 RWTS 3

Jog or off legs Swim UB

Grinder Pilates

Functional

Strides 75% AG3L1 FWTS 1

Jog or off legs

Swim UB

Grinder Pilates

Functional

Strides 80% AG3L2

Sports Specific 60%

FWTS 2

Jog or off legs

Swim UB

Grinder Pilates

Functional

Strides 85% Sports Specific

70% FWTS 3

Jog or off legs

Swim UB

Grinder Pilates

Functional Strides 90%

Sports Specific 80%

PreComp Wts

Functional

Rest

Functional 95% Strides Test Agility 90% test

Sports Specific 85% F WTS 3

Jog or off legs

Swim UB

Grinder Pilates

Functional

Sports Specific 90/95%

PreComp Wts

Functional

Assess Recovery

Functional

Low Intensity Sports Specific

<75%

PLAY

In this program one can mix in some sports specific training if the athlete plays a

multidirectional sport and integrate it into the running a bit earlier. Also a PreComp Wts session has been placed at Day 28 ( Week 4) to allow for recovery

before the 95% session. This is the sort of interplay that must occur when planning programs to avoid problems during the rehabilitation due to inadequate

recovery before an intense session.

Sample 42 day Program ( 6 weeks onwards)

After 4 weeks the phases become varied and need to be decided upon by diagnosis using a qualified person. On programs of this length the opportunity

exists to totally complete each phase and tick every box and test a week before competition.

SERIOUS STRAIN THAT MAY NEED 10 DAYS IMMOBILIZATION

This is an example of how long that these might take with Grade 3 Strains or multiple recurrence situations.

So tables for this hypothetical rehabilitation might look like this.

Days Phase Function of Phase

10 Acute ( Immobilization) Allow complete healing The aim is to control haemorrhaging ,

inflammation and pain.

21 Sub Acute ( Mobilization)

Continue healing but mobilize and promote Concentric strength exercises can begin in this phase when the athlete has achieved

full range of motion without pain

21 Remodelling Continue healing & start strength and jog phase DO concentric

exercise before eccentric exercise because eccentric contraction causes greater force than concentric contraction

42 Functional Start long term eccentric strength program then progressive speed

and agility program.

INJURY Immobilize

Immobilize Immobilize Immobilize Immobilize Immobilize Immobilize Immobilize

Immobilize Immobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Mobilize Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Remodel Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional ASSESS PLAYl

Often these require 6 weeks of only rest and general mobilization and then

another 6 week program must start after this block. This serious type of injury must be assessed by a clinician and these programs I have outlined are only

relevant in the later stages of these rehabs.

MOBILIZATION SESSION 1 (MOB 1) Minimal to zero awareness.

Definitely never over 3 on the Awareness Scale. ( Moderate awareness) These can be split up on one day

WALKING

Asses 5 mins at slow pace. If ok continue for 15 to 30 minutes with no awareness

BIKE

5 mins at slow pace. If ok continue for 15 to 30 minutes with no awareness .Make sure the seat allows almost full range. Use very low resistances on the bike to and

keep revolutions at 50 to 60 revs per minute for example.

POOL

10 mins walking slowly in waist deep water and light stretching of the hips ,

quadriceps, hip flexors and upper body.

MOBILIZATION SESSION 2 (MOB 2) Minimal to zero awareness.

Definitely never over 3 on the Awareness Scale. ( Moderate awareness) These can be split up on one day

WALKING

30 minutes with no awareness. If ok walk faster for another 15 minutes.

BIKE

5 mins at slow pace. If ok continue for 15 to 30 minutes with no awareness .Make sure the seat allows almost full range. Increase revolutions to 50 to 60 per minute but no faster.

POOL

10 mins of normal walking in waist deep water and light stretching. Then do 5/8 sets of 10 to 15 metres of each of the following at slow pace and no awareness

1. Backward walking 2. Side to sides 3. Carioca. ( one foot in front and then behind the body).

*Swimming is ok but you must place a pool buoy between your legs and tie feet together with theraband so as there you are only using your upper body.

MOBILIZATION SESSION 3 (MOB 3) Definitely never over 3 on the Awareness Scale. ( Moderate awareness)

These can be split up on one day

WALKING

30 minutes with no awareness. If ok walk faster for another 30 minutes.

BIKE

5 mins at slow pace. If ok continue for 15 to 30 minutes with no awareness .Make sure the seat allows almost full range. Increase revolutions to 60 to 70 per minute but no faster. You can vary the programs as long as you stay at low intensity.

POOL

10 mins of normal walking in waist deep water and light stretching of the hips and quadriceps. Then do 1 set of 10m of jooging in waist deep water. If pain free do another 10 sets of 10/15m of slow jogging walk back in waist deep water. Then do 8/10 sets of 10 to 15 metres of each of the following

4. Backward walking 5. Side to sides 6. Carioca. ( one foot in front and then behind the body).

Water Running: Put a vest on if you have access to one and go in deep water and do slow pool running. Do 10 sets of 15 seconds of slow pool running with 15 seconds recovery. Swimming is ok but you must place a pool buoy between your legs and tie feet together with theraband so as there you are only suing your upper boby.

RUNNING SESSIONS The aim of the hamstring rehabilitation running sessions are strictly rehabilitation

and not fitness. This needs to be addressed with a jog on alternate days and specific cross training. The agilities will assist fitness a little but specific needs for different sports need to be worked on with varied methods without impacting on

the important stride sessions. Also strides are normally every second day as against some other programs available. The aim is to add a specific weights

session after the running and then make sure the muscles have recovered from the strides. I believe this works just as well as cramming. and also gives the

opportunity to do some low intensity running on alternate days. The aim is to get the hamstring rehabilitated and not to break records.

Jogging Sessions Walk 5 mins Mobility Drills

Jog

Stride Sessions Walk 5 mins Mobility Drills Jog 1200m

Running Drills

MOBILITY DRILLS:

Do these before jog and before Run Drills when you start striding.

Arm Swings

10 Swings forward and back

Hip Rolls

Keep Back flat knees together 10 each side

Downward Dog

Hold each position for 2 seconds and repeat 3 times

Active Hamstring Stretch

On back. Legs up and over. Point toe. Move slowly into stretch in Jog Phase.

Balance Leg Swings 10 each side

Do these slowly with hips level

Scorpions 8 each side On stomach. Do slowly.

Prone Leg swing 8 each side Keep leg straight. Do slowly.

Slow Walking Lunges with Arms Overhead. 5

each leg. Hold each position for 2 seconds.

Walking Hip Stretch

3 sets of 2 seconds each stretch Hug knee to chest. Toe up

Walking Thigh Stretch

3 sets of 2 seconds each stretch Keep Hips Level

Over Hurdles forwards and backwards

5 stepovers each leg Simulate stepping back and fwd over small hurdles

RUNNING DRILLS To be used only when strides start.

Jog 1200m then do mobility then run drills.

In all these drills posture has to be perfect with neutral spine being the target and no front-side or rear-side mechanics. Weight should be always over the centre of gravity and also bodylean shoud be from the ground and not the hips. OVERSTRIDING AND HAMSTRING INJURY was discussed earlier and the drills must emphasize the paw back under the centre of gravity. The faster the leg is pulled through in the back swing the more efficient is the touchdown, Thus by eliminating overstriding , braking forces and contact times can be reduced.

Walking High Kicks 2*20m

Alternate high kicks. Gradual increase of intensity.

Skips 2*20m

Good posture. Active hips and keep toe up. Bring foot over opposite knee. Keep bodyweight over

centre gravity.

Butt Flicks 2*10m

Bring knee up then activate hamstrings and hit butt. Keep bodyweight over centre gravity.

Dead Leg Drills 2*20m

Step over knee and heel to butt and then cycle back to ground. Hip up, knee up then toe up then cycle.

Skip, extend and paw back 2*20m

Skips like earlier then extend out then paw back under hips.

High Knees 2*10m

Keep bodyweight forward and take medium height steps.

Straight Leg Bounding 2*20m

Don’t goose step. Work on pushing back and landing under hips.

Fast leg movements 2*20m

Step over ankles with fast movements and keep bodyweight over centre of gravity.

Hip Up Knee Up

Heel close to butt

Then cycle around back to start.

Emphasise cyclic action.

RUNNING SESSIONS

Jogging In a rehabilitation setting the pace should always be what you would run in an aerobic zone ( talk pace) for 3km and even a bit slower. If aware sometimes slowing to a very slow jog can stop the awareness and is ok. JOG 1 Walk 5 minutes Jog 5 minutes Mobility Session Then Jog 10*100 and walk back. Do not increase speed at all. What you would do a talk pace or slower 5km run at. JOG 2 Walk 5 minutes Jog 5 minutes Mobility Session Then Jog 10*200 and walk 100m Do not increase speed at all. What you would do a talk pace or slower 5km run at. JOG 3 Walk 5 minutes Jog 5 minutes Mobility Session Jog 4*800m and walk 400m recovery Do not increase speed at all. What you would do a talk pace or slower 5km run

JOG EXTRA *after the above sessions are completed. Walk 5 minutes Jog 5 minutes Mobility Session Example 1: Jog 4*1kmm and walk 400m recovery Example 2: 1km warmup then 3, 4 or 5 km depending on your sport. Preferable to stay in the aerobic zone ( talk pace) in a hamstring rehabilitation to allow recovery. If you need to run some distance then wait till the functional phase to cover more than 5km in one run.

If you are going ot increase pace a bit run it in thirds. First third easy, then second third medium, then last third medium to hard. Progressive.

STRIDES

You can use either the flying 20metres method or use 100 metres to do a progressive running program. Distance runners and triathletes may want to

extend this to 150 metre strides but I will stick to flying 20m and 100m in this book.

You can mix and match the two methods in a program if you want or if you don’t have someone to time you for the flying 20m strides. All you need to know is an

approximate time for your best 100 metre time so you can judge what 50/60/70% is. And remember in the 100 metre runs jog in for 5 metres then gradually

accelerate for 20 metres then finish off with 80 metres.

3 examples for a person who can run 100metres in 12 seconds might be below ( or 2.4 for a flying 20 metres off 20m run).

This might be a 21 day rehab and has 6 stride sessions in it after 3 jog sessions. Any of these methods can work and even as I said using 150m strides at low

intensity is also ok as long as the speeds progress carefully.

% Maximum Speed Program 1 Program 2 Program 3 50% 100m /18.0 seconds 100m /18.0 seconds 40/20/20 / 3,6 for 20

60% 100m /16.8 seconds 100m /16.8 seconds 40/20/20 / 3.36 for 20

70% 100m /15.6 seconds 100m /15.6 seconds 30/20/20 / 3.12 for 20

80% 100m /14.4 seconds 40/20/20 / 2.88 for 20 30/20/20 / 2.88 for 20

90% 100m /13.2 seconds 30/20/20 / 2.64 for 20 20/20/20 / 2.64 for 20

95% 100m /12.6 seconds 20/20/20 / 2.52 for 20 20/20/20 / 2.52 for 20

Program 1 is good for those who don’t have someone to time them. Just hold a watch. But you will have to also add some starts and sports specific short work if you only have used 100m for the rehab. Program. Note there are 12 strides in each of these sessions but only 6 strides have to be at the required speed. Make sure you stick to the plan on the day. Don’t run faster and faster. This is always a trap.

NOTE: If you are tightening up or fell aware in a planned session then slow down 10% and assess. If that is no good then jog and re-assess in 48 hours

USING FLYING 20 METRES

NOTE: If you are tightening up or fell aware then slow down 10% and assess. If that is no good then jog and re-assess in 48 hours

You need someone with a stop watch to help you with flying 20m.

WARMUP Walk 5 minutes Jog 5 minutes Mobility Drills

Jog 1200 metres Running Drills

Session = 3 sets of 4 Strides

Distances are

40/20/40 ( Accelerate evenly from a jog for 40m-Hold for 20m-Decelerate for 40m) 30/20/20 ( Accelerate evenly from a jog for 30m-Hold for 20m-Decelerate for 30m) 20/20/20 ( Accelerate evenly from a jog for 20m-Hold for 20m-Decelerate for 20m)

Accelerate evenly for specified distance ( 20/30 or 40m) and hold the required speed for 20m and then decelerate evenly for the required distance ( 20/30 or

40m).

Cones are set out at the start and then through the flying 20m area and the athlete has to pass between the cones.

The timer stands 20m away from the run zone and ½ way up the 20m zone. When the athlete first runs through the cones the timers starts the clock and

when the athlete runs through the second set of cones the timer stops the clock.

The session is always done in 3 sets of 4 strides with walk back recovery after each repetition and double the recovery time between each set.

40/20/40 to 30/20/30 to 20/20/20

Start timing when the athlete gets to the first blue cone closest to the timer and then stop the watch at the next blue cone. Athlete must accelerate evenly from the green cones to reach the required speed

at the blue cone and not before. It should look a smooth transition and not a sudden acceleration.

Timer 10 m

along and 20m

out.

SET 1 4 Strides: Warmup Set: Here the last run thru should be still a warmup and 5% less than the required time. SET 2 4 Strides: Do another warmup run in the first repetition and then do 3 strides at the required speed. SET 3 4 Strides: Do the first 3 strides at the required speed and then do a cooldown stride on the last stride that is 10% slower than required time.

NOTE: If you are tightening up or fell aware then slow down 10% and assess. If

that is no good then jog and re-assess in 48 hours .

DON’T GAMBLE

Once you have planned a session and a time then if you feel good don’t go faster and faster. Chances are you might tear and then it is back to day 1. Better safe

than sorry.

WHAT IS YOUR 100% FLYING 20m off 20m fly?

I timed the Essendon footballers in 1995 for a 20-20-20 on grass with runners. The grass was not perfect but it gave me a good indication of their times for

varied conditions. Of course on a synthetic track these times are quicker. Also if it is windy, try and get an area with a cross wind to standardize times a bit. Note

these times are not fitness tests but general tests that can be used for rehabilitation purposes.

With AFL footballers I found that the fast players averaged 2.2 , medium players 2.3 and slow players 2.4. These averages have proved useful since as baseline data for fit good male athletes in general. Of course a track and field sprinter can run under 2 seconds for a flying 20m and a marathon runner would have a totally

different maximal speed. In fact if dealing with marathon runners or distance runners who have a hamstring, then usually 100m upwards should be used for

the rehabilitation program.

Percentage of Max Speed for Flying 20

m/s 100% 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50%

6.7 3 3.00 3.15 3.30 3.45 3.60 3.75 3.90 4.05 4.20 4.35 4.50

6.8 2.95 2.95 3.10 3.25 3.39 3.54 3.69 3.84 3.98 4.13 4.28 4.43

6.9 2.9 2.90 3.05 3.19 3.34 3.48 3.63 3.77 3.92 4.06 4.21 4.35

7.0 2.85 2.85 2.99 3.14 3.28 3.42 3.56 3.71 3.85 3.99 4.13 4.28

7.1 2.8 2.80 2.94 3.08 3.22 3.36 3.50 3.64 3.78 3.92 4.06 4.20

7.3 2.75 2.75 2.89 3.03 3.16 3.30 3.44 3.58 3.71 3.85 3.99 4.13

7.4 2.7 2.70 2.84 2.97 3.11 3.24 3.38 3.51 3.65 3.78 3.92 4.05

7.5 2.65 2.65 2.78 2.92 3.05 3.18 3.31 3.45 3.58 3.71 3.84 3.98

7.7 2.6 2.60 2.73 2.86 2.99 3.12 3.25 3.38 3.51 3.64 3.77 3.90

7.8 2.55 2.55 2.68 2.81 2.93 3.06 3.19 3.32 3.44 3.57 3.70 3.83

8.0 2.5 2.50 2.63 2.75 2.88 3.00 3.13 3.25 3.38 3.50 3.63 3.75

8.2 2.45 2.45 2.57 2.70 2.82 2.94 3.06 3.19 3.31 3.43 3.55 3.68

8.3 2.4 2.40 2.52 2.64 2.76 2.88 3.00 3.12 3.24 3.36 3.48 3.60

8.5 2.35 2.35 2.47 2.59 2.70 2.82 2.94 3.06 3.17 3.29 3.41 3.53

8.7 2.3 2.30 2.42 2.53 2.65 2.76 2.88 2.99 3.11 3.22 3.34 3.45

8.9 2.25 2.25 2.36 2.48 2.59 2.70 2.81 2.93 3.04 3.15 3.26 3.38

9.1 2.2 2.20 2.31 2.42 2.53 2.64 2.75 2.86 2.97 3.08 3.19 3.30

9.3 2.15 2.15 2.26 2.37 2.47 2.58 2.69 2.80 2.90 3.01 3.12 3.23

9.5 2.1 2.10 2.21 2.31 2.42 2.52 2.63 2.73 2.84 2.94 3.05 3.15

9.8 2.05 2.05 2.15 2.26 2.36 2.46 2.56 2.67 2.77 2.87 2.97 3.08

10.0 2 2.00 2.10 2.20 2.30 2.40 2.50 2.60 2.70 2.80 2.90 3.00

10.3 1.95 1.95 2.05 2.15 2.24 2.34 2.44 2.54 2.63 2.73 2.83 2.93

10.5 1.9 1.90 2.00 2.09 2.19 2.28 2.38 2.47 2.57 2.66 2.76 2.85

10.8 1.85 1.85 1.94 2.04 2.13 2.22 2.31 2.41 2.50 2.59 2.68 2.78

11.1 1.8 1.80 1.89 1.98 2.07 2.16 2.25 2.34 2.43 2.52 2.61 2.70

AFL Footballers 20/20/20

Predicted Maximum Flying 20m times

FAST PLAYER 2.2

AVERAGE PLAYER 2.3

SLOW PLAYER 2.4

AFL Footballers 90% of max Flying 20m times

FAST PLAYER 2.42

AVERAGE PLAYER 2.53

SLOW PLAYER 2.64

There is a lot of difference between players so having baseline data is useful.

But most male team sport players in most codes can use the above baselines.

LETS HAVE A LOOK AT THE FASTEST PEOPLE IN THE WORLD!

ELITE FEMALE SPRINTERS 100m SPLITS 20-30m: 0.99s, Marion Jones 30-40m: 0.94s, Marion Jones

40-50m: 0.93s, Heïke Drechsler 50-60m: 0.92s, Heïke Drechsler

Thus with elite females in a race they can run under 2 seconds for a flying

20/20/20 and 1.86 for a 30/20/20 and 1.85 for 20m off a 40m start.

SLITE MALE SPRINTERS 100m SPLITS 20-30m: 0.89s, Maurice Greene

30-40m: 0.86s, Maurice Greene ( 40-50m: 0.84s, Carl Lewis

50-60m: 0.82s, Maurice Greene

So with the best ever males . 20/20/20 of 1.75 and 30/20/20 of 1.7 and 40/20/20 of 1.66.

Of course these times are from maximal starts but this gives you an indication of what can happen and how variable testing and norms can be!.

MALES and FEMALES ( .2 Difference?)

The above stats demonstrate the difference between the sexes

SEX Flying 20 from 20m start

Flying 20 from 30m start

Flying 20 from 40m start

MALE 1.75 1.7 1.66

FEMALE 1.93 1.86 1.85

Difference .18 .16 .19

So I would surmise that in general for the flying 20m the difference should be .2

for females for the purposes of a rehabilitation program..

Fit female athletes Predicted Maximum Flying 20m times

FAST PLAYER 2.4

AVERAGE PLAYER 2.5

SLOW PLAYER 2.6

Fit Females

90% of max Flying 20m times

FAST PLAYER 2.64

AVERAGE PLAYER 2.75

SLOW PLAYER 2.86

100m session

100m. Make sure you have an accurate 100m marked out or an athletics track. Then have a 5 metre run in and jog very slowly to the start. Then over the first 20m accelerate

very gradually until you reach your specificied time.

5 metres slow jog in to start of 100m. Start Watch. Then careful 20m acceleration. Hold for 80m at required time for the 100m. Stop Watch.

Jog 5m Build 20m Hold 80m

NOTE: If you are tightening up or fell aware then slow down 10% and assess. If that is no good then jog and re-assess in 48 hours

This can be used as an alternate method to timing a rehabilitation but you still should

use some flying 20m timed by another person later in the program.

HOW TO DO THE SESSION

WARMUP Walk 5 mins Jog 5 mins

Mobility Drills Jog 1200 metres

Running Drills

12*100m STRIDES Then 3 sets of 4

Walk back recovery

Set 1 4 Run throughs at warmup speed

Set 2 1 more 100m stride warming up then 3 strides at goal speed

Set 3 3 *100m strides at goal speed then 1 10% slower

EXAMPLE Your fastest time for a 100m is 12.5 seconds

You need to do a 60% speed session. Goal Time is 17.5 off a jog start for 5m then 100m

Set 1

20/19/18.75/18.5 seconds

Set 2 18/17.5/17.5/17.5

Set 3 17.5/17.5/17.5/19

NOTE: If you are tightening up or fell aware then slow down 10% and assess. If

that is no good then jog and re-assess in 48 hours .

Percentage of Max Speed 100m

m/s 100% 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50%

6.3 16 16.00 16.80 17.60 18.40 19.20 20.00 20.80 21.60 22.40 23.20 24.00

6.3 15.75 15.75 16.54 17.33 18.11 18.90 19.69 20.48 21.26 22.05 22.84 23.63

6.5 15.5 15.50 16.28 17.05 17.83 18.60 19.38 20.15 20.93 21.70 22.48 23.25

6.6 15.25 15.25 16.01 16.78 17.54 18.30 19.06 19.83 20.59 21.35 22.11 22.88

6.7 15 15.00 15.75 16.50 17.25 18.00 18.75 19.50 20.25 21.00 21.75 22.50

6.8 14.75 14.75 15.49 16.23 16.96 17.70 18.44 19.18 19.91 20.65 21.39 22.13

6.9 14.5 14.50 15.23 15.95 16.68 17.40 18.13 18.85 19.58 20.30 21.03 21.75

7.0 14.25 14.25 14.96 15.68 16.39 17.10 17.81 18.53 19.24 19.95 20.66 21.38

7.1 14 14.00 14.70 15.40 16.10 16.80 17.50 18.20 18.90 19.60 20.30 21.00

7.3 13.75 13.75 14.44 15.13 15.81 16.50 17.19 17.88 18.56 19.25 19.94 20.63

7.4 13.5 13.50 14.18 14.85 15.53 16.20 16.88 17.55 18.23 18.90 19.58 20.25

7.5 13.25 13.25 13.91 14.58 15.24 15.90 16.56 17.23 17.89 18.55 19.21 19.88

7.7 13 13.00 13.65 14.30 14.95 15.60 16.25 16.90 17.55 18.20 18.85 19.50

7.8 12.75 12.75 13.39 14.03 14.66 15.30 15.94 16.58 17.21 17.85 18.49 19.13

8.0 12.5 12.50 13.13 13.75 14.38 15.00 15.63 16.25 16.88 17.50 18.13 18.75

8.2 12.25 12.25 12.86 13.48 14.09 14.70 15.31 15.93 16.54 17.15 17.76 18.38

8.3 12 12.00 12.60 13.20 13.80 14.40 15.00 15.60 16.20 16.80 17.40 18.00

8.5 11.75 11.75 12.34 12.93 13.51 14.10 14.69 15.28 15.86 16.45 17.04 17.63

8.7 11.5 11.50 12.08 12.65 13.23 13.80 14.38 14.95 15.53 16.10 16.68 17.25

8.9 11.25 11.25 11.81 12.38 12.94 13.50 14.06 14.63 15.19 15.75 16.31 16.88

9.1 11 11.00 11.55 12.10 12.65 13.20 13.75 14.30 14.85 15.40 15.95 16.50

9.3 10.75 10.75 11.29 11.83 12.36 12.90 13.44 13.98 14.51 15.05 15.59 16.13

9.5 10.5 10.50 11.03 11.55 12.08 12.60 13.13 13.65 14.18 14.70 15.23 15.75

9.8 10.25 10.25 10.76 11.28 11.79 12.30 12.81 13.33 13.84 14.35 14.86 15.38

10.0 10 10.00 10.50 11.00 11.50 12.00 12.50 13.00 13.50 14.00 14.50 15.00

DISTANCE RUNNERS, TRIATHLETES OR RECREATIONAL ATHLETES.

Most people will know their approximate 100m time. Some don’t. So a triathlete might use a 14 to 16 seconds 100m time as their predicted maximum time. So if

it is approximately 14 seconds then 90% speed is 15.5 and 50% speed is 21 seconds for example. If you don’t know your 100m be conservative then predict a slower rather than faster time as your maximum. I think 13 seconds should be as fast as a recreational runner should use as their predicted maximum time for

100m in their hamstring rehabilitation. Otherwise use 150m metres and approximate a maximum and percentages of that maximum.

YOUNG ATHLETES

This becomes more difficult and here it is worth using 100m data to develop a rehabilitation running programme. So if a 12 year old has done a hamstring ( very

rare) then use a conservative 100m maximum time to develop a program.

AGILITY 1 LEVELS 1 50 to 60% perceived intensity

Side to side (8 sets of 15 seconds)

4 repetitions of 15 seconds each side Don’t let feet touch and bend legs a bit.

Carioca (8 sets of 15 seconds) 4 repetitions of 15 seconds each side

Keep core switched on.

Backwards Forwards over a line ( 6 sets of 15 seconds)

Backwards Running ( 6 sets of 15 seconds)

AGILITY 1 LEVELS 2 60 to 65% perceived intensity

Side to side (12 sets of 15 seconds) 6 repetitions of 15 seconds each side

Don’t let feet touch and bend legs a bit.

Carioca (12 sets of 15 seconds) 6 repetitions of 15 seconds each side

Keep core switched on.

Backwards Forwards over a line ( 6 sets of 15 seconds)

Backwards Running ( 6 sets of 15 seconds)

Pitter Patter 6 sets 15 seconds Small steps moving forward at walk pace at no

faster than 75% intensity

AGILITY 2 LEVELS 1 60 to 70% perceived intensity

3 repetitions each set with 30 seconds rest between exercises 1 minutes rest between sets

Forwards 5 metres and side to side 5 metres Stay low and switch core on.

Figure 8 with 3 cones 5 metres apart. Each rep is twice through

Run forwards 2 cones backwards 2 cones ( cones 3 metres apart) repeat 4 times.

10 Slalom Cones 3 metres apart Lead with hip and move through the slalom

course

Speed Ladder Each rep is twice through

Ickey Shuffle

Cones

5 metres

apart.

Cones

5 metres

apart.

Cones

3 metres

apart.

Cones

3 metres

apart.

AGILITY 2 LEVEL 2 60 to 75% perceived intensity

Decrease the distance between cones 3 repetitions each set 30 seconds rest between exercises

1 minutes rest between sets

Forwards 3 metres and side to side 3 metres Stay low and switch core on.

Figure 8 with 3 cones 3 metres apart Each rep is twice through

Run forwards 3metres then backwards 3 metres repeat 5 times.

12 Slalom Cones 1.5 metres apart Lead with hip and move through the slalom

course

Speed Ladder Crossover Drill

Each rep is twice through

AGILITY 3 LEVELS 1 70 to 80 % perceived intensity

3 repetitions each set with 30 secs rest reps. 1 minutes rest between sets

Modified ILLINOIS TEST Cones 2 metres apart and work in a 4 metre

rectangle. Start standing up.

Cones 2m apart ( 6m length)

4m

Modified T Test Cones 6 and 3 metres apart.

Forwards then side to side both ways then backwards to start. Start standing up.

Circle Agility Run Have the 6 cones 4 metres from the middle. Then vary plant leg each turn and stay low.

Move around the circle

360 degree turns 3 metres apart Accelerate then decelerate and do 4*360

degree turns changing the direction you do the turn each time.

Speed Ladder Fast foot drill

Each rep is twice thru

AGILITY 3 LEVEL 2 80 to 85 % perceived intensity

Increase distance in this level to increase speed. 3 repetitions each set with 30 secs rest reps.

1 minutes rest between sets

ILLINOIS TEST Cones 3.3 metres apart and work in a 5 metre

rectangle. Start off the ground.

Cones 3.3m apart ( 10m length)

5m

T Test Cones 10 and 5 metres apart.

Forwards then side to side both ways then backwards to start

Circle Agility Run Have the 6 cones 6 metres from the middle. Then vary plant leg each turn and stay low.

Move around the circle

360 degree turns 5 metres apart Accelerate then decelerate and do 6*360

degree turns changing the direction you do the turn each time.

Speed Ladder 3 sets each side Fast foot drill done laterally in speed ladder

Each rep is twice thru

AGILITY TEST

These should be done at 90/95% and used for assessment and also conditioning.

Warmup with 1 effort at 75%

Do 2 maximum efforts with 1 minutes rest to assess fatigue. Don’t do both tests. Choose. Do these after your 90% or 95% evaluation of

maximum speed. Then if you play a team sport do your specific skill after this test.

ILLINOIS TEST

Do 2 tests. Start on stomach

T-TEST

Do 2 tests. Start with hand on the line and opposite foot.

Normative data for the Illinois Agility Run Test from Sports Coach Website. ( Normative data for 16 to 19 yo)

Gender Excellent Above Average

Average Below Average

Poor

Male <15.2 secs 15.2 - 16.1 secs

16.2 - 18.1 secs

18.2 - 18.3 secs

>18.3 secs

Female <17.0 secs 17.0 - 17.9 secs

18.0 - 21.7 secs

21.8 - 23.0 secs

>23.0 secs

Table Reference: Davis B. et al; Physical Education and the Study of Sport; 2000

http://www.brianmac.co.uk/illinois.htm

It is a good idea to do a test in pre-season and then when you are

doing the 90% or 95% agility test try and replicate the same surface and testing protocols.With the

illinois test the athlete should start on their

stomach.

ILLINOIS TEST % MAX

100% 95% 90%

13 13.65 14.30

13.5 14.18 12.15

14 14.70 12.60

14.5 15.23 13.05

15 15.75 13.50

15.5 16.28 13.95

16 16.80 14.40

16.5 17.33 14.85

17 17.85 15.30

17.5 18.38 15.75

18 18.90 16.20

18.5 19.43 16.65

19 19.95 17.10

19.5 20.48 17.55

20 21.00 18.00

Normative data for the T Test

http://www.fitness4football.com/Fitness_Testing/t_test.htm

Gender Excellent Good Average

Male <9.5 s. 9.5 to 10.5 s. 10.5 to 11.5 s.

Female <10.5 s 10.5-11.5 s 11.5-12.5 s

T TEST % MAX

100% 95% 90%

8 8.40 8.80

8.5 8.93 7.65

9 9.45 8.10

9.5 9.98 8.55

10 10.50 9.00

10.5 11.03 9.45

11 11.55 9.90

11.5 12.08 10.35

12 12.60 10.80

12.5 13.13 11.25

13 13.65 11.70

13.5 14.18 12.15

14 14.70 12.60

It is a good idea to do a test in pre-season and then when you are doing the 90% or 95% agility test try and replicate the same surface and testing protocols.With the T Test start with a hand and the opposite foot on the line.

AGILITY TESTS AND TRACK AND FIELD ATHLETES? VALID? Outside of the scope of this book is the testing and evaluation protocols for track and field sprinters. Given I have emphasized the need for longer rehabilitation programs for speed athletes the testing and evaluation would be different. So there is no need to test agility for straight line athletes. My perspective for a track and field athlete would be to do the 90/95% flying 20metre tests and also multiple hops for distance. Then the next session would have to be a 90% 150 metre evaluation for example, The next session might have to be some starts and then maybe on the weekend a time trial for a 200m at 95% intensity. Thus if all ok the athlete might compete the next week at 100%. Again coaches would all have different evaluation procedures but one rule is to leave 96 hours between 95% efforts and above and of course move slowly with fast athletes and tick every box and then make sure they have recovered from the testing and the rehabilitation program..

MOB 1 WTS - Minimal to zero awareness. Definitely never over 3 on the Borg Scale. ( Moderate awareness)

Seated Leg Extensions 3*15 each leg Bend and straighten the knee and there should never be more than

minimal awareness preferably zero

Standing Leg Movements 3*10 each leg Balance on one leg and at less than 50% speed swing the leg

backwards and forwards no more than 20 degrees either side. No jerking or ballistic movements at all.

Supermans on a Swiss Ball Maintain perfect form and do 6 each leg and arm at a very slow

rhythm. In this stage these can even be done on the ground. You must use the gluteal muscle here and not the hamstrings so do it slowly.

Bodyweight Squats 45/75 degrees 3*10 repetitions Squat to 45 degrees only and maintain perfect posture. Use a 3 count

down then hold 1 and then up 3.

Calf Raises 3*15 Do double leg calf raises to full range using bodyweight only

*Ice hamstring in a lengthened position

MOB 2 WTS - Minimal to zero awareness. Definitely never over 3 on the Borg Scale. ( Moderate awareness)

Lying Bodyweight Leg Curls

Make sure your hips are propped up and slowly curl up and down with no awareness. Use a tempo of 2 up / 1 hold and 3 down.

Standing Leg Swings Short Arc 3*15 each leg

Balance on one leg and at less than 50% speed swing the leg backwards and forwards no more than 20 degrees either side. No

jerking or ballistic movements.

Slow Run Cycle with no catch at all: 3*5 cycles each leg

( 50% intensity) Take 3 seconds to do each cycle and maintain proper posture and

bring hip up/knee up/toe up then cycle around at 50% intensity

Double Leg Bridges 3*6 ( hold 6 seconds)

Hold for 6 seconds and make sure you use gluteals.

Supermans on flat. 3 * 6 each leg/arm.

Keep hips level and don’t’ rotate. Switch on Gluteals and hold for 3 seconds each repetition.

Bodyweight Squats 75 degrees 3*15 repetitions

Squat to 75 degrees only and maintain perfect posture. Use a 3 count down then hold 1 and then up 3.

Calf Raises Single Leg 3*10 each leg

Do single leg calf raises to full range using bodyweight only

*Ice hamstring in a lengthened position

Increase

range in

MOB 2

MOB 3 WTS Definitely never over 3 on the Borg Scale. ( Moderate awareness)

Seated Theraband Curls

Get a low resistance theraband ( green) and attach to wall. Then pull the band in for a count of 3 and back to full extension slowly for

a count of 3

Isometrics 3 sets of 6 seconds each

Again in the chair press at 60 to 75% maximum at almost full extension, then at 45 degrees and then at 90 degrees against the

chair.

Theraband Hip Extensions

Stabilize stance leg and keep hips level. Then using the gluteals pull the band back for a count of 3 and then release back for count

of 3. Maintain neutral spine.

Slow Run Cycle 3*5 cycles each leg ( 50% intensity) Take 3 seconds to do each cycle and maintain proper posture and

bring hip up/knee up/toe up then cycle around at 50% intensity

Hamstring Mobility

Have hip bent to 90 Hold this position and gently straighten the knee until you feel a stretch at the back of the thigh. Hold this for a

count of 10. There must be no awareness at all with this exercise so limit ranges if there is.

Double Leg Bridges with adductor squeeze Keep hips level. Bridge by contracting gluteals and not hamstring. If

you cannot do this then you need to seek help to achieve proper gluteal firing. Squeeze light ball at 25/50% force for 6 seconds and

do 6 reps

Bodyweight Squats Parallel 75/90 degrees

Squat to 75 degrees only and maintain perfect posture. Use a 3 count down then hold 1 and then up 3.

Calf Raises Single Leg Maximum reps With one leg and going full range do as many repetitions as you

can. When the range drops stop.

*Ice hamstring in a lengthened position

REMODEL WEIGHTS 1 All these sessions can be repeated in a long rehabilitation.

All weights should be easy and controlled in last repetition in this program. Isometrics 3 angle 45/60/90 Set 1 50%-Set 2 75-Set 3 80/90% force. Do either sitting in a chair or with partner resistance in prone.

ALTERNATE *3 1 Leg Squats Maintain perfect posture and control Keep hips square and level. Squat down to hold one second. Head up and knee over foot.

Step Ups (45 to 60 degree box) 3 * 15 each leg Warmup slow stepups 6 each leg. Make sure you lift through the hip and also keep the hips level.)

ALTERNATE *3 Single Bridges on the floor. Hold at top position Keep hips level .Set 1 hold 2 secs. Set 2 4 secs. Set 3 6 secs Make sure you use your gluteals and not your hamstrings.

Lying Resisted Leg Curl Increase resistance used in MOB 3 Wts and change tempo to 2 in hold 1 and 4 out. Work to full extension with leg and control end range.

ALTERNATE *3 Arabesque 3 sets of 6 to10 seconds each leg 3 repetitions. Stand on one leg and and 10/20 degree bend in stance leg bend slowly with arms out to 90 degrees and hold position..

Standing Theraband Hip Extensions Increase resistance used in MOB 3 Wts . Stabilize stance leg and keep hips level. Then using the gluteals pull the band back for a count of 2 and then release back for count of 4. Maintain neutral spine.

ALTERNATE *3 Plank 30 seconds each repetition. If hips drop then stop and re-adjust.

Reverse Hyper on a Swiss Ball 3 sets of 10 Using the gluteals raise legs to straight This can also be done on a bench

ALTERNATE *3 Side Plank 3 sets of 10 to 30 seconds each side. Maintain a straight line through your body. Keep hips pushed through.

Calf Raises can be maintained in this section Supermans and other work can be used. Pilates Scooter exercise can be used.

REMODEL WEIGHTS 2 All weights should be easy to moderate and controlled in last repetition in this

program.

Machine Leg Curls Concentric One Leg The weight used here has to be light to medium. Warmup with 2 legs. I ok do with one leg and use tempo 2 up-1 hold- 4 down. ALTERNATE *3 Partial Lunges Bodyweight Maintain perfect posture and control. Step out and squat down to ½ way and hold .

Step Ups (45 to 60 degree degree box) 3 * 15 each leg Warmup slow stepups 6 each leg. Make sure you lift through the hip and also keep the hips level.)

ALTERNATE *3 Bridges on a bench 45 /60/90 degrees. Keep the hips level .Drive through the heel. Make sure you use your gluteals and not your hips.

Intro Eccentric Wobbles Bodyweight only 3 sets 10 each leg Bend knee 90 to 100 degrees and back to 80. Move 10 degrees either side of 90. Do at continuous tempo at 50/60% speed. Tempo of 2-0-2 then 1-0-1 if ok. Or Slow Bicycle Leg Swings EG: 6 swings each 10 seconds

ALTERNATE *3 Single Leg Windmill Touches Stand on one leg and lift the opposite arm. Keep perfect posture and 10/20 degree bend in stance leg bend slowly and touch stance foot..

Move 10 degrees either side of this angle.

Cable Hip extensions 10 each leg Stabilize stance leg and keep hips level. Then using the gluteals pull the cable back for a count of 2 and then release back for count of 4. Maintain neutral spine. Use a light to moderate resistance. ALTERNATE *3 Plank Move to 60 seconds If easy do it in Push Up Position

Side Lunges with a windmill 3 sets of 8 each leg Stand on one leg and slide out as far as possible maintainin level hips and good posture. Slide back slowly.

ALTERNATE *3 Side Plank 3 sets of 20 to 20 seconds each side Hold position at top. If easy do it with straight arms and legs out. Maintain a straight line through your body.

REMODEL WEIGHTS 3 This should be done with the 70% speed running session.

All weights should be moderate and controlled in last repetition in this program.

Machine Leg Curls Slow 2 up/1 down The weight used here has to be moderate. Control the downwards movement till leg is straight. Tempo of 2 up / 1 hold and./ 4 down to full extension

ALTERNATE *3 Lunges Bodyweight Normal/Rotation and elbow to instep Maintain perfect posture and control. Vary the type of lunge. Step out and squat down. Push back to start.

Step Ups BodyWt (90 degree box) 3 * 10 Warmup slow stepups 6 each leg. Then lift from hips and use a medium weight that allows good technique. Use a light weight ( EG 10 to 40kgs)

ALTERNATE *3 Swiss Ball Hip Lifts 3 sets of 6 each leg Warmup with 2 legs then switch to one leg. Keep the hips up and switch the gluteals on

Intro Eccentric Flicks Bodyweight only 3 sets 10 each leg Don’t go faster than 60% speed. Start at 90 degrees bend in the knee. Flick foot at end but don’t catch at faster then 75% Intensity. * Nordic lowers: hands on swiss ball could be used. Or Bicycle Leg Swing

ALTERNATE *3 Three Way Touch on one using opposite hand. Have cones 1 metre in front and ½ metre apart. With opposite hand maintain perfect posture and touch cones, lift and repeat.

Work from 90 degrees to the ground but don’t catch faster than 60%

Pilates Reformer Scooter 3*10 each leg Maintain neutral spine Use the gluteals.

ALTERNATE *3 Plank with rear leg extension 3 sets of 3 to 6 each leg If strong enough do this on hands and lift rear leg usibng only the

gluteals. Maintain neutral spine and don’t like hips.

This can be done on elbows

Side Lunges 3 sets of 6 each leg Step out and do a small lunge and hold for 1 second. Make sure other leg is straight.

ALTERNATE *3 Side plank in side lying 3 by 6 to 8 hold 3 seconds each leg Push the hips up and through. Hold the top position. Maintain a straight line through your body.

Lunge to side and then

return back to start.

FUNCTIONAL WEIGHTS 1 All weights should be moderate to hard and with good technique in last repetition

in this program.

Eccentric Machine Leg Curls Slow 2 up/1 down The weight used here has to be medium. Control the downwards movement till leg is straight. Tempo of 2up/ 1 hold and 4 down.

ALTERNATE *3 Lunges Weight Overhead 3 sets 6 to 8 each leg Maintain perfect posture and control. Step out and squat down. Push back to start.

Step Ups Weights (90 degree box) 3 * 6 each leg Warmup slow stepups 6 each leg. Then lift from hips and use a medium weight that allows good technique. Use a light weight ( EG 10 to 40kgs)

ALTERNATE *3 Swiss Ball Curls Bridge and Leg Raise 3 sets of 8 Keep the hips up and switch the gluteals on If you can’t do the leg raise do the bridge component.

Eccentric Catches Bodyweight only 3 sets 15 each leg Increase speed with each set (EG 75% to 85% to 90% ) Catch foot at end range but not maximal. Nordic lower using Swiss Ball or without a ball only to 1 or 2 o’clock could be used. Or Bicycle Leg Swing done fast 12 per 10 secs

ALTERNATE *3 Double Leg Romanain Deadlifts

Use a very light weight ( EG 5 to 30kgs) and maintain perfect posture. * BACK RAISES on BENCH can be used instead or continue to do

Bodyweight cone touches.

Hops on Spot 3 sets of 6 each leg Do these at 50/70% intensity but make sure you keep hips level and land softly on the ball then heel.

ALTERNATE *3 Plank with pushup and rotation 3 sets of 6 to 10 each side Do a pushup and then rotate outwards. If too hard then do Hip Rolls or Leg Overs.

Side Lunge with a squat 3 sets of 6 to 8 each side Lunge sideways then hold the squat positing and lift body over that leg. Keep trunk straight ad hips level and go back to starting position

ALTERNATE *3 Side Plank (arm & leg raise) 3 * 3 secs each side hold 2 secs Hold position at top Maintain a straight line through your body.

Lunge and then squat and

lift to the lunge side.

• If there any back problems then Romanian deadlifts may have to be omitted and core exercises such as prone holds/supermans and other controlled back exercises on exercise balls may need to be considered.

• Any players with specific core issues may need extra exercises such as dead bugs and continued biofeedback to ensure proper trunk stabilization.

FUNCTIONAL WEIGHTS 2

All weights should be with perfect control ( eg Swiss ball curls) and with controlled power and speed in jumps and catches for example.

Ball Hamstring Curls ( 2 or 1 leg): 3 sets 5 to 8 each leg If you cannot do this do bridges one leg on a bench and double leg swiss ball curls

ALTERNATE *3 Lunges Forwards and Reverse with weight overhead. Maintain perfect posture and control. Do a front lunge then move backwards and without touching in the middle do a reverse lunge.

Alternating Step Jumps (60 degree box) 3 * 6 each leg Warmup slow stepups 6 each leg. Then spring up explosiivley and switch legs each jump.

ALTERNATE *3 Eccentric Catches 3*10 done explosively Do a warmup set bodyweight then use ankle weights if ok. Use moderate wts.( 250g -1kg for strong male) Do fast, catch at end range. Nordic lowers for 3 sets 5 could be used. Or Bicycle Leg Swing done fast 12 per 10 secs with theraband

Total Hip extension machine 3*10 each leg Using the hip actively thrust the arm back until you have reached full hip extension.

ALTERNATE *3 Single leg Romanian Deadlifts 3 sets of 6 to 8 each leg Use a medicine ball and tuck to chest and maintain curve in spine. Bend stance leg. * BACK RAISES on BENCH can be used instead if back.

Side to side Ski jump and stick 1 metre apart max. Stand on one leg and jump sideways and land and hold for 2 seconds Miantain level hips and good posture and hold landing. Repeat ALTERNATE *3 3 way Medicine Ball Rotation or “woodchop” 12 to 15 reps. Do a straight twist then twist from high to low and low to high and repeat. Keep feet pointing in straight direction.

Hops over cones Maintain strict posture and land soft and even. Jump up and over small cones and flex knee a bit.

ALTERNATE *3 Leg Overs 3 sets of 8 to 10 each side

Keep back flat and then with straight legs rotate tosides and control movments both ways

• If there any back problems then Romanian deadlifts may have to be omitted and core exercises such as prone holds/supermans and other controlled back exercises on exercise balls may need to be considered.

• Any players with specific core issues may need extra exercises such as dead bugs and continued biofeedback to ensure proper trunk stabilization.

FUNCTIONAL PROGRAM 3 All weights should be with perfect control ( eg Swiss ball curls) and with controlled power and

speed in jumps and catches for example. This program drops the heavy hamstring eccentric exercises to more specific eccentric exercises

to allow recovery given increase in running intensity. The latest this session should be done is 5 days before an event.

IE a Monday before a Saturday event to allow recovery.

Ball Hamstring Curls with hips up: 3 sets 5 to 8 each leg If you cannot do this do bridges one leg on a bench and double leg swiss ball curls

ALTERNATE *3 Multidirectional Lunges (Twice thru each leg) Bodyweight Maintain perfect posture and control. Lunge forward/45 degrees forward /side / 45 degrees back & reverse.

Lunge forward/45 degrees forward / side / 45 degrees

back & reverse

Step Up Jumps using 90 degree box. 3 sets 4 to 6 each leg Warmup slow stepups 6 each leg. If 90 degrees is too high then use 60 degrees. Make sure you work through the hips.

ALTERNATE *3 Hip Extension Machine 3*10 done explosively Using fast action at the hip and a tight core explode backwards but maintain posture. Do these at maximum speed this session.

Hops on spot heel to butt 3 sets of 3 to 6 each leg Bring knee up in jump then tuck heel to butt. Maintain strict posture and land soft and even.

ALTERNATE *3 Single leg Romanian Deadlifts 3 sets of 6 to 8 each leg Use a medicine ball light dumbbells and maintain curve in spine.Bend stance leg. * BACK RAISES on BENCH can be used instead.

Ski jump 1 to 1.5 metre apart max. 3* 6 to 8 each side Stand on one leg and jump sideways and explode back. Miantain level hips and good posture and soft landings. Repeat ALTERNATE *3 Fast medicine ball work against wall 3 sets 8 /10 each side Bend your knees and throw ball a metre away form wall and then repeat at 100% intensity. Try with one leg.

Combination Plank Exercise. Twice thru each side. Plank with rear leg lift each leg then side plank with arm and leg raise both sides then front plank on hands with front leg raise and repeat.

ALTERNATE *3 Run Simulation Leg Cycle 3 sets of 3 cycles each leg Stand on one leg and cycle leg over knee and work o keeping the core tight and neutral spine and pelvis stable and tucked in. Do for core and not eccentric or speed like the bicycle leg swing.

• If there any back problems then Romanian deadlifts may have to be omitted and core exercises such as prone holds/supermans and other controlled back exercises on exercise balls may need to be considered.

• Any players with specific core issues may need extra exercises such as dead bugs and continued biofeedback to ensure proper trunk stabilization.

• If total Hip Extension machine is not available then use therabands for extensions or do cable hip extension

14 DAY WTS 1

All weights should be moderate to hard and with good technique in last repetition in this program.

Swiss Ball Hammy Curls 2 Legs 3*8 to 10 Lift Hips up Curl in and then extend right out agiain so legs are straight..

ALTERNATE *3 Lunges Bodyweight Normal Maintain perfect posture and control.. Step out and squat down. Push back to start.

Step Ups BodyWt or Weights (90 degree box) 3 * 10 Warmup slow stepups 6 each leg. Then lift from hips and use a medium weight that allows good technique. Use a light weight ( EG 10 to 40kgs)

ALTERNATE *3 Swiss Ball Hip Lifts 3 sets of 6 each leg Warmup with 2 legs then switch to one leg. Keep the hips up and switch the gluteals on

Intro Eccentric Flicks Bodyweight only 3 sets 10 each leg Don’t go faster than 60% speed. Start at 90 degrees bend in the knee. Flick foot at end but don’t catch at faster then 75% Intensity. * Nordic lowers: hands on swiss ball could be used. Or Bicycle Leg Swing ALTERNATE *3 Three Way Touch on one leg Have cones 1 metre in front and ½ metre apart. With opposite hand maintain perfect posture and touch cones, lift and repeat.

Work from 90 degrees to the ground but don’t catch faster than 60%

Pilates Reformer Scooter 3*10 each leg Maintain neutral spine Use the gluteals.

ALTERNATE *3 Plank with rear leg extension 3 sets of 3 to 6 each leg If strong enough do this on hands and lift rear leg usibng only the

gluteals. Maintain neutral spine and don’t like hips.

Side Lunges 3 sets of 6 each leg Step out and do a small lunge and hold for 1 second. Make sure other leg is straight.

ALTERNATE *3 Side plank in side lying 3 by 6 to 8 hold 3 seconds each leg Push the hips up and through. Hold the top position. Maintain a straight line through your body.

* Nordic lowers: hands on swiss ball could be used. Or Bicycle Leg Swing

14 DAY WTS 2

All weights should be moderate to hard and with good technique in last repetition in this program.

Swiss Ball Hammy Curls 1 Leg 3*8 to 10 Lift Hips up Curl in and then extend right out agiain so legs are straight..

ALTERNATE *3 Lunges Use Weight Overhead Maintain perfect posture and control.. Step out and squat down. Push back to start.

Alternating Step Jumps (60 degree box) 3 * 6 each leg Warmup slow stepups 6 each leg. Then spring up explosiivley and switch legs each jump)

ALTERNATE *3 Total Hip extension machine 3*10 each leg Using the hip actively thrust the arm back until you have reached full hip extension.

Alternate of switch legs each

rep

Eccentric Catches 3*10 done explosively bodyweight only Do fast, catch at end range. Use to make sure speed of contraction ok and not for eccentric strength Or Bicycle Leg Swings done for 12 reps every 10 seconds without resistance.

ALTERNATE *3 Back Raises on a bench 3*10 to15 Hold at top for 2 seconds Don’t arch

Hops on Spot 3 sets of 6 each leg Do these at 50/70% intensity but make sure you keep hips level and land softly on the ball then heel.

ALTERNATE *3 Plank with pushup and rotation 3 sets of 6 to 10 each side Do a pushup and then rotate outwards. If too hard then do Hip Rolls or Leg Overs.

Side Lunge with a squat 3 sets of 6 to 8 each side Lunge sideways then hold the squat positing and lift body over that leg. Keep trunk straight ad hips level and go back to starting position

ALTERNATE *3 Side Plank (arm & leg raise) 3 * 3 secs each side hold 2 secs Hold position at top Maintain a straight line through your body.

72 hours before Competition PreCompetition Program

Notice some variations. This program might be one for fine tuning with some balance work or gluteal retraining or core stability training.

All weights should be moderate to hard and with good technique in last repetition in this program.

Bridges Bench ( 8 each leg) Hold 2 seconds Keep hips level. Start at 90 degrees with hip and then move out 10 to 15 degrees each set.

ALTERNATE *3 Supermans. ( 6 each leg) Hold 2 seconds Hold 2 seconds

1 Leg Squats for pelvic stability 6 each leg to 90 degrees Keep hips level. Head up. Knee over foot

ALTERNATE *3 Single Leg Swiss Ball Curls 8 each leg Keep hips up. Work through a full range. Keep the hips level.

HIP EXTENSION EXERCISE Total Hip Extension or Cable Extension or Pilates Scooter or Side Lunges

ALTERNATE *3 Arabesque 6 each leg and hold 2 seconds This can be done on the ground or on a wobble board

PLANK on elbows 3 sets of 30 seconds OR Wobble Board OR Specific Gluteal activation exercise or core exercise

ALTERNATE *3 Med Ball Twist Seated 3*10 each side OR Leg Overs OR Specific core stability need like Dead Bugs

SIDE PLANK on elbows 3 sets of 15 to 30 seconds OR Back Raises on bench OR Reverse Hypers

ALTERNATE *3 Run Simulation Leg Cycle 3 sets of 3 cycles each leg Simulate the catch at end range at 75% intensity

STRETCHING AFTER TRAINING The stretches in the diagrams are very basic but suitable for each phase.

ACUTE PHASE In the acute phase the hamstring should be placed in a gentle stretch position

when iced. Other than that there is no need to stretch in this phase given healing is the main aim.

MOBILIZATION PHASE

Light stretches of all muscle groups in the pool are recommended. Also a general light stretching routine should complement the mobilization. The hamstring

stretch should be very low intensity ( < 50% intensity) and healing still is the main aim so any aggressive hamstring stretches must be avoided. Again the

hamstring should be placed in a gentle stretch position when iced

REMODELLING PHASE

Because there is still a weakness during this phase but scar alignment must take place low to medium intensity hamstring stretching can begin. Emphasis is on

low to medium and again avoid aggressive stretching of any kind.

FUNCTIONAL PHASE

Here the intensity and scope of the stretching can increase with partner assisted stretching being of use. Again maximal stretching is to be avoided in my opinion.

STRETCH MOBILIZATION PHASE

STRETCH REMODEL PHASE

Hip Flexor Stretch Arms Up

Hip Stretch Lying on back

Standing Quad Stretch

Back Stretch

Hamstring Stretch 1 75% perceived intensity

Standing Groin Stretch

Maintain strict attention to core

Lat stretch

Hip Flexor Stretch

Hands on hips. Neutral Spine.

Hip Stretch 90/90 Keep Chest Up

Side Lying Quad Stretch

Back Stretch

Modified Hamstring Stretch 50% Intensity Stretch

Calf Stretch

Lat stretch

STRETCH FUNCTIONAL PHASE

Hip Flexor Partner Assisted

3 contractions 6 secs 10 sec stretch Have hips on table and resist a 25% contraction for

6 seconds then do 3 more contractions and stretches.

Hip Stretch Partner Assisted

3 contractions 6 secs 10 sec stretch Lying on back push knee to chesr. Have athlete

resist with 25% force for 6 seconds. Repeat 3 times

Quad Stretch using support 2*15 seconds each

side Hook foot on support and then keep hips square and

banc neutral and stretch quadriceps

Back Stretch Partner 2*15 seconds each side

The partner should provide pressure to the hips whilst holding the shoulders down.

Hamstring Stretch Partner Assisted 3 contractions 6 secs 10 sec stretch

Have the athlete resist with about 25% force. For 6 seconds. Then they should use their quads to

stretch their hams. Repeat 3 times at increasing angles.

Standing Hip Stretch 5*2 secs es

Start with arms extended and then bend over to the side.

Standing Groin Stretch Maintain strict attention to core

Lat stretch 5*2 secs es

PLAN YOUR OWN REHABILITATION Mon Tue Wed Thu Fri Sat Sun