Chronic Hamstring Pain: Gymnastics Case Study

In this case study you’ll see how I blend take The Eclectic Approachand throw in a little yoga as to treat a youth athlete. 

History: Pt is a high-level gymnast with a h/o acute hamstring injury 8 months ago. She was treated in a traditional outpatient PT setting and is now pain free with ADLs. She still has pain during running, tumbling, and vaulting preventing her from competing at her highest level. Alleviating factors include rest, activity avoidance, over the counter pain medication.  

Objective:

• R SLR PROM lacking 20 degrees from opposite side 
• FADDIR decrease and painful pinch with overpressure
• Unable to maintain transverse abdominis (TA) contraction and breathing with hook lying knee lifts, significantly more ASIS movement on R
• Bridge with increased activation of hip flexors on R
• Palpable soreness of proximal R HS near ischial tuberosity 
• Test/retest of gymnastics skills complicated by concurrent UE injury (different mechanism of injury but could be another case study on its own) that limited UE weight bearing during the first 1-4 visits. 

1st Visit:

• Corkscrew hamstring/sciatica tensioner (see Dr. E's post here) 
• Hip inferior glide grade III
• Home program: self standing hamstring/sciatic nerve tensions (see Dr. E's post here)
• By end of treatment seeing 5-10 degree improvement in R SLR PROM

2nd Visit:

• SFMA Rolling - patient had the most difficulty going supine-prone
• IASTM proximal hamstring 
• Posterior chain activation exercise including single leg bridge, double leg bridge with single leg lift
• Yoga poses: Warrior I, II, III series for challenging hamstring response to stress and concentric/eccentric loads
• By the end of treatment session pt lacking only 5 degree PROM test by SLR compared to unaffected side. Also able to perform splits and cartwheel pain free. 

3rd and 4th visit: 

• Completing practice pain free (with the exception of vaulting - separate wrist issue) 
• Strength deficit on R - unable to perform single leg squat to the floor 
• Worked on retraining of landing mechanics with 2 footed and single leg jumping to improve force distribution during gymnastics. 
• Continuing posterior chain activation exercises from above with additional of single leg squat.
• Yoga poses to focus on pelvic control and neutral spine in quadruped with extension of arms and legs. Progressing difficulty of core rotational stability. 
• Added chair pose with emphasis on seating femoral head in acetabulum through tactile cueing of hip ERs prior to starting pose. Pt seeing immediate improvement in squat by being able to lower down farther and with decreased pain. 
• Instructed on how to use yoga strap to perform a self-inferior glide/hip corkscrew for R hip (will post a video of this soon!) 
• By 4th visit had equal HS PROM for the first time in 8 months. 

Final Thoughts:

• Sciatic neurodynamics was very important for regaining full hamstring motion needed for gymnastics 
• Activation of posterior chain and hip external rotators crucial to retraining squatting 
• This may be obvious…but your rehab needs to be SPORT specific. Too many times I see gymnasts who are “discharged” from PT, however still have deficits that either severely limit their gymnastics or put them at high risk for re-injury. 

Christine Walker owns her own PT practice inside in Charlotte, NC where she helps active adults and athletes get back to the activities and sports they love without painkillers, injections, or multiple trips to the doctor's office. To learn more visit her website or connect with her on Twitter.

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Keeping it Eclectic...