34. Aspetar Hamstring Protocol Full video

The central tenet of the rehabilitation protocol is a requirement for set criteria (specific physical testing) to be proven prior to allowing progression to the next stage. Daily measurements of subjective pain, pain with palpation, range of movement or flexibility, and strength allows the clinician to adapt the protocol for the player on that particular day depending on the presentation of the individual, as well as identify the response to the previous day’s treatment. Although we suggest specific exercises and progressions within each stage, clinical reasoning is continuously required from the clinician to execute the protocol optimally for each session. In the clinical reasoning process, the clinician will consider factors such as the presumed mechanism (swing phase injury versus stance phase, active versus passive stretch type injury), sport-specific hamstring demands, and presumed individual risk factors such as trunk stability and lumbo-pelvic control. Arbitrarily the rehabilitation protocol consists of 6 stages, three “physiotherapy” stages and 3 sport specific stages. An overlap of exercises between the stages is allowed, recognizing the fluidity of the rehabilitation process and reflecting an integrated protocol with set criteria for progression. The main feature of the protocol repeated in each stage is the early but safe resumption of repeated high speed running and direction change movements. All hamstring injuries (Grade 0-3) are treated with the same protocol. Since the protocol is criteria based, it implies that usually a grade 3 injury would remain for a longer time period in Stage 1. In general: * All exercises should be performed close to pain free limit. If the exercise/movement provokes pain (≥ 2 VAS) from the injured area, the exercise is immediately adjusted or terminated. * The patients should be instructed to perform the exercises with adequate control/stabilization of the hip and trunk. Variations: * Depending on the localization of the injury (medial/lateral), tibial IR or ER is applied when appropriate during exercises with knee flexion movements appropriate