Hamstring rehabilitation ladder

      Hamstring bottom ladder

      

      1)      RICE – Rest, Ice, Compression, Elevation

The first- line principle for treating an acute injury:

a)      Rest for 24-48 hours to prevent the clot spreading and an increase of inflammatory exudate. Mobilization too soon produces thicker scar tissue, which is not easily penetrated by fibroblasts and it may provoke continued bleeding.

      b)      Ice will cool the periphery and shut down local vessels to decrease bleeding. Ice straight from the fridge may be less than 0 degrees and will produce an ice burn, unless separated from the skin by a cloth. Melting ice(wet ice) will be at 0 degrees and may be used as a bath for 20 minutes, but locally applied ice, for 5-10 minutes can have an effect. Reusable cold packs, which may be stored in the fridge, are available, as are some chemicals that freeze on mixing. Frozen packets of peas, which mould to the shape of the body, may prove most cost – effective. Care must be taken with ice placed around nerves, as they can suffer a cold-induced neuropraxia.

     c)      Compression is again designed to reduce inflammatory exudates, and the spread of haemorrhage.

     d)     Elevation prevents tracking of inflammatory products to the periphery, thus requiring less effort to return these products centrally.

2) Isometrics. Sit and cross the injured leg over the good ankle and resist knee extension of the good leg. Use the rule of 7, which has been described in previous ladders

3) Stretch for hamstring and calf muscles

4) Heels. Stand on step with both feet together. Do not favour the bad leg. Raise and lower the heels at a slow rhythm until the calf aches of the injury gives pain, then stop. Repeat three to five times during the day.

5) Patter and skipping routine

This simple exercise is effective in raising the pulse rate and building fitness without straining the knees or hips. It also takes up very little time. Quality, not quantity, is vital in fitness training. The secret to pattering is not to lift the feet far off the ground. A slow patter is more like a fast jog on the spot, with the knees kept low. The feet must be lifted only 2.5-5 cm off the floor. A fast patter has the same low knee and foot lift, but pattering is done as fast as possible. It is testing, but simple.

Routine for an unfit athlete(3 minutes)

1min  slow patter

5s      fast patter

50s    slow patter

5s      fast patter

50s    slow patter

10s    fast patter

Rest for 3 minutes, whilst doing stretching exercises. Repeat the above routine at least twice, preferably four times.

Routine for a fairly fit athlete(5 minutes)

50s   slow patter

10s   fast patter

40s   slow patter

20s   fast patter

50s   slow patter

10s   fast patter

30s   slow patter

10s   fast patter

50s   slow patter

30s   fast patter

Then rest for 3 minutes, whilst doing stretching exercises. Repeat the above training routine at least once, preferably three times.

Routine for a fit athlete(16 minutes)

Perform the routine as for the unfit athlete once, followed immediately by the routine for the fairly fit athlete, repeat.

6) Swimming routine. Freestyle may be painful so use a gentle leg kick, up to pain tolerance

7) Bike routine. Do not use hamstring to pull through the pedal at the bottom of the cycle

8) Rowing and bike routines. Begin using  hamstring to pull pedal through the bottom of the cycle. Start rowing, although coming forward may be painful, only work to discomfort

9) Start chair raises. Both legs together and move to one when 25-30 reps can be performed pain-free. Start isokinetic exercises in sitting and prone positions

10) No pain? If walking and climbing do not produce pain, move to Hamstring top ladder

Hamstring top ladder

Use Achilles ladder but switch stages 3 and 5. Add in the bean bag run after stage 10.

Bean bag shuttle. As for stage 10, but incorporate bending to touch or pick up an object, such as a bean bag, from the floor.

Continue cross- training for fitness. Start each training session from the bottom of the ladder. Perform six of stage 1, then six of stage 2, etc., until pain of loss of rhythm halts the training. Early ladder steps may be reduced from six to two repetitions when roking at higher stages. Check that the leg rhythm is equal, and do not gallop. One way to avoid favouring an injured leg is to count from 1 to 9 whilst running, which sets a rhythm for the legs to follow. Match the feel of the bad leg to the good leg, Counting 1,2; 1,2; tends to stress any limp. Check heel pick up and knee lift are the same height. Stop if any pain lasts more than 20-30 seconds, and do not progress up the ladders if there is loss of rhythm. Start using a ballistic stretch between each 100 metres by swinging the leg into a high kick, like a ballet dancer, slowly to the point of discomfort. As the injury improves, build up the speed of the leg swing, especially in kicking sports. 

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English