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“Problems cannot be solved by the same
level of thinking that created them” A.E.
Mathieu Gram
Hamstrings
Mathieu Gram
Most common injury in
Mathieu Gram
Hamstring – Incidence & Severity
• Approximately 6 players/squad/season
• Miss approximately 3 matches or weeks of
play
Wo...
Risk factors
• Previous hamstring injury  >2x risk
• Age
• ACL injury (altered proprioceptive feedback)
• Reduced flexibi...
Mathieu Gram
Clinical reasoning
+ Psychosocial
Mathieu Gram
Anatomical links
TibFib joint
SI Joint
m. Romboidei
ACL
Tsuda et al., 2001
Beltran et al., 2003
Hoskins et al., 2005
m. Po...
Strong framework?
Mathieu Gram
Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
Mathieu Gram
Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
Mathieu Gram
Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
Mathieu Gram
Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
SIJ
Lx
Mathieu Gram
Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
“Problems cannot be solved by the same
level of thinki...
Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
TibFib Joint
Mathieu Gram
Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
TibFib Joint
SI Joint
Mathieu Gram
Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
TibFib Joint
SI Joint
Lx
Woods et al., 2004
Mathieu Gr...
Muscular
When evaluating hamstring pain,
Evaluate:
- Framework  Lumbar-Pelvic dysfunction?
- Tension  Trigger Points?
- ...
Muscular
When evaluating hamstring pain,
Evaluate:
- Framework  Lumbar-Pelvic dysfunction?
- Tension  Trigger Points?
- ...
Neural
When evaluating hamstring pain,
Evaluate neurodynamics:
Piriformis syndrome
Mathieu Gram
“Problems cannot be solved by the same
level of thinking that created them” A.E.
Treatment of hamstring injuries should al...
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Hamstring injuries

Hamstring injuries

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Hamstring injuries

  1. 1. “Problems cannot be solved by the same level of thinking that created them” A.E. Mathieu Gram
  2. 2. Hamstrings Mathieu Gram
  3. 3. Most common injury in Mathieu Gram
  4. 4. Hamstring – Incidence & Severity • Approximately 6 players/squad/season • Miss approximately 3 matches or weeks of play Woods et al., 2004 – Hoskins et al., 2005 Mathieu Gram
  5. 5. Risk factors • Previous hamstring injury  >2x risk • Age • ACL injury (altered proprioceptive feedback) • Reduced flexibility ??? • Low hamstring strength ??? • Strength deficits or imbalances ???  Isokinetic testing – specificity? Engebretsen et al., 2010 Arnason et al., 2004 Tsuda et al., 2001 Verrall et al., 2001 Christensen et al., 2000Mathieu Gram
  6. 6. Mathieu Gram
  7. 7. Clinical reasoning + Psychosocial Mathieu Gram
  8. 8. Anatomical links TibFib joint SI Joint m. Romboidei ACL Tsuda et al., 2001 Beltran et al., 2003 Hoskins et al., 2005 m. Popliteus Mathieu Gram
  9. 9. Strong framework? Mathieu Gram
  10. 10. Strong framework? Tension TLF Hodges et al., 1997 Barker et al., 2004 Mathieu Gram
  11. 11. Strong framework? Tension TLF Hodges et al., 1997 Barker et al., 2004 Mathieu Gram
  12. 12. Strong framework? Tension TLF Hodges et al., 1997 Barker et al., 2004 Mathieu Gram
  13. 13. Strong framework? Tension TLF Hodges et al., 1997 Barker et al., 2004 SIJ Lx Mathieu Gram
  14. 14. Articular When evaluating hamstring pain, Evaluate biomechanics of: “Problems cannot be solved by the same level of thinking that created them” A.E. Mathieu Gram
  15. 15. Articular When evaluating hamstring pain, Evaluate biomechanics of: TibFib Joint Mathieu Gram
  16. 16. Articular When evaluating hamstring pain, Evaluate biomechanics of: TibFib Joint SI Joint Mathieu Gram
  17. 17. Articular When evaluating hamstring pain, Evaluate biomechanics of: TibFib Joint SI Joint Lx Woods et al., 2004 Mathieu Gram
  18. 18. Muscular When evaluating hamstring pain, Evaluate: - Framework  Lumbar-Pelvic dysfunction? - Tension  Trigger Points? - Strength - Length Vogt et al., 2003 Mathieu Gram
  19. 19. Muscular When evaluating hamstring pain, Evaluate: - Framework  Lumbar-Pelvic dysfunction? - Tension  Trigger Points? - Strength - Length Vogt et al., 2003 Gluteus Maximus vs Hamstrings Mathieu Gram
  20. 20. Neural When evaluating hamstring pain, Evaluate neurodynamics: Piriformis syndrome Mathieu Gram
  21. 21. “Problems cannot be solved by the same level of thinking that created them” A.E. Treatment of hamstring injuries should also be directed at non-local hamstring factors. Hoskins & Pollard, 2005 Mathieu Gram

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