TY - JOUR
T1 - Surgical and therapeutic management of a complete proximal hamstring avulsion after failed conservative approach
AU - Kirkland, Amy
AU - Garrison, Craig
AU - Singleton, Steve
AU - Rodrigo, Juan
AU - Boettner, Friedrich
AU - Stuckey, Sarah
PY - 2008/12
Y1 - 2008/12
N2 - Fish eye STUDY DESIGN: Case report. Fish eye BACKGROUND: After 2 attempts at conservative care for a diagnosis of hamstring strain, the patient had a surgical hamstring allograft reconstruction. The purpose of this report is to describe the physical therapy approach to postoperative management of a hamstring reconstruction. Fish eye CASE DESCRIPTION: A 24-year-old female coach who sustained a complete avulsion of the proximal hamstring tendon while playing softball had a surgical hamstring reconstruction using an Achilles tendon allograft. Precautions concerning range of motion and stretching, weight-bearing status, and brace were followed to protect the surgical graft. Treatment incorporated cardiovascular, strength, and proprioception exercises, and progressed with the focus on correct movement patterns and eccentric muscle control during functional movements. Fish eye OUTCOMES: The patient attended 25 physical therapy sessions over 7 months. Muscle strength improved from 4/5 to 5/5. Straight-leg raise range of motion decreased from 145° to 90°. Lower Extremity Functional Scale (LEFS) scores improved from 15/80 to 70/80. Fish eye DISCUSSION: A complete avulsion of the proximal insertion is rare. Conservative management of hamstring tears has traditionally focused on end-range passive stretching, modalities, and direct hamstring strengthening. New evidence recommends a program that is more protective of the injured tissue and includes exercises such as core stabilization; indirect hamstring strengthening may be beneficial in the treatment of hamstring injuries. This concept was taken into account when considering the rehabilitation protocol and progression for this patient. Fish eye LEVEL OF EVIDENCE: Therapy, level 4.
AB - Fish eye STUDY DESIGN: Case report. Fish eye BACKGROUND: After 2 attempts at conservative care for a diagnosis of hamstring strain, the patient had a surgical hamstring allograft reconstruction. The purpose of this report is to describe the physical therapy approach to postoperative management of a hamstring reconstruction. Fish eye CASE DESCRIPTION: A 24-year-old female coach who sustained a complete avulsion of the proximal hamstring tendon while playing softball had a surgical hamstring reconstruction using an Achilles tendon allograft. Precautions concerning range of motion and stretching, weight-bearing status, and brace were followed to protect the surgical graft. Treatment incorporated cardiovascular, strength, and proprioception exercises, and progressed with the focus on correct movement patterns and eccentric muscle control during functional movements. Fish eye OUTCOMES: The patient attended 25 physical therapy sessions over 7 months. Muscle strength improved from 4/5 to 5/5. Straight-leg raise range of motion decreased from 145° to 90°. Lower Extremity Functional Scale (LEFS) scores improved from 15/80 to 70/80. Fish eye DISCUSSION: A complete avulsion of the proximal insertion is rare. Conservative management of hamstring tears has traditionally focused on end-range passive stretching, modalities, and direct hamstring strengthening. New evidence recommends a program that is more protective of the injured tissue and includes exercises such as core stabilization; indirect hamstring strengthening may be beneficial in the treatment of hamstring injuries. This concept was taken into account when considering the rehabilitation protocol and progression for this patient. Fish eye LEVEL OF EVIDENCE: Therapy, level 4.
KW - Achilles allogratt
KW - Hamstring reconstruction
KW - Physical therapy
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U2 - 10.2519/jospt.2008.2845
DO - 10.2519/jospt.2008.2845
M3 - Article
C2 - 19047774
AN - SCOPUS:57449115323
SN - 0190-6011
VL - 38
SP - 754
EP - 760
JO - Journal of Orthopaedic and Sports Physical Therapy
JF - Journal of Orthopaedic and Sports Physical Therapy
IS - 12
ER -