A 16-year old male high school football player reported to BTF with right hamstring area pain. He said he was sprinting at football practice and felt a “pulling sensation” in the right hamstring area and felt immediate pain. He said it felt like the hamstring muscle was “balled up” and was “very tight’.
During an initial posture examination at BTF by Dr. Chad Moreau, he demonstrated a right lateral shift of his pelvis (note how his right arm lies closer to his right hip) and external rotation of his right lower extremity (note how his right foot is turned outward).
He also demonstrates a significant anterior pelvic tilt (on the lateral view you can also see that his pelvis is rotated forward and also to the right).
During the orthopedic examination & functional screen, he demonstrated:
1) positive bilateral adduction drop test (modified Ober’s Test)
2) decreased left hip internal rotation at 23 degrees (normal is 45 degrees)
3) decreased right hip external rotation at 21 degrees (normal is 45 degrees)
Inability to get into left hip adduction (see image 1 above) means that he is unable to get his body weight to shift over to the left side efficiently. Add to this lack of left hip adduction is his lack of left hip internal rotation (image 2) and compensatory lack of right hip external rotation (image 3) and we have a situation that leads to increased work load for the right hip musculature (hamstrings and adductors).
These postural and functional issues above create tension in the body. His right hamstrings and adductors were abnormally tight. He also had a sacral and ilium misalignment that we typically see in someone with low back pain or hip dysfunction.
Treatment over the 2 weeks at 2 visits per week initially focused on myofascial release therapy at BTF to reduce and eliminate the abnormal tension in his right hamstrings and adductors. This breaks up adhesions that form in the fascial layers and increases the blood supply to the injured tissue to stimulate the healing response.
Chiropractic manipulation of his sacrum and ilium addressed his alignment issues.
Shockwave therapy was used on his right hamstrings in order to break up fascial adhesions and improve blood flow to the area which brings vital healing nutrients into the injured tissue.
Compression – Using compression of the injured area in the form of bands (also called Voodoo bands because of their “magic” healing properties). Compression bands are helpful in improving blood flow to the area immediately after the bands are removed. The athlete repeats all the exercises he did with the band, without, after removal.
He was instructed on postural restoration exercises at BTF and then asked to do them every day in order to create a change in his postural and functional asymmetries. The focus on the repositioning exercises was to facilitate the left hamstrings, adductors and abdominal muscles and right hip flexors in order to encourage left hip internal rotation and right hip external rotation while unloading the right hamstrings.
For the first 2 weeks of his recovery, he was asked avoid sprinting and aggressive lower body strength training, but he could still do core and upper body strength training and bodyweight exercises like squats and lunges if he didn’t notice them increasing the right hamstring area pain.
At the week 3 mark the previous functional tests that were problematic were now as follows:
1) a negative left adduction drop test which means that now he functionally has adequate left hip adduction
2) left hip internal rotation at 45 degrees (normal)
3) decreased right hip external rotation at 45 degrees (normal)
Now he will add return to sprinting and more aggressive lower body strength training exercises.
At BTF we absolutely love getting people to FEEL – RECOVER – PERFORM BETTER! If you need help with an injury, please give us a call at 310-534-1900 or email [email protected].
