Meet today's guest bloggers:
Dr. Terry Gebhardt, PT, DPT
Dr. Gebhardt completed his Master of Physical Therapy at the U.S. Army-Baylor University Graduate Program in 1998. During Dr. Gebhardt's 7 years of physical therapy practice in the Army he specialized in treating a broad range of musculoskeletal injuries. He has worked extensively with injury prevention initiatives and has been a leader in the development of training programs designed to maximize fitness while preventing injury. Dr. Gebhardt relocated to Colorado in 2004 to complete his Doctorate of Physical Therapy degree and Fellowship in Manual Therapy at Regis University. His areas of clinical expertise and interest include spine and sports rehabilitation where he incorporates his passion for fitness with physical therapy.
Dr. Gebhardt is an avid back country skier and ultramarathoner. He is a member of the American Physical Therapy Association (APTA), American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) and a Certified Strength and Conditioning Specialist (CSCS). He has also published research in the Journal of Orthopaedic and Sports Physical Therapy and is currently active in clinical research.
Dr. Timothy W. Flynn, PT, PhD
Dr. Flynn is board certified in Orthopaedic Physical Therapy (OCS), a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT), and a frequent research presenter at state, national, and international meetings. Dr. Flynn is widely published including 5 textbooks, 6 book chapters, over 50 peer-reviewed manuscripts on orthopaedics, biomechanics, and manual therapy issues. He was the editor and author of The Thoracic Spine and Ribcage - Musculoskeletal Evaluation & Treatment and The Users' Guides to the Musculoskeletal Examination, and the author of 3 educational CD-ROMs on Orthopaedic Manual Physical Therapy. Dr. Flynn has received numerous research grants. Awards include the James A. Gould Excellence in Teaching Orthopaedic Physical Therapy, the Steven J. Rose Excellence in Research (twice), the AAOMPT Outstanding Research Award (twice), and the Distinguished Alumnus- Marquette University Program in Physical Therapy. Dr. Flynn continues to maintain an active research agenda in the areas of spinal and extremity manipulation, low back disorders, characterization of spinal instability, and the development of clinical prediction rules.
Dr. Flynn is an expert clinician who is dedicated to providing the highest quality care possible. His primary clientele is made up of individuals suffering from low back pain, chronic spinal disorders, failed back surgeries, and chronic pain disorders. Dr. Flynn's clinical expertise is frequently sought by national and international clients. He is on the executive board of Evidence in Motion (www.evidenceinmotion.com) an education and practice consultation company which passionately promotes a culture of evidence-based practice within the physical therapy profession. Dr. Flynn is the immediate past President of the American Academy of Orthopaedic Manual Physical Therapists (www.aaompt.org), an Associate Editor for the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), and editorial board member of Manual Therapy. He is a Distinguished Professor of Physical Therapy at Rocky Mountain University of Health Professions (www.rmuohp.edu) where he teaches professional and post-professional students in the area of musculoskeletal management, advanced manipulation skills, and evidence-based practice.
Hamstring Strain and Injury: Advice From The Experts, Part II
In Part I of this entry, we discussed some of the most effective treatments for chronic hamstring strains and injuries. Despite being pain-free with typical daily activities, many athletes continue to have pain with their sport several months and even years after a hamstring injury. Unfortunately, there is a high recurrence rate of hamstring strains because of incomplete rehabilitation or returning to sport too soon. Residual scar tissue and persistent muscle weakness are two common reasons for the persistent pain and high recurrence rate following a hamstring strain.
Fortunately, regardless of how long the injury has persisted, Trigger Point Dry Needling and Astym treatment can help reduce or eliminate scar tissue and knots in the muscle called trigger points. These hands-on treatments combined with the appropriate exercise routine can help resolve even the most chronic hamstring strains.
Considering there is such a high recurrence rate of hamstring strains, many have asked what can be done to prevent these injuries from recurring and even better, prevent them from happening in the first place. Although hamstring stretching is commonly recommended for injury prevention, a hamstring flexibility program has not been shown to reduce the incidence of hamstring injuries and in fact it may lead to what is called stretch weakness, where the muscle is highly flexible but weak and prone to injury. In contrast, several studies have found the incorporation of specific strengthening called eccentric exercises into a training program can significantly reduce hamstring strain injuries. Eccentric exercise involves slowly straightening your knee against resistance (working your hamstring muscles) so that the muscle is engaged while it is lengthening. If you are recovering from an acute or chronic hamstring strain, your physical therapist can help you determine when it is appropriate to begin eccentric training. It is important to start slowly when beginning an eccentric strengthening program, as there tends to be greater muscle soreness associated with this type of strengthening.
In addition to eccentric training, exercises that focus on neuromuscular control of your core muscles and lower extremities have been shown to accelerate injury recovery and prevent re-injury. Think of neuromuscular control as the system that creates coordinated movement. This control system frequently “shuts down” following injury. Simply strengthening the muscles is usually not enough to restore neuromuscular control. Exercises to re-establish the motor control are critical in preventing injury recurrence. Examples of such exercises following a hamstring strain include high knee marching, skipping, and explosive running starts with a focus on leg power development. Finally, a program emphasizing varying trunk movements during running (e.g. upright posture, forward flexed and forward flexed and rotated) has been shown to reduce hamstring injury recurrence by 70%.
If you participate in sports where hamstring injuries are more common such as running, soccer, softball, and tennis, remember to include exercises similar to those listed above to reduce your risk of hamstring injury. Your physical therapist or personal trainer can help you develop the optimal training program. If you happen to be one of the unfortunate ones who is still suffering from a chronic hamstring injury, remember you do not need to put up with the pain. There are effective treatments available to help you return to the sport you love.