In the acute stage of proximal hamstring tendinopathy, the goal is to load the hamstring and tendon without causing unnecessary flare up. As this is a compression tendinopathy, in which excessive hamstring tendon tension on stretch is the aggravating factor, a large emphasis should be placed on improving lumbo-pelvic awareness and then strength to de-emphasise an excessive anterior pelvic tilt. Anterior pelvic tilt will move the proximal attachment superiorly (up) and has the potential to cause further compression as the hip goes into flexion. For this reason, motor control plays a large role.
Early Stage:
isometric holds - 4 sets of 45 seconds
Motor Control:
Build awareness of pelvic position. Learn to dissociate hip motion from pelvic motion. Learn to hinge without anterior pelvic tilt by modified wall Jefferson curl. Specific reps less important for motor learning.
Early to Mid Stage:
Start to build some strength-endurance/hypetrophy - 3 sets of 8 - 12, continue to strengthen posterior pelvic tilt, light Jefferson curl
Mid to Late Stage:
Add the hinging pattern back in with a focus on avoiding excessive anterior pelvic tilt. Build some real strength.
Elastic Energy Storage Stage -
Add in some plyometric hamstring exercises as speed to improve tendon elasticity and hamstring spring.
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