Lower Extremity Strengthening, Neuromuscular Re-Education And Graded Activity For A Runner With Distal Hamstring Tendinopathy: A Case Report

Background and Purpose: Hamstring injuries are common injuries athletes face with high recurrence rates. Many hamstring injuries, including hamstring tendinopathy are caused by non-contact mechanisms like running due to its role in eccentrically controlling rapid knee extension and hip flexion. Despite its prevalence, there is controversy surrounding the optimal treatment of a hamstring strain. The purpose of this case study was to document the physical therapy (PT) interventions for a runner with an acute distal hamstring injury and tendinopathy. Case Description: The patient was a 23-year-old active male referred to outpatient PT with a diagnosis of patellar tendinitis. The procedural interventions included patient education and activity modification, progressive lower extremity (LE) resistance training, neuromuscular re-education, soft tissue mobilizations, stretching, and running assessments. The patient received PT twice a week for 12 weeks. Outcomes: The patient’s score on the Lower Extremity Functional Scale improved from 41/80 to 70/80. His right (R) knee flexion and extension strength improved bilaterally from 3+/5 to 4/5 and his running cadence improved from 158 to 170 steps/minute. The patient no longer experienced hamstring tenderness with palpation. When performing a step up on a 4-inch platform, the patient’s functional testing improved from having no ability to feel his R quadriceps contract with posterior knee pain to gaining the ability to feeling his quadriceps recruit with no pain. Discussion: This case report demonstrated the purpose of how LE strengthening, graded activity, and neuromuscular reeducation could be beneficial to help a runner return back to full activity. Future research should focus on cadence assessment and rehabilitation for long-distance runners in addition to running cadence education for patients with hamstring injuries