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Problems cannot be solved by the same
level of thinking that created them A.E.
Mathieu Gram
Hamstrings
Mathieu Gram
Most common injury in
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Hamstring  Incidence & Severity
 Approximately 6 players/squad/season
 Miss approximately 3 matches or weeks of
play
Woods et al., 2004  Hoskins et al., 2005
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Risk factors
 Previous hamstring injury  >2x risk
 Age
 ACL injury (altered proprioceptive feedback)
 Reduced flexibility ???
 Low hamstring strength ???
 Strength deficits or imbalances ???
 Isokinetic testing  specificity? Engebretsen et al., 2010
Arnason et al., 2004
Tsuda et al., 2001
Verrall et al., 2001
Christensen et al., 2000Mathieu Gram
Mathieu Gram
Clinical reasoning
+ Psychosocial
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Anatomical links
TibFib joint
SI Joint
m. Romboidei
ACL
Tsuda et al., 2001
Beltran et al., 2003
Hoskins et al., 2005
m. Popliteus
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Strong framework?
Mathieu Gram
Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
Mathieu Gram
Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
Mathieu Gram
Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
Mathieu Gram
Strong framework?
Tension TLF
Hodges et al., 1997
Barker et al., 2004
SIJ
Lx
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Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
Problems cannot be solved by the same
level of thinking that created them A.E.
Mathieu Gram
Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
TibFib Joint
Mathieu Gram
Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
TibFib Joint
SI Joint
Mathieu Gram
Articular
When evaluating hamstring pain,
Evaluate biomechanics of:
TibFib Joint
SI Joint
Lx
Woods et al., 2004
Mathieu Gram
Muscular
When evaluating hamstring pain,
Evaluate:
- Framework  Lumbar-Pelvic dysfunction?
- Tension  Trigger Points?
- Strength
- Length
Vogt et al., 2003
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Muscular
When evaluating hamstring pain,
Evaluate:
- Framework  Lumbar-Pelvic dysfunction?
- Tension  Trigger Points?
- Strength
- Length
Vogt et al., 2003
Gluteus Maximus
vs
Hamstrings
Mathieu Gram
Neural
When evaluating hamstring pain,
Evaluate neurodynamics:
Piriformis syndrome
Mathieu Gram
Problems cannot be solved by the same
level of thinking that created them A.E.
Treatment of hamstring injuries should also
be directed at non-local hamstring factors.
Hoskins & Pollard, 2005
Mathieu Gram

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