Case Study: Hamstring Pull In High School Sprinter

Background

Male high school senior sprinter who sustained a grade 2 left hamstring strain/tear (confirmed by MRI) during the final heat of the indoor state meet. For context, his personal best in the 100m was 11.04s (outdoor) and he had committed to attending a Pac 12 program in the fall. He’d only been running track competitively for two years but was always one of the “really fast kids” when he played team sports. He had rehabbed with another provider but never attempted anything that resembled running in the eight weeks since the original injury. When asked directly, the athlete reported to us that goblet squatting was the most aggressive activity he performed prior to our evaluation. He also reported that a physician told him to sit out the spring season “because the tissue has to heal”. To be fair, we never spoke to that physician directly and therefore received this information second hand. We did not reach out to said physician because the athlete was a direct access patient looking for a completely different plan of care. Understandably, the athlete did not want to miss the spring season so pending any red flags during the evaluation, our intention was to prepare him for his first team practice which was exactly two weeks away. To be clear, our definition of success here was preparing the athlete to confidently and asymptomatically practice with his team, not necessarily to make him faster or meet ready in the little time that we had available.

Constraints

• Time: Two weeks to prepare for the first practice without the athlete having done anything resembling running for two months
• Financial: Luckily not an issue because the athlete was covered for out of network care and his policy afforded enough visits to work with us in person every weekday between his initial evaluation and his first team practice. We encounter plenty of people for whom that kind of treatment volume does pose a significant financial burden and adapt our planning accordingly. In those instances, decreased financial independence necessitates that athletes perform the majority of the programming independently, however. This compromise need not compromise outcomes, however. The burden is on the provider to adapt to the patient’s constraints, not vice versa. In an ideal world, disposable income and/or one’s insurance coverage wouldn’t pose a constraint. Medicine isn’t practiced in a vacuum though and economic factors often influence the plan of care.
• Interpersonal Factors: Non-issue. Model athlete in terms of enthusiasm and motivation to train and compete.

Initial Findings (Day 1)

• Completely asymptomatic/pain free though athlete hadn’t been running. No pain with manual resisted knee flexion or hip extension.
• No pain on palpation relative to uninjured side
• Low hanging movement fruit: limited hip extension bilaterally (especially left), limited hip internal rotation bilaterally (especially left), limited toe touch (8” from floor), limited deep squat (barely broke parallel w/feet straight and shoulder width stance)
• No significant medical or surgical history
• Running analysis not performed until Day 2

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