What does the starting point look like? What questions are you asking? What does the initial exam look like, um, to rule in or rule out the suspicion of a hamstring injury?

Yeah, um, good question, and I think it's a very important part is the initial assessment.

Um, you'll probably see within the, the pathway that we have some clinical perils, and one of them is what you don't find at the start often finds you later.

So identifying the key sepcits-- key deficits and tracking them throughout allows, allows the targets in progressive rehab.

And as well as begin with the end in mind.

So we need to have a structured assessment and, and knowing what the end goal is.

So what are our return to play goals? So in terms of what questions we ask, um, well we do ask what the mechanism was.

Um, what do y'all-- what's your take on some of those movements? Is it just not replicating the forces and the positions that would be, uh, more appropriate for return to sprinting and, and sprinting itself and these other movements are more valuable, or do some of those, uh, positions or activities I'm describing you all actually use and, and are helpful?

If you could highlight two of them for our listeners today for hamstring, Dermot, what would you choose and why?

It's really important to get a, a very strong assessment, and that's including subjective as well.

Like, we want to know...

When we see a lot of hamstrings, and we can see up to 200 hamstrings a year in Aspetar, we, we start to see patterns, and we start to see what is important to ask and what is important to test.

And we know, and we've all made the mistake before, that we missed something on our assessment, and we're thinking it's doing really well, and then we come back, and something happens like, "Oh yeah, I should've checked that, uh, at the very start." So one of the clinical pearls is what you don't find at the start often finds you later.

Identifying key deficits early and tracking them throughout allows for a targeted and progressive rehab.

So let's say a guy comes in with recurrent hamstring, and we do our hamstring tests, we do maybe our hip tests, and he's okay as, as expected.

Would you, would you agree with that?

Dermot, can you walk us through the overview of the hamstring pathway? What's happening at each of the stages, and then what are the milestones you're looking for for the athlete progressing?

So we've six different phases, foundation, reload, accumulation, transition, simulation, and resilience.

And one thing that helps us with is just understanding where the player is in his particular rehab.

So if I say to Simon, "I have to go," he has to see my player for the day or for the week, I can say he's in accumulation phase, so then he has an understanding of roughly where he sits within the clinical milestones, what tests he is, and what running, uh, speeds he can reach.

So then we have a, a, like just by saying accumulation, we've a general understanding of what he can do and what he cannot do yet.

So just starting with foundation phase, which is the first phase, and this is typically for maybe a post-op hamstring or a very high-grade hamstring, and it's mainly isometrics or, or low-level motor control exercises.

We're not, definitely not running yet.

How did you decide where to put the emphasis and, and how to change that as rehabilitation progresses?