Ep 277: Clinical pearls for thigh muscle rehabilitation (part 2), with Dermot Simpson & Simon Wallace

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.

But then we find out he's had a ankle surgery or a syndesmosis operation or recurrent ankle sprain, and he has a lot of dorsiflexion restriction on, let's say, his left side, and he's getting a lot of problems on his right side, then we need to be aware of that as well because we know when they're running at, at higher speeds, they might be putting an extra strain on that contralateral hamstring.

Likewise, maybe they had an ACL graft, and that inner range hamstring strength, the, the medial hamstrings are just not activating as well, or they were not getting the same output from that, so we need to be aware of that.

Or it can be other motor control deficits.

So this is why it's imperative to do a full assessment, as I said.

And even just to come back to subjective questions, I think it goes on to the second clinical pearl in, in the assessment is begin with the end in mind.

Um, a comprehensive assessment framework ensures rehab stays aligned with return-to-play goals.

So probably the point there is, I mean, if we have, let's say, a player who's played five games in the last 12 months versus a player who's played 35 games, then it may be a bit different to how we approach it, especially towards the end stage, because we know his chronic load over the last year is a lot less, and it may need a bit extra training on the pitch because we don't want the player to turn into, I think it was termed many years ago, a chronic rehabber, where he comes back, and he hasn't got the load up, and then he plays a few minutes, and he gets another injury.

It may not even be a hamstring injury.

So I think we have to take that into account.

And sometimes we just need to know what the goal is of the player.

So let's say he's, he's preparing for a World Cup.

He had a, a grade three C hamstring.

The World Cup's three, four weeks away, and he wants to make it.

Then we have to prioritize towards that because in the end, the player, along with the medical team, will, will make this choice whether we want to get him ready for that or whether it's off-season, and we know we can take a little bit more time with, with the player as well.

And likewise, even though our pathway is the progressions are associated with running speeds, you may, may have a goalkeeper versus a winger, and we know a goalkeeper will do accelerations, especially the modern-day goalkeepers.

You've probably seen the World Cup who's on the edge of the box and needs to accelerate, but probably not reaching top speed.

So we need to be maybe more bespoke in how we're looking at his running progressions as opposed to a winger who's gonna do a lot of repeated sprints down the line.

So that's probably the two clinical pearls from assessment and just one from, uh, milestones.

So criteria-based milestones provide a structured evidence-informed pathway through rehab by progressing based on clinical benchmarks, not just time or MRI classification.