Do You Use the Nordic Exercises in Your Office?

This blog will allow you to recognize hamstring injuries faster, provide a simple downloadable rehabilitation program for your patients, and teach you one exercise to treat and prevent the re-occurrence of a hamstring injury.

Chiropractic Evaluation of Hamstring Injuries

Symptoms

• Most hamstring injuries occur abruptly during activity, with a tearing feeling accompanied by significant pain. 

• The most common presenting symptoms include pain in the lower buttock and posterior thigh when straightening the leg, particularly while ambulating or flexing forward.

Clinical Signs

• Visible bruising may occur at the injury site and slowly gravitates inferiorly. 

• The point of maximum tenderness often represents the site of injury. 

• Range of motion testing may produce pain upon passive hip flexion and knee extension, i.e., straight leg raise. 

Orthopedic Tests

Manual muscle and orthopedic testing reproduce pain upon resisted hip extension or knee flexion. However, due to the bi-articular nature of the hamstring, multiple test positions may be needed to assess function. Use these three tests to Rule-In or Rule-Out a hamstring injury.

Doormat sign

The patient reports pain when they simulate the movement of wiping their foot on a mat while standing. 

Hamstring Drag Test

Ask a standing patient to take off the shoe of the injured leg while holding that shoe on the ground with the forefoot of the unaffected leg. 

Braggard's Test

This test will differentiate between hamstring injury and lumbar radiculopathy. Adding ankle dorsiflexion to the SLR will not affect biceps tension but will impact nerve tension, i.e., radiculopathy. It is important to note that individuals who have sustained recurrent hamstring injury may have scar tissue that interferes with normal sciatic neurodynamics. (3)

The Treatment and Prevention of Hamstring Injuries

The management of hamstring injuries is challenging for clinicians and patients. Patients may become frustrated with delayed healing, persistent symptoms, and re-injury rates that occur between 12 and 31%. (4) Keep in mind athletes who do not adequately rehabilitate their injury and return to a sport prematurely are at greater risk of re-injury and diminished performance. (5) 

Try this exercise with your next patient suffering from a hamstring injury.

Nordic Exercise

There is significant evidence suggesting that incorporating (Nordic) eccentric strength training exercises assists in rehabilitation hamstring injuries and minimizes recurrence. (6)  A study in the British Journal of Sports Medicine looking at programs for injury prevention concluded that the Nordic hamstring exercise reduces hamstring injury risk by 51%. (7) As hamstring weakness is the most prevalent risk factor for developing this injury, it is also the critical variable in the rehab of these problematic cases. The Nordic Hamstring exercises will solve both problems. 

To learn more about all three phases of rehab for the hamstring, check out ChiroUp's condition reference for the most up-to-date information on this common disorder. You can also prescribe your patients a detailed condition report within ChiroUp’s platform. If your patients understand their condition as well as you do, you can work together to solve this often debilitating condition. Get started with ChiroUp today!

• References

  1. Ribeiro-Alvares JB, Dornelles MP, Fritsch CG, de Lima-E-Silva FX, Medeiros TM, Severo-Silveira L, Marques VB, Baroni BM. Prevalence of hamstring strain injury risk factors in professional and under-20 male football (soccer) players. Journal of sport rehabilitation. 2020 Mar 1;29(3):339-45.

  2. Wan X, Li S, Best TM, Liu H, Li H, Yu B. Effects of flexibility and strength training on peak hamstring musculotendinous strains during sprinting. Journal of sport and health science. 2021 Mar 1;10(2):222-9.

  3. Bertelsman TJ, Steele BC. Hamstring Strain. www.ChiroUp.com. Accessed 2/21/22. https://app.chiroup.com/clinical-skills/conditions/96

  4. Sherry MA, Best TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. Journal of Orthopaedic & Sports Physical Therapy. 2004 Mar;34(3):116-25.

  5. Drezner JA. Practical management: hamstring muscle injuries. Clinical Journal of Sports Medicine. 2003 Jan 1;13(1):48-52.

  6. Copland ST, Tipton JS, Fields KB. Evidence-based treatment of hamstring tears. Current sports medicine reports. 2009 Nov 1;8(6):308-14.

  7. Van Dyk N, Behan FP, Whiteley R. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. British journal of sports medicine. 2019 Nov 1;53(21):1362-70.