Hamstring Avulsion

[tilly_:)]

Hi,

Later this week, I have a new client who fell and suffered from a complete tear of her hamstring tendon at the ishchial tuberosity nine weeks ago. This was confirmed with an MRI. Instead of surgery, her doctor recommended that she take the conservative approach of PT in the hopes that scar tissue will reattach the tendon. I'm not sure if she's had another MRI since the initial one. I think she did have second MRI early into PT. She requested another MRI recently. Her doctor will not order another one because she has made progress while in PT.

While in PT, she told me that she has developed compensatory patterns and sciatica pain in the other leg. The PT won't help her because it's not part of her script. His advice: go see a massage therapist.

She told me that she can feel where the tear is and pushes in on the area... made me cringe when I heard her say that. She says that she experiences pain in the area when it is damp and cold outside.

I've had clients with partial tears. But, never a complete tear without surgery. Right now, I plan on checking her pelvic alignment and working on her hip flexors, glutes, and psoas. But, I'm really leery of working on the affected hamstring or trying to help realign scar tissue with friction and eccentric contractions.

Any advice on how to approach this? Has anyone had similar experiences? I appreciate any and all thoughts.

 

[munis]

Hamstring Avulsion

Any advice on how to approach this? Has anyone had similar experiences? I appreciate any and all thoughts.

Make sure and cover yourself by getting a script from the MD and a subsequent written document from her, as to what areas she is requesting worked. Make sure they compare properly. Then, follow up with the MD (get him/her on the phone or e-mail).

Don't work what your not comfortable working.

That's my best advice for now.

 

[sknmysanity]

Hamstring Avulsion

Any advice on how to approach this? Has anyone had similar experiences? I appreciate any and all thoughts.

Make sure and cover yourself by getting a script from the MD and a subsequent written document from her, as to what areas she is requesting worked. Make sure they compare properly. Then, follow up with the MD (get him/her on the phone or e-mail).

Don't work what your not comfortable working.

That's my best advice for now.

Thank you. I'm going to call her tomorrow and email her a physician referral form to be completed prior to her scheduled massage. Her PT can not prescribe massage. Maybe, he would be willing to discuss the specifics of her case with me with her written consent. I think I have that form too.

I've had other doctors refer their patients to me for massage. I haven't had to contact any doctors about their patients though. I haven't contacted a PT before to discuss a client's injury/treatment. How does that work? After she signs a release form with both me and the PT, do I contact the PT or ask her to have the PT contact me?

 

[gillianprowe]

Hamstring Avulsion

I believe you should be able to get a consent form from the client stating she is ok with you contacting her PT, and at the same time she can sign consent with her PT, stating she is ok with them discussing her case.

 

[TonyWithLove]

Hamstring Avulsion

You need to see imaging before working on that hamstring attachment!

It's probably way too early to start with eccentric loading. But best way I have found to isolate that attachment is to have patient place injured leg on a chair with a slight bend in the knee. Patient then moves into slight lumbar flexion. Instruct patient to drive heel into chair for 2-3sec, and repeat. Exercise can be performed am & pm. Work well for all those athletes with hamstring tendonosis issues.

 

[Baki]

Hamstring Avulsion

You need to see imaging before working on that hamstring attachment!

It's probably way too early to start with eccentric loading. But best way I have found to isolate that attachment is to have patient place injured leg on a chair with a slight bend in the knee. Patient then moves into slight lumbar flexion. Instruct patient to drive heel into chair for 2-3sec, and repeat. Exercise can be performed am & pm. Work well for all those athletes with hamstring tendonosis issues.

Thank you for the exercise suggestion. Since the client is in physical therapy, I am only providing massage. I was referring to eccentric loading while stretching as a means to realign scar tissue after cross fibering. I agree it is too soon to do that.

She brought her MRI review, but didn't have a completed physician referral form at the time of her appointment. She will have it before scheduling future appointments. She is also considering getting a second option and finding another doctor in order to get another MRI to confirm the tendon is attaching correctly and surgery is not needed.

She was not in any pain at the time of her appointment. PT must be working wonders for her because her gait and posture looked better than most people without injuries! I had her fill out an intake form and sign a release form. I gave her relaxation massage with the emphasis on improving circulation and going light on both legs, feet and ankles.

 

[Tofu]

Hamstring Avulsion

Your too modest your treatment is probably a big reason for her improvement

I really like giving patients active isolated stretching as a bench mark as to whether I can be more aggressive with treatment. If they are able to do moevment pain free its probably a good sign I can move to assited stretching techniques.

 

[lovincupcakez]

Hamstring Avulsion

Your too modest your treatment is probably a big reason for her improvement

I really like giving patients active isolated stretching as a bench mark as to whether I can be more aggressive with treatment. If they are able to do moevment pain free its probably a good sign I can move to assited stretching techniques.

AIS has a detailed series of strengthening methods and protocols that would be an excellent complement to the work this client is already receiving. It starts very, very gently, and she can safely build up to ever-more-challenging work.

If you are not familiar with Active Isolated Stretching, do you know some other form of active stretching/strengthening method that falls within your scope of practice as an MT? If not, stick to massage and refer this client to a personal trainer familiar with corrective exercise once she is discharged from physical therapy.

 

[michael b]

Hamstring Avulsion

Hi Athletica,

Oh, it was the client's first appointment. So, I deserve no credit. Thank you for the good advice for assessing how aggressive you can be.

Hi Jason,

Yes, I am familiar with AIS and MET. I plan on incorporating more corrective techniques once I receive a completed physician referral form.