title: Surgical and therapeutic management of a complete proximal hamstring avulsion after failed conservative approach.
abstract: METHODS
  Case report.
  
  
  BACKGROUND
  After 2 attempts at conservative care for a diagnosis of hamstring strain, the patient had a surgical hamstring allograft reconstruction. The purpose of this report is to describe the physical therapy approach to postoperative management of a hamstring reconstruction.
  
  
  METHODS
  A 24-year-old female coach who sustained a complete avulsion of the proximal hamstring tendon while playing softball had a surgical hamstring reconstruction using an Achilles tendon allograft. Precautions concerning range of motion and stretching, weight-bearing status, and brace were followed to protect the surgical graft. Treatment incorporated cardiovascular, strength and proprioception exercises, and progressed with the focus on correct movement patterns and eccentric muscle control during functional movements.
  
  
  RESULTS
  The patient attended 25 physical therapy sessions over 7 months. Muscle strength improved from 4/5 to 5/5. Straight-leg raise range of motion decreased from 145 degrees to 90 degrees . Lower Extremity Functional Scale (LEFS) scores improved from 15/80 to 70/80.
  
  
  CONCLUSIONS
  A complete avulsion of the proximal insertion is rare. Conservative management of hamstring tears has traditionally focused on end-range passive stretching, modalities, and direct hamstring strengthening. New evidence recommends a program that is more protective of the injured tissue and includes exercises such as core stabilization; indirect hamstring strengthening may be beneficial in the treatment of hamstring injuries. This concept was taken into account when considering the rehabilitation protocol and progression for this patient.
  
  
  METHODS
  Therapy, level 4.
authors.affiliation: Proaxis Therapy, Greenville, SC, USA. Kirkland@proaxistherapy.com
authors.forename: Amy
authors.initials: A
authors.lastname: Kirkland
authors.forename: J Craig
authors.initials: JC
authors.lastname: Garrison
authors.forename: Steven B
authors.initials: SB
authors.lastname: Singleton
authors.forename: Juan
authors.initials: J
authors.lastname: Rodrigo
authors.forename: Friedrich
authors.initials: F
authors.lastname: Boettner
authors.forename: Sarah
authors.initials: S
authors.lastname: Stuckey
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation*; D000328:Adult; D001265:Athletic Injuries / Q000534:rehabilitation / Q000601:surgery* / Q000628:therapy; D001484:Baseball / Q000293:injuries*; D005260:Female; D006801:Humans; D018482:Muscle, Skeletal / Q000293:injuries*; D013848:Thigh / Q000293:injuries*; D014184:Transplantation, Homologous; D017211:Treatment Failure