Hamstring Injuries – Incidence and Treatment

Hamstring strains, or injury to the hamstring tendon, can be a challenge to both the athlete and clinician when attempting to rehabilitate, recover, and return to prior activity level. This is due in part to a number of factors including the high incidence rate of this type of injury, slow healing process, and persistent symptoms. It has been found that nearly 1/3 of hamstring strains recur within the first year following return to sport without a proper and comprehensive rehabilitation program.

Hamstring injuries can occur in a variety of sports. Hamstring injuries that result from high-speed running as in track and football generally occur during the end swing phase of the gait cycle. In this type of injury the lateral hamstring tendon, or biceps femoris is generally the most often injured. Hamstring strains can also occur during activities such as dancing, kicking, and water skiing. These injuries result from simultaneous hip flexion and knee extension, which places the hamstring in an extreme stretch position. This type of injury typically presents in the semimembranosus, or most medial tendon.

The primary goal of hamstring rehabilitation is to return the athlete to his/her prior level of performance with minimal risk of injury recurrence. Factors that must be considered during rehabilitation include hamstring weakness, fatigue, lack of flexibility, and muscle imbalances between the hamstring and quadriceps muscles. In addition, limited quadriceps flexibility and strength and pelvic, core and trunk strength deficits may contribute to hamstring injury risk and should be addressed.

Hamstring injuries are generally classified according to the amount of pain, weakness, and loss of motion present. They are categorized by the extent of muscle fiber or tendon damaged, resulting in grades of I (mild with minimal damage), II (moderate with minimal disruption of fibers without a tear), and III (severe with complete tear or rupture). Your physical therapist will perform a thorough evaluation during your initial visit. The evaluation will include a battery of tests that measure range of motion, strength, and pain. This will help to provide a reasonable estimate of rehabilitation duration and a basis for beginning treatment.

The physical therapist will develop an appropriate treatment regime for your return to prior level of function and sport participation. Initial exercises may include hamstring stretching and strengthening (with specific focus on eccentric hamstring strengthening and neuromuscular control), quadriceps flexibility and strength, and lumbopelvic control. The treatment program is specific to each individual and each injury, and should be tailored to promote the goals of the patient. Progression criteria is based on factors such as pain response, strength and flexibility improvements, and activity progression. Agility activities, plyometric exercises, and return to sport-related activities will be incorporated when deemed appropriate and based on progression criteria.

Proper rehabilitation is necessary following hamstring strains in order to return to prior activity level. Physical therapy can provide you with the proper treatment aspects to assist you in your return and prevent reinjury once return-to-sport is accomplished.


Heiderscheit B, Sherry M, Silder A, Chumavno E, Thelen D. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. Journal of Orthopaedic &Sports Physical Therapy. 2010; 40:67-81.



Excel Sports and Physical Therapy is looking for a certified and licensed athletic trainer to cover 5-6 days per week at a high school for the 2015-16 academic year.

Responsibilities include every day practice and game coverage, first aid and emergency care,  running and managing an athletic training facility, budgeting, injury tracking and record keeping. The athletic trainer will report to the Activities Director and the Outreach Program Director. The high school uses Sportsware  for injury tracking and ImPACT testing for concussion testing. New graduates are welcome to apply. Benefits package offered.

Applicants should e-mail a cover letter, resume and five references to Nathan Wilmes at nwilmes@excelsportspt.com.

Employment Opportunity

Excel Sports and Physical Therapy is looking for a PRN Athletic Trainer to assist in the afternoons/evenings on a daily basis. Interested applicants should contact Nate Wilmes to apply.

Nathan J. Wilmes, MEd, ATC, LAT, EMT-B, CSCS
Director of Outreach Athletic Training Services
Excel Sports & Physical Therapy
Cell: 314.805.4627

Excel in the Community: Cheer Legendz

Maggie Richardson, AT for Fort Zumwalt North High School, recently provided an injury prevention screening to Cheer Legendz in Manchester, Missouri. Ms. Richardson worked with women’s gymnastics while completing her athletic training degree at SEMO, so she was a great fit offer some injury prevention advice to the competitive cheer team at Cheer Legendz. Ms. Richardson provided some helpful information about ankle strengthening exercises and core strength training.

Welcome to the Excel Sports and Physical Therapy Team!

Excel Sports and Physical Therapy is welcoming a few new athletic trainers to their staff. Shannon Hypke will be at Saint Charles West, Sarah Lohse will be at Fort Zumwalt South, and Samantha Fehlhafer will be at Saint Dominic High School. Ms. Hypke and Ms. Lohse are both recent graduates from Lindenwood University’s Masters degree program. Ms. Fehlhafer, a University of Iowa graduate, will be moving from the PRN ranks, and starting a new full-time coverage position at SHDS. The first of its kind at SDHS, and she is very excited about this opportunity. Lastly, Excel welcomes Krista Farnes to the STL Louis area. Ms. Farnes is a recent graduate of the University of Florida in Gainesville and will be assisting with PRN opportunities.

Excel in the Community

Dr. Larkin, of Advanced Bone and Joint, and five Excel athletic trainers, gave a presentation to the FZSD Board of Education on Monday, July 21. The topic was concussions at the high school level, and the report included an overview of the concussions incurred in the district high school sports programs, the average number of days that an athlete was out, as well as the return to play protocols.

The ATs were JoAnn Spann (FZS), Maggie Richardson (FZN), Courtney Jacob (FZE), Jenn Raisbeck (FZW), and Nate Wilmes.

Gamekeeper’s Thumb: Ulnar Collateral Ligament Injury

Gamekeeper’s thumb also known as skier’s thumb is an injury to the ulnar collateral ligament (UCL). The UCL is most frequently torn at its insertion on the proximal phalanx. Injury to the UCL typically occurs when the thumb is forcefully pushed away from the palm such as during a fall onto an out stretched hand or repetitively stretched with less force during athletic or work activities. Symptoms of a UCL injury include instability of the thumb, weakness, and pain. Acute injury can also demonstrate local swelling and bruising.

Key in the management of UCL injury is determining if the ligament is sprained or torn. The anatomy of the ligament and surrounding soft tissue can lead to tears in the ligament which are held apart and require surgical intervention to repair. Both conservative and post-surgical management includes custom splinting by a certified hand therapist followed by ROM and strengthening activities to restore pinch and grip strength.

Full recovery and return to work or athletics is expected in 4-6 weeks with successful conservative management and 10-12 weeks following surgery.

See Yadier Molina’s injury here:


GAC Baseball Classic at TR Hughes

WHEN: April 18-19, 2014

WHERE: TR Hughes Ballpark






Please see the attached flyer for more details and information!

GAC Baseball Classic 2014 Schedule

March is National Athletic Training Month!

March is National Athletic Trainers Month, and during
March, athletic trainers across America are being recognized for their
commitment to helping people prevent injuries and stay healthy and active.
Athletic trainers are allied health care professionals. Highly educated and dedicated
to the job at hand, athletic trainers can be found in high schools and
colleges, corporations, professional sports, the military, performing arts and
clinics, hospitals and physician offices. Please visit nata.org for more
information about the athletic training profession.

Attention Missouri Athletic Trainers:

Pat Anthony Forbis

Pat Anthony Forbis, 58, of Jefferson City, passed away unexpectedly Wednesday, February 12, 2014, at University Hospital.

Mass of Christian Burial will be 11 a.m. Monday, February 17, 2014, at St. Andrew Catholic Church in Holts Summit.

Visitation will be 3-7 p.m. Sunday at St. Andrew Catholic Church in Holts Summit with a prayer service at 2:30 p.m.

Further arrangements are pending with Dulle-Trimble Funeral Home.

Directions can be found at