SC: Proximal hamstring/Adductor Pain with Deep Squat and Running Week 3

Review of this week’s conversation:
- Report is similar symptoms as noted from previous week below
  - Feels continued discomfort in high hamstring and adductor has been very painful
- Reproduction of pain with standing adductor activation
- Burning sensation in the lateral aspect of the glute with weight bearing leg during bear position
- Significant pain in the periscapular region with mild relief following self myofascial release
  - Symptoms aggravated by static sitting postures
  - Tigger point at scalene insertion reproduces symptoms in the median nerve distribution into the hand
- Running with any increase speed also reproduces hip/groin pain
Plan for this week:
- Continue with the strength circuit below since you don’t feel it had any negative impact
  - Be careful with the ball bridge progression in that it does isolate the hamstring pretty well and overdoing that movement can increase pain
- Implement more self myofascial release in your warm up
  - I know you have done some of this but I have my own techniques I have found to be helpful so give them a try
- Shoulder/Neck: Didn’t get much feedback so will continue to progress as planned
  - Activate deep neck flexors without over activation of SCM and scalenes
  - Scapular depression and self 1st rib mobilization
  - Progress loading into thoracic extension
- Hip
  - Progress loading of hip flexor similar to what is required for running
  - introduce self release strategies for psoas and proximal hamstirng
Goals this week
- Establish a good light mobility/warm up sequence to be done everyday
  - This is meant to reduce pain when symptoms are irritated and focus on establishing good muscle recruitment patterns
  - If any of the movements cause pain or feel like they are not having any significant impact, email me and I will substitute some other options
- Establish some strength circuits that can be done 3-4x per week to challenge the system
  - Goal is 8-20reps SLOW or for time 30-90sec
Mobility/Warm Up Sequence: This can be done everyday
- One set of 8-20 reps for each movement
- Shoulder Extension/Internal Rotation Bridge VIDEO
  - This combines shoulder mobility, quad stretch, light glute activation
  - 8-20 reps slow and controlled
- Puppy Pose Progression VIDEO
  - Promotes thoracic ext and mobilization of lat
  - May progress to the movement below if able
    - Down Dog to Up Dog Floor VIDEO
- Self 1st Rib/AC Joint Mobilization VIDEO
  - Focus on the downward reach with the exhale
- Tall Kneel with Scapular Depression/Retraction VIDEO
  - Maintain some lower abdominal tension as you lean back
- Step Knee Flexion Intro VIDEO
  - Get as much space as comfortable between feet by using a higher step or standing further away from lower step
  - maintain abdominal control so your back does not drop into excessive lordosis
- NEW: Try some of the myofascial release techniques below: Assess if any of the movements below are drastically different when comparing your painful and non painful side
  - Let me know which ones are different if any
  - Supine Hooklying Quad/Psoas VIDEO
  - Self MFR Quad/Hip Flexor VIDEO
  - Side Lying IT Band VIDEO
  - Self MFR Hamstring VIDEO
  - Self MFR Ball Glute/Piriformis VIDEO
Strength Circuit #1:
- This should be done every other day (3-4 days per week)
- Goal is for 8-20 reps or 30-90sec
- Do 1 set of each exercise and then repeat the circuit 2-3x
- Laying on Back Weight Pull Over and Band Pull Over VIDEO
  - Focus on 4-5 sec eccentric load and get through full range of motion
  - may work best using an a short curl bar
  - Pick a weight that you are able to get through full range, slow eccentric, and keep low back flat against floor
  - Goal: Load into thoracic ext and latissimus stretch
- Table Top Progression VIDEO
  - Keep pressure on heels
  - Scapula down and back avoiding anterior tilt of scapula
  - Same slow and controlled rule applies
- Bridge Progression Physio Ball (Choose 1)
  - Continue with slow and controlled motion
  - Good starting point will be level 3
  - Level 1:Isometric Co-activation Abdominal/Glute Phase 1 VIDEO
  - Level 2: Abdominal Control With Hamstring Curl Phase 2 VIDEO
  - Level 3: Double Leg Bridge Phase 3 VIDEO
  - Level 4: Hamstring Isometric with Contralateral Leg Raise VIDEO
  - Level 5: Double Leg Bridge With Hamstring Curl Phase 4 VIDEO
  - Level 6: Single Leg Bridge Phase 5 VIDEO
  - Level 7: Single Leg Bridge With Hamstring Curl Phase 6 VIDEO
Strength Circuit #2
- Same rules as above, can be done every other day
- Bear Pelvic Control VIDEO
  - Warm Up with 5-10x, then try the mountain climber below with press of foot into floor to load hip flexor….do this slow and controlled
  - Bear Hip Extension->Mountain Climber VIDEO
- Side Step Band Progression VIDEO
  - Once again slow and controlled, if you do it fast it will be easier
  - Should feel this in the stance leg
- Counter Push Phase 1 VIDEO
  - This is not incredibly difficult but has been useful to fire the glute in a runner stride like position