Dear Michael,
In order to respond to your e-mail,I need to know what kind of patient
population you have in mind. Are these patients orthopedic, neurological,
ACL-injured, etc.? The only time I can think (from an ortho bent) of in
which the patient would have stronger hamstrings than quadriceps is in a
patient with a significant knee injury/immob, which resulted in a large
amount of quadriceps atrophy. Otherwise, in typical "normal" populations,
the hamstrings to quadriceps ratio is around 60% (concentric/concentric
isokinetic). Rehab depends on the patient population.
For example, an ACL injured athlete benefits significantly from have an
abnormally elevated ham/quad ratio, because the ham is serving in a
protective stabilizing mechanism to protect the knee from ant displacement
of the tibia during functional activities. In a patello-femoral pt.
population, generally VMO facilitation is the norm focus. In both patients,
neurophysiological mechanisms of the body in response to injury has
occurred. In the patello-femoral pt, it would be advantageous to reverse
the increased ham/quad ratio, whereas the ACL patient's ham/quad ratio
should be promoted into further increases (especially if not surgically
repaired). So, yes, I agree that the basis for the changes is neuro, but I
would contend that the attempts to stretch med hams and strengthen VMO
(tape, US, exs, e-stim) is an equally neuro approach. You cannot separate
neurological function from musclular function in rehab or otherwise.
Jill K., ATC, SPT
My querry into hamstrings comes from the clinical problem of patients
with what I call "hamstrings-driven gait". That is, during normal
striding, hamstrings, especially medial, in some individuals te
over quads (that is to say, the hams/quads ration--whatever that
is----is abnormally elevated). These individuals seem to be prone to
certain hip and leg symptomatology and biomechanical inefficiency,
including TFL pathology, posterior Glud med. lengthening, VMO
insufficiency, with patellar tracking problems etc etc. The standard
exercises seem to be "hams stretches"--once again, whatever this
means---, quads drill, VMO retraining, patellar taping, US for local
pathologies etc. What I think we should be attempting to do is to
somehow change the recruitment pattern such that quadriceps plays a
larger role, with hams playing less. I recognize that this is a
neurophysiological problem (I think). Thoughts anyone?
Michael Ritchie
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