Designing a Return to Activity Protocol for a Proximal Hamstring Rupture in a Collegiate Heptathlete: A Case Study

There are few return-to-activity protocols and functional tests specifically designed for a proximal hamstring rupture for athletic trainers to follow when clearing an athlete for return to activity. To address this problem, the purpose of this study is to describe and evaluate a return to activity protocol that includes functional testing for a post-surgical proximal hamstring rupture to assess readiness for return to activity. This case study collected data from a 20-year-old, 6ft 2in, 185lb (87.9 kg) collegiate heptathlete that ruptured his proximal hamstring that required surgical treatment. The student athlete’s (SA) return to activity process is evaluated and explained. The SA went through numerous function tests to determine return to activity status. The first testing session was conducted 8 months post-surgery. He was then re-assessed 4 months later. During testing, the SA also wore accelerometers to gather more quantitative data to identify gait abnormalities due to the injury. The first round of testing revealed greater strength in his left (affected) leg compared to his right (unaffected) leg. The SA was not able to complete all the tests during the first round of testing due to muscular fatigue and soreness, suggesting low muscular endurance at that point in time. Thus, he was not cleared to return to activity and continued to do rehabilitation exercises to increase the endurance of the hamstring muscles. The second round of testing was completed 4 months later which revealed that he had gained endurance in the hamstring muscles and his strength had increased. At this point, he was cleared for full return to activity. This return-to-activity protocol with specific functional tests could serve as a template for other athletic trainers who are seeking to return an athlete to full activity after suffering a proximal hamstring rupture (See Appendix I).