Fine-tuning proximal hamstring tendinopathy rehab: Lessons from the DJ’s mixing deck

You thought your party days were behind you right? Well, not if you want to make sure your hip rehab exercise prescription “slays” (I think that’s what the cool kids say these days).

Below you will see a set of mixing decks that will help you come up with “some absolute bangers” when it comes to your hip rehab exercise prescription.

I am going to dive into how to choose the best exercise anywhere along the rehab continuum (1), and explain this in the context of a notoriously difficult condition to treat – proximal hamstring tendinopathy (2). I’ll guide you along the way with some videos and a “how to” guide on navigating our mixing decks.

This blog is going to be a follow on from Dr Joanne Kemp’s Practical on the management of hip pain, so if you’d like in-depth knowledge on how the experts manage hip pain then check it out HERE.

Alright let’s get stuck in…

The below mixing decks are the only tools you need for hip-based exercise prescription, from a biomechanics perspective at least. Please don’t forget my first blog which covers the biopsychosocial factors in mastering exercise prescription in physiotherapy (3). So let’s get acquainted with our mixing decks so you know how to use them when your next hip pain patient comes dancing (or maybe not so much) through your clinic doors…

Each selector is on a scale of 1-10 where 1 is the least and 10 is the max (see image below).

CH1 : Exposure

This channel selects for how biomechanically specific you are trying to be when loading the injured tissue.

E.g. High hamstring tendon

1 = hips extended, anterior chain loaded

5 = moderate degree of hip flexion and knee extension with a posterior chain loading pattern

10 = full hip flexion, knee extension, posterior chain loaded.

CH2: Range Of Motion (ROM)

This channel selects for what range you are loading the tissue through.

E.g. High hamstring tendon

1 = hips extended, knee extended

5 = half hip flexion, knees extended

10 = full hip flexion, knee extended.

CH3: Stance

This channel selects for distribution of load through each limb.

E.g. High hamstring tendon

1 = Feet hip/shoulder width apart

3= Sumo stance

5 = Feet in a B stance

7= Split stance

10 = Unilateral/reciprocal contralateral

CH4: Contraction type

This channel is self explanatory

CH5: Contraction speed

Again, self explanatory.

CH6: External load (our rotating selector knob)

This is as a % Rep Max (RM) rather than a ground reaction force or impulse.

Aight DJ let’s mix it up for our high hamstring tendinopathy patient!

Early protect; The arrival music

1. Minimal involvement protecting the tissue, remain locked in hip extension while loading anterior chain, Rate of Perceived Exertion (RPE) <5
2. Inner range hip extension
3. Bilateral stance
4. Isometric hamstring muscle action
5. Slow speed
6. Bodyweight

This could involves exercises such as the reverse Nordic, or sissy squat (see below) where the aim is to have the hamstring activate but not be the focal muscle group for the exercise:

Early expose: The dinner set

1. Slight hip flexion, while loading posterior chain RPE= 6
2. Inner-range hip extension
3. Bilateral stance
4. Isometric hamstring muscle action
5. Slow speed
6. 70% ramped isometric push or hold type contraction (4)

This could involve a list of exercises like an isometric mid thigh pull, isometric back extension, or isometric reverse hyperextension, see these below:

Mid-late stage: The after dinner set (things are heating up now!)

1. Moderate degree of hip flexion, posterior chain loaded RPE= 7
2. Mid-range
3. Split stance
4. Isotonic
5. Moderate speed
6. 50% 1RM

This could include exercises like a b stance Romanian Deadlift (RDL) in a rack, a split squat to a box, or a b stance hip bridge, see below:

Late stage: Time to hit the dancefloor!

1. Maximal hip flexion posterior chain loaded RPE= 10
2. Outer-range
3. Unilateral
4. Isotonic
5. Moderate speed
6. 50% 1RM

This could involve exercises like a single leg arabesque, a pistol squat, or a single leg reverse hyperextension. See below examples:

Late stage: Performance – the midnight set, get your hands in there air and jump jump jump.

1. Maximal hip flexion, posterior chain loaded RPE= 10
2. Outer-range
3. Unilateral/contralateral
4. Plyometric
5. Ballistic
6. 100% 1RM

Blend that together to get a hang power clean, box step up, a hamstring switch plyometric, or a single leg bound. Check these exercises out below:

Wrapping up

So that’s it, the lights are on and the parties over. Your patient has danced their way out of your treatment room and is telling everyone about your sick mix.

*NB: Remember we did give examples relating to a high hamstring tendinopathy, but you can use this exact same template to grade your adductor-related groin pain, Femoroacetabular Impingement Syndrome, or Greater Trochanteric Pain Syndrome rehab programming.

If you’d like to learn more about how the experts manage hip pain, watch Dr Joanne Kemp’s full Practical HERE.