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PULLED HAMSTRING, PART 2 In Part 1 of this article, we began our discussion of the hamstrings by taking a look at the anatomy, how and why these muscles are frequently injured, and how to assess precisely where the various hamstring injuries occur in the posterior thigh. Now, in Part 2, we'll cover the specific friction therapy treatment techniques and rehabilitation exercises. TREATMENT CHOICES SeLF-TReaTmenT Whenever possible, it is important to avoid activities that create pain. The client should not stretch, except as described in the exercise here, or until he or she feels no pain for two weeks. Even then, stretching must be done gently at first. The use of ice for 15 minutes at a time throughout the day may also be helpful. Flexing and extending the knee of the injured leg 10–15 times right after icing helps to prevent the formation of new, unwanted scar tissue. The entire healing process should take between 1–6 weeks, depending on the severity of the injury. If self-treatment does not help within two weeks, professional treatment should be sought. FRICTIOn TheRaPy These treatments are very effective for reducing adhesive scar tissue and inhibiting re-formation of poorly formed scar tissue. I will describe friction massage for the three most injured areas: the muscle belly, the common tendon at or near the ischial tuberosity, and the distal portion of the hamstrings behind the knee. Friction therapy to the muscle belly. When treating the muscle belly, there is often a broad area of adhesive scar tissue that requires treatment. With the client lying prone, the practitioner stands facing the injured thigh. Depending on the size of the area that needs to be worked, the practitioner may use just a few fingers to friction the injured portion of the muscle or all of the fingers of both hands. Place the fingertips on the medial side of the painful area and anchor the hand by resting the thumb of the working hand(s) on the lateral aspect of the thigh (Image 1). Press downward into the thigh and pull the fingertips toward you, moving horizontally across the hamstring muscle. Do not move over the skin as you would when using oil; just move as far as you can, taking the skin with you as you friction the muscle fibers. Always begin gently and increase your pressure as the tissue becomes less sensitive. Pressure may be increased over the course of 5–10 minutes or over several weeks Semimembranosis Semitendinosis Biceps Femoris Sobotta: Atlas der Anatomie des Menschen @Elsevier GmbH, Urban & Fischer Verlag Munich. tune in to your practice at ABMPtv 95