Physical therapist Tracey Wagner and colleagues described a case report of a competitive triathlete suffering from right hamstring cramping. The patient had bilateral hamstring tightness and bilateral gluteus maximus weakness. Dynamic assessment of gait, lunge, and step-down movements was performed. The therapists noted that a lack of knee extension in midstance and terminal swing bilaterally was consistent with the patient’s hamstring tightness. In addition, excessive hip adduction and internal rotation with posterior trunk lean supported the finding of hip weakness.

The therapists theorized that impaired gluteus maximus neuromuscular control increased the load on the hamstrings during terminal stance phase, leading to the overuse and cramping. Their hypothesis was substantiated through a biomechanical analysis.

The patient completed a home exercise program over 8 months, attending physical therapy once a month. The program included 3 phases:

  1. Isolated muscle recruitment (Weeks 0-4): gluteus maximus exercises including sidelying clam, prone isometric gluteus maximus, and quadruped triplanar movement.
  2. Weight-bearing strengthening (Weeks 5-16): Monster walk, forward and backward walk with elastic band loop around thighs and step-downs
  3. Functional training (Weeks 17-24): jumps and leg swings

After the intervention, the patient successfully completed 3 half-triathalons without cramping. His gluteus maximus strength increased, as well as his hamstring flexibility and functional performance.

This case report supports a simple hip exercise program with Thera-Band® band loops to help reduce the demand on hamstrings that might lead to chronic cramps.

REFERENCE: Wagner T, et al. Strengthening and neuromuscular reeducation of the gluteus maximus in a triathlete with exercise-associated cramping of the hamstrings. J Orthop Sports Phys Ther. 2010 Feb;40(2):112-9.

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