Management Of Hamstring Injuries By Physiotherapy - Part Two
The remodelling phase of the healing period occurs over the weeks up to the sixth
week after injury and at this point the patient should be tested by the physiotherapist and be able to perform a full strength resisted hamstring contraction without any problems. Isotonic work in prone with ankle weight is the initial approach with lighter weights and higher repetitions to start with, moving on to heavier weights with lower repetitions provided the injury does not complain. Being too adventurous in increasing the weights can lead to re-injury or to the development of a more chronic and troublesome problem.If a muscle shortens while it is contracting and doing work the contraction is said to be concentric and if the athlete can manage this well then they can move on to working the muscle eccentrically. Eccentric muscle activity exists when muscle contraction is proceeding during which time the muscle is extending in length rather that shortening. Since eccentric muscle work is maximally stressful for a muscle this type of rehabilitation should be closely supervised. The starting position is on the front with the lower leg flexed to ninety degrees with an ankle weight and then lowering the leg down to the floor with close control.
This process continues as long as the injured area is not painful until the affected leg can perform as strongly as the unaffected leg (within 10 percent or so) then the programme can be progressed to a more active and vigorous one. During the whole programme the hamstring is regularly stretched to promote healing in a lengthened position and return it to the same length as the unaffected side. The functional stage of hamstring healing is the time from roughly two weeks to six months from the time of the injury, depending on the severity of the initial damage. Patients should have no apparent pain, a normal gait pattern and the ability to walk quickly.
A speed walking programme can now be started and when they can manage thirty minutes of this they could be progressed on to small periods of jogging. If there is no adverse reaction and thirty minutes of jogging is achievable then the patient can start to run faster and insert short sprints into the regime. Sprints can become more energetic gradually with sudden stops, turns and re-accelerations providing a gradually closer approximation to real sporting manoeuvres as specific movements related to the relevant sport are added. As therapy proceeds then plyometric exercises can be added to stress the muscular system more profoundly and promote power and speed which will be required.
The idea of employing plyometric work is to promote the ability of a muscle to contract more forcefully by stretching it strongly in the initial phase of the exercise and using jumping and bounding type exercises to do this. Stronger muscle output can be facilitated in this manner and the muscle can be hardened to manage increased stresses. Skipping or jumping rope is a lower level plyometric manoeuvre and physiotherapists will then increase the dynamic nature of the exercises by introducing jumping and bounding work over objects.
The athlete can return to their particular sport at very variable times from about 3 weeks after the event up to 6 months if the injury is severe. A physio will check out the athlete in detail to make sure that they do not exhibit any loss of power, tissue length, strength, balance and coordination which may not be visible on superficial testing. Prior to competitive play it is recommended that the athlete warms up well and stretches comprehensively although little scientific evidence is available to back up this advice. An injury to a small part of the muscle or a superficial injury to the muscle may allow someone to return to their sport in the shorter time period.
In a study it was found that athletes who required more than one day to be able to walk normally without pain were more likely to need a longer time of rehabilitation over the three week mark. Typical medications recommended are non-steroidal anti-inflammatory drugs to reduce the inflammatory reaction and potentially speed healing.
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