A remodelling stage can be said to exist up towards the sixth week after the muscle strain and later in this period the physiotherapist will assess the patient’s ability to make a full power hamstring contraction against resistance without pain or hesitation. If this is achieved then isotonic work with ankle weights can start such as in prone with light weight and higher repetitions, gradually adding weight with time. To prevent the possibility of injuring the muscle again or of developing a more long term problem the progression should be taken slowly in terms of the force put through the muscle tissue.
Once the concentric exercises (movements where the muscle is shortening as it is doing work) have progressed well then patients can start to do an eccentric strengthening programme. Eccentric muscle work occurs while the muscle is lengthening during the activity and while force is being applied to it and by it. Eccentric muscle contraction puts the maximum strain on muscle fibres so slow progress is to be expected as well as to be desirable. With the patient on their front and a weight round the ankle the knee can be bent to ninety degrees (foot pointing up towards the ceiling) and then the leg allowed to straighten in a controlled manner.
Provided there are no increases in pain the rehabilitation continues until the affected leg can reach a performance level close to that of the normal leg ,then the patient can be moved on to a more energetic physiotherapy programme. During the entire rehabilitation period it is important to continue to stretch the injured area to ensure it maintains its length and heals in a lengthened soft tissue position. From around two weeks up to 6 months, varying with the injury severity, is the functional rehabilitation phase at which point the patient will be able to walk normally without pain and be able to speed walk.
Fast walking can be encouraged as a treatment goal and when the patient can manage half an hour without problems short bursts of jogging can be added. Without pain problems developing once half an hour of jogging is achievable then faster running and short lengths of sprinting can be inserted into the treatment plan. Gradual increase in the force and length of the sprinting is allowed, adding quick halts, twists and sprinting again to reflect more accurately the real world manoeuvres which can gradually become more specific to the sport concerned. The physio may now add plyometric exercises to increase the muscle and tendon stresses and deliver the speed and power which is necessary.
Plyometric work is characterised by stretching the muscle in the early part of the movement then contracting it concentrically, which often looks like jumping and bounding. Stretching a muscle facilitates its contraction and so allows a stronger effect to be produced as well as stressing the muscle more so it accommodates to increased force. Initially a less stressful exercise can be performed such as skipping (jumping rope) and progression under physio supervision to jumping sideways over benches, up onto higher levels and so on.
Returning to sporting competition can occur any time from around three weeks after injury up to six months or more for a very severe injury. It is important to test an athlete in detail to ensure he or she is not suffering from any deficits of strength, power, length, coordination or balance which may be subtle and not easily evoked. Warm up and stretching prior to playing competitively is emphasised although there is no clear scientific evidence to back up these recommendations. If patients have a more superficial muscle injury or have only injured a small portion of their hamstring muscle then they may be able to return to normal sport towards the earlier times.
One study showed that any athlete who needed more than a day to be able to walk without pain had an increased likelihood of needing more than three weeks of rehabilitation back to normal activity. Medication used to treat these injuries is typically non-steroidal anti-inflammatories to try and reduce the levels of inflammation and facilitate healing.
Topic: ankle weights, functional rehabilitation, injury severity, maximum strain, muscle contraction, muscle strain, muscle work, rehabilitation phase, slow progress, treatment goal