Guest blog by Paul Head
Paul holds a BSc Sports Therapy degree from University of Central Lancashire (UCLAN) and is a pre reg physiotherapy student. He received first Class Honours Classification (78% average) and an award for Academic Excellence in the field of sports therapy / physiotherapy from DJO UK. Find out more about Paul here…
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Hamstring Strain Rehabilitation
Soft Tissue Mobilisations
Hunter (2004; 2007) soft tissue mobilisations around the injured lesion and transverse glides across the healing tissue during passive and active movements of the muscle to promote collagen alignment and promote pliability of scar tissue formation. Rushdon and Spencer (2011) found that hamstring muscle extensibility and ROM improved greater when a static end range transverse medial glide technique was applied to the biceps femoris muscle for a period of 30 seconds along with a physiological stretch. When compared to a physiological stretch alone. A group of expert clinicians gathered together (Orchard et al, 2008) about their clinical expertise in dealing with muscle strain injuries. They agreed upon ice being very beneficial and early mobilising of the soft tissue and active movements within pain be commenced even <24 hours post injury. Ice applied for 20 mins after every rehabilitation session is also recommended.
In recent studies that have compared different rehabilitation protocols after acute hamstring strain injuries which showed good results in both time to return to play and re injury rates. Askling et al (2013) performed a study that compared two different rehabilitation protocols for acute hamstring strains. They used 75 male and female football players that had clinical signs of an acute hamstring injury. They separated the subjects into two different protocols. These were a L protocol which included exercises to put load onto the hamstrings during maximal dynamic lengthening. The exercises involved movements of the hip and knee with eccentric muscle actions. The C protocol consisted of conventional concentric and stretching rehabilitation exercises. Both protocols started 5 days post the injury with regular follow ups and progressions in load and speed of the exercises. Their results showed that the L protocol had a significantly shorter (28 days) return to play when compared with the C protocol (51 days). Also there was only one re injury between both groups which happened to a subject from the C protocol.
Slider et al (2013) also compared two different but heavily supported rehab programmes for hamstring strains. They separated 25 subjects who had a hamstring injury within 10 days and involved in sports, into a progressive agility and trunk stabilization (PATS) group and progressive running and eccentric strengthening (PRES) groups. They found both rehab protocols to be efficient in return to sport times and both had low re injury rates a year post return to sport participation with 2 in PATS group and 2 in the PRES group.
Sherry and Best (2004) also compared two different rehabilitation protocols. They had 24 athletes separated into: static stretching, isolated progressive hamstring resistance exercise and icing (STST) and progressive agility and trunk stabilization exercises and icing (PATS) groups. Their interventions lasted for 2 months on return to sport, with 3 sessions a week. The STST group had a 54% re injury rate whereas the PATS group had no re injuries within 16 days of returning to sport. With the STST group also showing a significant increase in re injury rates a year post returning to sport with 70% compared to 7.7% in the PATS group.
The exercises that were used in the most beneficial rehabilitation protocols were:
The Extender’. Stabilise the thigh of the injured leg with the hip ﬂexed approximately 90° and then perform slow knee extensions to a point just before pain is felt. Twice every day, three sets with 12
‘The Diver’. The exercise should be performed as a
simulated dive, that is, as a hip ﬂexion (from an upright trunk position)
of the injured, standing leg and simultaneous stretching of the arms
forward and attempting maximal hip extension of the lifted leg while
keeping the pelvis horizontal. Once every other day, three sets with six repetitions.