Injuries to a muscle are extremely common in sports participation at all levels whether that is an elite level athlete or just your weekend warrior who likes playing tennis with some friends on a weekend. Injury to a muscle is common and can affect any muscle in the body, usually the bigger the muscle or the more force it has to absorb the higher the chance of injury occurs. For this article I will explain how a muscle injury occurs and then how we manage the condition with a specific focus in the videos on hamstring group and the rehabilitation process (purely because it is one of the more common sites for a muscle strain we do see) at Hobsons Bay Health Group.
What causes a muscle strain?
A muscle strain can have multiple causes but predominantly these injuries involve a rapid eccentric contraction (muscle is lengthening whilst contracting) that takes the tissue outside of its tolerance; we usually see this occur at the site of the musculotendon junction (where the muscle meets the tendon). As a consequence of this we see damage to the muscle fibres as well the neurovascular tissue that is connected. With being specific to the hamstrings we often see a mechanism of ‘overstretching’, this overstretching involves the muscle (and associated joints it acts on) being taken above and beyond the range of motion it can tolerate. Examples of this are kicking in ball sports, any sports that may involve the splits like tennis (reaching and sliding for the ball), dancing and even water skiing.
Managing Muscle Strains
For the successful management of muscle strains we sub-divide this into 3 areas to give the patient the best outcomes;
- Phase 1 – Acute Rehabilitation – The first phase happens immediately after the injury, this is generally the most active part on behalf of your Osteopath. It involves improving the patients function and tolerance to moving as well as decreasing their pain levels. This may be aided by the use of ice, compression with potential need for some immobilisation to decrease the load through the muscle to minimise any scar tissue formation, but this is dependent on the grade of severity. For a hamstring this may involve a heel lift in a shoe (will avoid knee extension – tensions the hamstring) or crutches to avoid using the leg to walk on (walking has high hamstring involvement).
Phase 1 exit criteria:
- No pain during normal day to day activities.
- Range of motion that is pain free within 75% of the opposing side.
- Resolution of inflammatory symptoms
- Be able to produce a pain-free isometric contraction at different ranges.
Phase 2 – Progressive loading – Once we are able to use the injured muscle through our daily activities such as walking and household chores we can begin to load the tissue. By building the tissues capacity it will be able to tolerate the stress a lot better, we do this by gradually changing the load, volume and speed of the movement as well as the complexity of it to make it more challenging. This is where the ‘art’ of coaching pairs up with our clinical reasoning, because it is a fine balance between pushing too much and potentially moving backwards and not pushing hard enough which yields in a lack of progress (neither are ideal). Eccentric biased training has the highest ranking in regards to the rehabilitation and this is because (as mentioned earlier) it is usually this contraction where we see the most injuries occur. It is also important that we view the rehabilitation process as a way we can make the ‘whole’ athlete stronger and more resilient because the body functions as a unit and not in isolation, so it would be silly to only focus on the injured site. We can do this by doing some more complex movements such as a squat, multi-directional lunge or step-ups.
Phase 2 exit criteria:
- Pain free range of motion (when compared to the other leg).
- Have greater than 85% symmetry of the opposing side (can test this with force plates/jumps/dynamometers).
- Commencement of low velocity sports tasks – such as light running, short kicking or short throwing.
Phase 3 – Return to training/performance – Once completing the exit criteria for the previous phase we will know that the individual has pain free range of motion and similar strength between both sides and has returned to the pre-injury state. During in this next phase we look to make the individual stronger than what they previously were, in this phase we look to improve the individual’s confidence in regards to the previously injured site. Biomechanical analysis can be performed by an experienced coach or health professional; with specific mention to the type of sport they are playing (i.e. if they are a field based, kicking sport athlete running as well as kicking assessment would be conducted to make sure they don’t have any other factors which may predispose them to re-injury). Specific muscle testing is a great way to objectively assess the individuals function and capacity and compare between sides. Some key areas that you could include would be; Rate of force development (how quick a muscle contracts), Muscle capacity/endurance as well as neuromuscular timing and coordination.
I.E – For a Hamstring strain we could use a hand held dynamometer to assess rate of force development as well as the strength produced between the 2 sides.
Phase 3 exit criteria:
- Return to baseline of strength (within 90% similarity between sides)
- Completing the desired activity/sport at match intensity
- The individual has 100% confidence in the previously injured side.
How can Hobsons Bay Health Group help?
At Hobsons Bay Health Group we specialise in assessing, diagnosing, treating and managing any injury that come through our door.
We do this via multiple methods:
- Traditional Osteopathy examinations to the lower back as well as hips as well as other regions of the body.
- Strength Testing to identify any strength discrepancies that may be causing your injury or pain.
- Movement screening to see how well you move through different functional tasks.
Our treatment process achieves pain relief in the shortest amount of time by using hands on Osteopathy techniques such as soft tissue massage, joint manipulation, articulation and stretching techniques, and may include Dry Needling and/or Taping techniques.
Your management plan will involve an individualised training plan to build your strength and capacity (muscle and tendon strength, stamina, specific flexibility) often to improve discrepancies from side to side that could be the true cause of your injury.
For any help in regards to any injuries you may be suffering from yourself or you have any questions relating to any other injuries feel free to get in touch via email at email@example.com or book an appointment with you allied health practitioner.
- Askling C Types of hamstring injuries in sports British Journal of Sports Medicine 2011.
- Järvinen, T. A., & Järvinen, T. L. (2005). Muscle injuries: Biology and treatment (Vol. 33). American Journal of Sports Medicine.
- LaStayo, P., Woolf, J., & Lewek, M. (2003). Eccentric Muscle Contractions: Their Contribution to Injury, Prevention, Rehabilitation, and Sport. Journal of Orthopedics and Sports Physical Therapy, 33, 557-571.