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The 6 Stages to Effective Rehabilitation

Following on from our last post ‘Chiropractic and Sport Injuries‘ we thought we would take a more in depth look at one of the more common presentations to us here at Synergy Healthcare, especially at this time of year… hamstring strains!

Man stretching lower legsFrom a slight strain or a ‘twinge’ to a more serious grade ‘tear’ it is unfortunately an injury that often reoccurs especially if a thorough rehabilitation program is not completed.

A systematic review performed in the UK and published in the 2009 Strength and Conditioning Journal 31(1) concluded; there are 6 key steps or stages that need to be addressed in order to properly rehabilitate and reduce the chance of reoccurrence.

  • Initial Treatment: The general RICER protocol should be followed during the first 48 hours of any acute soft tissue injury. Rest, Ice, Compression, Elevation and Referral (to a qualified professional)
  • Restoring Range of Motion: A stretching protocol involving a minimum of 4 stretching session each day using a combination of 3-4 stretches held for 30-45 seconds each. It was suggested that the early increase in range of motion is essential in reducing scar tissue formation.
  • Initial Strengthening: Along with stage 2, Resistance training (very light to no resistance) is introduced incorporating use of available range of motion. Exercises such as deadlifts, Romanian deadlifts and light leg curls will target the hamstring group.
  • Slow Eccentric Strengthening: Eccentric movement is defined as a muscle lengthening under a load, for example during a squat going from a standing position to squat position is eccentrically utilising muscles and from squat to stand is a concentric action. It has been shown that eccentric action is essential for muscular hypertrophy (cell size) and hyperplasia (cell number). So this stage requires introduction of slow lowering exercises such as Deadlifts, Nordic Hamstring Lowers, back extensions and lunges, with most focus on the lengthening or eccentric phase of the exercises.
  • High Speed Eccentric: As above but introducing more plyometric (jumping) based exercises and sports specific drills at greater speeds, for example; split jumps, depth jumps from a bench and other bounding drills.
  • Sports Specific: The last phase of a full rehabilitation program involves taking the athlete from straight line activities to dynamic change of direction tasks with different surfaces and body positions e.g. single leg bounding, acceleration drills, zig-zag running and hopping activities.

It is essential each phase is carefully monitored to avoid aggravation of the condition. If you have been struggling with a hamstring injury and finding it a frustrating recovery come and have a chat with us at Synergy Healthcare or give us a call on 02 9522 2125 to see how we can assist you with your troublesome hamstring!


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