Rehabilitation Procedures

Rehabilitation Procedures and Return to Play policies- Hamstring Tear
A hamstring tear, which is still commonly known as a "pulled" or "strained hamstring," Involves the rupture of a large or small number of muscular fibres as a result of having been stretched beyond their capacity and can range in severity from a small tear in the muscle to a complete rupture, tearing your hamstring, and can occur from a number of physical activities, for example: football, gymnastics and MMA and will put you out of vigorous movement for an amount of time depending on its severity and proper rehabilitation procedures must be applied. Rehabilitation procedures used for a Hamstring tear is best done through stages; those stages being progressive mobilisation, graduated exercise (stretching, conditioning, total body fitness), Training and the use of hot and cold. Once these procedures have been used effectively on the patient and they are starting to look towards returning to play there are various stages that must be cleared to ensure the full recovery of the patient and to ensure the injury does not re occur. The return to play procedures include: indicators of readiness for return to play (pain free, degree of mobility), monitoring progress (pre-test and post test), psychological readiness, specific warm up, return to play policies and procedures and ethical considerations (pressure to participate, use of pain killers). Progressive Mobilisation, which is restoring the range of movement to the injured area gradually through active/passive movement by the athlete and remedial practitioner. Movement should be slow, progressive and remain relatively pain free. For this specific type of injury Hydrotherapy is ideal, it includes small amounts of activities like walking, swimming or running in a pool. Hydrotherapy is a crucial and key first step of rehabilitation because of the low weight bearing properties and low impact characteristics of exercising in water will help to gradually recover pain free, and the resistance will help to recover some strength .After this you will eventually move on to walking on solid ground and various other activities that will return strength and elasticity to the hamstring. When the patient has been cleared to move on from hydrotherapy and ready to further increase their recovery, it is time to move on to Graduated exercise, starting with stretching, stretching is the next crucial step to recovering the injury and is so effective because it returns blood flow and elasticity to the hamstring and surrounding muscles. When stretching, there are many different types and techniques. Proprioceptive neuromuscular facilitation stretching or PNF stretching would be ideal for this sort of injury. Using PNF stretching to "hold and relax" the muscle and then "contract and relax" the muscle, this is where we see the injured patient with an injured hamstring would use a lying hamstring stretch, this is where the patient lies on the floor or a mat and your trainer would push your leg upwards toward your head to a point we a slight uncomfort is felt. After holding that for 20-30 seconds the patient will rest for a moment, then the trainer will proceed to stretch the hamstring again but this time the patient will push force against the stretch, using this we can progressively increase the blood flow to the hamstring which will increase its flexibility, range of motion and will return some strength to the injury. This technique for stretching is so ideal because it is fastest and most effective way known to increase static-passive flexibility.
Conditioning is the next key step of rehabilitation this is pain free exercises, this is done to restore and increase the muscular strength. Weight bearing exercises is the most weight recommended during conditioning because it is still relatively early in the rehabilitation procedure so the hamstring is to fragile. Effective exercises include: body weight squats (this is because the weight is centered evenly throughout the body making sure there is no further risk of injury), balancing exercises, changes of direction and swimming. Lunges are not recommended unless the injury is only minor. The final stage of graduated exercise is the all important
Total body fitness is regaining the level of physical and mental fitness reached by an athlete before the injury occurred. Improving the fitness allows an athlete to become adequate to return the game they injured themselves in. providing strength and fitness to the body, it allows for better achievements to be made and minimises injury to happen again. For rehabilitation towards body fitness these adaptions may help with hypertrophy of the muscles, strengthening of the tendons and ligaments, increase muscle elasticity of fibers, increased joint mobility and to gain full confidence in knowing that the injury area can handle match stress. When the athlete is moving towards almost completely recovered we can move on to training, keeping in mind that whilst still in the rehabilitation process, all training should be limited. The athlete should return to play as long as the injury is completely pain free and no pain occurs during any form of exercise or activity during full range of mobility within the injured area. Fitness and skills should be advanced before returning to any sport/activity. Training for a return from an injured hamstring includes any skills tests like that of what you would experience in a game just less intense and any other things that are required for the specificity of the game. The use of training when nearing the end of the rehabilitation process must be used to ensure your entire body is fit to return to exercise.
Also while in Rehabilitation the use of hot and cold therapy can be the pivotal step into recovering and returning to play. Heat therapy is ideal for increasing elasticity or flexibility of connective/muscle tissue and to stimulate blood flow of sore, stiff muscles or joints in this case the hamstring. Cold therapy is the best immediate treatment for injuries because it constricts the blood vessels and limits internal bleeding at the injury site, therefore reduces swelling and pain. Cold therapy is also helpful in treating some overuse injuries or chronic pain in athletes. An athlete who has chronic hamstring pain that increases after running during progressive overload may want to ice the injured area after each run to reduce or prevent inflammation.
By this stage the athlete should be in the vicinity of completely healed and heading towards returning to their sport or physical activity, while this may be, the athletes or rehabilitation administrator or coach must prepare the athlete by covering the return to play stages, this is such an essential stage in the patients recovery because it is ensuring you are ready in all the components of health. Knowing when, as the patient yourself or the coach/carer, returning to play must be allowed is indicated by readiness to play, the first indicators being pain free and full range of motion, if these two areas are not what they should be, returning to play should not be allowed, to be pain free and have full range of motion you should be able to compare your injured hamstring to your uninjured, if both have the same freedom of movement, and the movements are essentially pain free then your fit to play. If the injured body part is lacking motion, the athlete may not be able to compete without inflicting further pain and injury. Being pain free can be determined on two points, firstly you may feel pain free in your training and movements which would indicate your ready to return to play but also it is unlikely that your training would be at the same intensity as a match, for example in rugby league you would not tackle or take a hit at the same power from a mate on your team as you would the opposition.
Returning an athlete to play may depend of said athlete meeting a certain criteria or fitness test to determine readiness. Having both pre-test and post-test results and monitoring the progress for fitness allows the trainer, coach or medical practitioner to make an educated decision on the player's present fitness without risking further injury. Types of pre and post testing are: visual observations of the athlete, observation of video footage of the athlete. If the athlete is showing all the physical signs of being able to return to play there are still considerations that need to be made, like the athletes physiological readiness. After an injury, an athlete may feel anxious about returning to play after such, what would feel like, a long period. In this case , a coach may play them in a lower division until they are back to their best physical game and physiological confidence. To ensure an athlete is physiologically ready means such as discussion and observation of behavior of player at training can give you a perspective of how they are feeling, also using tape or wrapping the injured site, in the case the hamstring, the player can be more confident in that it will not be re-injured and it will also give support and proprioceptive awareness to the athlete. To further improve this a set of specific warm ups can heighten the confidence of the player as well as its main purpose of ensuring a thorough warm up. Designing a specific workout that applies and focuses on the injures area will be needed to ensure the hamstring is properly warmed up to ensure adequate flexibility, blood flow and readiness to perform. An example of some warm ups are: PNF stretching, lunges, bodyweight or lightly weighted squats and some skill and co ordination activities. When returning to sport there are often policies that must be followed that outline procedures or rules that an athlete must follow when returning from a serious injury, the essence of these policies are based on maintaining the wellbeing of the athlete. When nearing the end to your rehabilitation, eagerness to get back on the field and help your team out will be on the top of your mind, especially if they are struggling. Athletes can fell pressure from many different angles, such as internal pressures like letting the team down, not wanting to lose/wanting to win, external pressures include, financial pressures and pressures from sponsors or the media. If they do give in to these pressures they are risking re-injuring themselves before they are fully healed, which may mean going back to rehabilitation for a longer period of time and thus letting down the team and everyone else further. Because of these pressures pain killers become a risk that some athletes decide whether to take or not to dull the pain while they play. This is not a full proof way of recovering and it is possible to re injure yourself if you return to play while on painkillers before you’re are fully healed. When gaining a serious injury like a torn hamstring, rehabilitation is an essential process that an athlete must go through to ensure a full recovery and they are able to return to sport. There are specific stages that you must follow for it to be effective. When your rehabilitation has been effective and finished and deciding to return to play there are stages that the athlete must cover to make sure both he/she and the coaches and officials are ready for the athlete to return to physical activity

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