This guest post was written by Dr. Allan Tissenbaum.
He is an Orthopaedic Surgeon based in Pittsburgh, PA, specializing in both Surgery and Sports Medicine.
Outside of work, he is a top ranked Masters Sprinter winning several National titles in the M50 category and prior years. He has run 11.07 in the M45 100m and 11.42 in M50.
This is Part 2. Read Part 1, Hamstrung by the Hamstring – Treatment and Prevention
Initial Injury Management: Day 1-10
This is an area that is loaded with old wives tales and misinformation. The human body reacts to any injury in the same manner. An injury causes some bleeding which leads to a physiologic cascade of events. An early player in this sequence involves inflammatory cells moving into the injured area. These cells release many chemicals that are needed to get the reparation and healing process started. It is unfortunately common practice for the acutely injured to be started on a regiment of NSAIDS immediately after the injury. NSAID is an acronym for non-steroidal anti-inflammatory drug. They go by the common names, Motrin, Aleve, Naprosyn and a host of others. Taking these drugs acutely is counter intuitive, they are actually going to retard the healing process, exactly what you do not want to be doing as inflammation is the first phase of healing.
RICE: Rest, Ice, Compression and Elevation are still the main stays of the acute treatment. Rest should not last too long. Most of the rest should be in the form of further injury avoidance rather than complete rest.
Above: Hamstring injury, Day 4 post-injury
The key during this phase is to encourage healing while discouraging atrophy and scar formation. One thing that is often neglected in healing is muscle fiber organization. When a muscle is torn the fibers are disrupted and tend to reattach in a haphazard manner or through scar formation. Doing some exercise, stretching and encouraging these muscles to fire will help the muscle to heal in the correct orientation.
These days overlap with the above due to the varying nature of the injury. One should begin some type of active recovery, stretching and continued icing. Activity may be introduced depending on the severity of the injury. Most athletes find it very hard to be “shut down”. I prescribe some type of exercise to aid the athletes both physically and mentally. An UBE upper body ergometer is often an exercise that can be accomplished at this time. My own personal favorite is stair running, this can be done very early in the recovery period and it does not put undo strain on the hamstrings. This is also an exercise that can stress both your aerobic and anaerobic systems and you can feel as if you had a work out. These can initially be done very slowly and eventually one can run up the stairs often times weeks before one can sprint or run on a flat surface.
A therapist or trainer who can help with the stretching and strengthening often supervises this phase. All of these activities should be done essentially pain free, and one does not move onto the next phase until one can do all of the above pain free.
Day 20 onwards – to be continued.