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Is rest, ice, and gradual stretching the best way to treat that acute Hamstring Strain?

Often times following an acute muscle strain we are instructed to rest, ice, gradually return to gentle stretching, and then gradually begin to strengthen this muscle again. Often this strengthening program consists of isolated movements to specifically strengthen this muscle. In a research article entitled “A Comparison of Two Rehabilitation Programs in theTreatment of Acute Hamstring Strains” in JOSPT (March 2004) the authors sought to put this traditional approach to the test. 24 participants were designed to one of two groups; one group completed a rehab protocol of static stretching, isolated progressive hamstring resistance exercise, and icing. The second group completed a rehabilitation program of progressive agility and trunk stabilization exercises and icing. The authors looked at the average time to return to full sports, the re-injury rates at two weeks, and the recurrence at 1 year. The group completing the agility and core strengthening program returned to sports approximately two weeks earlier; however the most important finding is related to re-injury rates. 6 of the 11 athletes in the group that completed the traditional program had a recurrence of injury in the 1st two weeks versus 0 of 13 in the agility/core strengthening group. At 1-year 7 of 10 athletes completing the traditional program had suffered a re-injury versus 1 of 13 in the agility/core strengthening group. These findings strongly support the inclusion of agility activities and core strengthening activities into an athlete’s rehabilitation program following an acute Hamstring Strain.

I feel that these findings point toward the crucial role that neuromuscular control plays into improving a muscles overall function following an injury. We need to retrain our bodies to utilize proprioceptive input through these injured tissues. If the body does not utilize this input appropriately we are setting ourselves up for a re-injury to this tissue or some other segment in the kinetic chain. For example, if you injure your Hamstring and never re-establish this neuromuscular connection by placing the tissues in situations where it is required to work appropriately, you will lead to overstressing the other segments that assist in helping the hamstrings with certain functions. How often do you see an athlete coming back from one injury too soon, only to injure another part of their body upon return to the playing field?

Also the agility group may have experienced less s scar tissue formation due to utilizing the musculature in multiple planes and placing more functional stresses through the healing tissue. While the stretching and isolated strengthening group trained mainly in the saggital plane, the second group was placing gentle stresses through their hamstrings from a variety of different directions and angles. This is comparable to walking in a straight line only for 4-6 weeks then asking your body to tolerate the forces placed on it with bounding to the side, side lunging, twisting on one foot, or planting and cutting. You can see why the injury re-occurrence is so high, simply put we don’t move in isolated movements.

This article also brings to light the crucial role of re-establishing and improving core stability following an injury. Often times following an injury to an extremity you can safely train core stability even before specific activities can be completed for that segment. For example, while recovering from an acute knee sprain, you can safely work on core stability exercises to maintain your current strength levels or work towards improving your overall core strength.

Based on the findings of this study, I think we may need to re-examine our management of acute hamstring strains. Clinically I’ve utilized these principles in treating acute calf and hamstring strains and see tremendous improvements in both the short term and long term results for these patients.

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