Posts tagged muscle strain
How Painful Should My Physical Therapy Feel After A Hamstring Strain?

One of the most common questions we receive in our Boulder Physical Therapy practice involves how much pain should be felt with exercise. This is a complicated answer dependent on many factors including but not limited to the nature of the injury. In general, the field of sports medicine is moving away from a purely R.I.C.E. (rest, ice, compression, elevation) approach to injury recovery and has found a progressive, optimal loading approach may be better suited to less severe muscle injury. In fact, within acute muscle strains, exercise has been shown to accelerate a patient’s recovery compared to rest. General guidelines exist on the acceptance of a mild to moderate pain (1-4/10) which stops at the conclusion of exercise in these muscle strains, but a new research study examined the differences between this approach and a pain avoidance approach.

Hickey and colleagues in the Journal of Orthopedic and Sports Physical Therapy randomized 43 men with acute hamstring strains to one of two Physical Therapy groups (2019). Both groups underwent the same bi-weekly progressive rehabilitation program (bridging, hip extension, hamstring sliders, and nordic hamstring curls) but one group was instructed to remain pain free (0/10) while the other was allowed to complete these exercises with mild pain (<4/10). Authors completed a subjective and clinical examination at the start and conclusion of the study period (2 months) and also followed each athlete up to 6 months after their return to play. Authors reported no difference in time to return to play between the two groups, but the athletes allowed to exercise with mild pain demonstrated improved strength and hamstring muscle healing (measured by ultrasound) compared to the pain free group. Authors reported “the conventional practice of pain avoidance during hamstring strain rehabilitation may not be necessary” and instead advocated for an approach consistent with progressive, optimal loading.

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Identifying Soccer Players At Risk For Future Groin Injuries

Groin strains are the second most common muscle strain, behind the hamstring, among soccer players.  The dynamic movements required by both offensive and defensive players place high demands on the long muscles of the hip and knee.  Our previous blogs have shown the effectiveness of Physical Therapy interventions to reduce the risk of future hamstring strains, but before we reduce the risk for groin injury we must first understand the risk factors for these injuries.  

A recent journal article aimed to identify pre season risk factors which helped identify professional soccer players who sustained a groin injury during their upcoming season (Langhout et al. JOSPT. 2018).  Authors completed medical histories and physical exams (flexibilty, strength) on 190 players from 9 professional teams.  They reported 11% of athletes sustained a groin injury at some point during their season.  Consistent with previous research athletes who reported a prior groin injury were 3 times more likely to sustain a future groin injury.  Similar to what we find in hamstring injury, hip flexibility did not identify players at risk for future groin injury.  

This article highlights the importance of rehabilitating a previous muscle injury with Physical Therapy.  Athletes who complete a standardized Physical Therapy program are able to both accelerate the healing of their injury, as well as, reduce their risk for future injury.

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Early Physical Therapy for Muscle Injuries Accelerates Recovery and Return to Sport

Muscle injuries (strains) are a common injury among both inactive and active people.  These injuries can become recurrent and lead to significant losses in function and sport participation.  Research has previously shown injections such as PRP (platelet rich plasma) are costly and ineffective to treat these muscular injuries.  Conversely, these injuries require Physical Therapy and early, progressive loading of the injured tissue to both promote healing and re establish its' pre injury tensile strength.  The main question remaining is how soon Physical Therapy should be started after an acute injury.

A recent study in the New England Journal of Medicine conducted a randomized controlled trial of 50 amateur athletes who sustained either a thigh or calf muscle strain (Bayer et al. 2017).  Athletes completed the same rehabilitation program but were randomized to either early Physical Therapy (2 days) or delayed Physical Therapy (9 days after injury).  The rehabilitation program consisted of 1 week of frequent stretching followed by 2-4 weeks of daily, progressive loading of the injured tissue.  The final phases of the Physical Therapy rehabilitation program consisted of dynamic loading with increased resistance 3 days a week and finally completed the return to sport phase in weeks 9-12 consisting of functional exercises and heavy strength training 3 days per week.

As expected, the authors showed a 25% faster return to sport in the early vs. delayed Physical Therapy group (62.5 vs. 83 days).  Importantly, the authors showed no increase in risk of injury among the athletes who completed the early vs. late rehabilitation programs.  Authors reported this study supports the importance of early loading compared to immobilization of injured tissue.  Previous research has shown immobilization impairs connective tissue cells and their ability to heal and return to pre injury composition.  Authors stated the "importance of regular and controlled mechanical loading early after trauma" to facilitate an optimal return to activity.

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