Hamstring muscle strain
Scenario: Mrs N is a 31 year old female that came to see me at the practice. She injured her right Hamstring muscle when participating in a 10km trail run. She didn’t warm up properly and after the race she felt a pain posterior to her thigh. Her pain is present at rest and she struggles to walk and climb stairs. She present with a large hematoma posterior to the knee. She came to me 3 days post-injury asking advice on what she can do.
A hamstring strain is a tear involving one or more of the hamstring muscles. It can range from a mild tear to a complete tear depending on how much of the tissue is involved.
Mrs N we have 3 phases of healing when we look at your injured muscle
Phase 1: The inflammatory phase: This is what happens immediately after the injury to about 48 hours after the injury. It is an inflammatory response that causes you pain, swelling, redness and warmth around the injured area. This is your body’s way of protecting itself. The swelling causes stabilization in the area, just like when you can’t move your neck after a car accident.
Phase 2: The repair phase: This is when the inflammation has gone down and your body begins to repair the injured area. Your body will begin to lay down collagen to replace the damaged tissue structure. Oxygen and vitamin C are necessary to aide in the collagen formation. This process last from 72 hours to six weeks after the injury. The structure of the collagen is unorganized at this point. So in this phase we are slowly helping the collagen Type I fibers to be deposited and arranged along the lines of tensile strength required in your hamstring.
Phase 3: The remodelling phase: once the collagen has been regenerated in the second phase of healing, it is not well aligned that it will be capable of withstanding any stresses placed on it. The collagen is similar to sticky glue at first. It needs to be moulded in certain alignments in order to be able to perform the functional capabilities of the tissue it is replacing. This phase is an improvement in the quality, orientation and tensile strength of the collagen. This phase last from 3 weeks to 12 months. Collagen will only have its full tensile strength at 6-12 months. The main aims of rehab here is to focus on applying the necessary loading in all types of muscle work to help improve the muscle condition, scar and tensile strength.
Achilles heel
Scenario: Mr J came to you saying that he needs your opinion whether if he should still run the trail run in 2 weeks’ time after experiencing some pain and weakness in his calf muscle while running and training very hard for the race. This can be concerning to you as you would really love for him to be able to run but preferably pain-free and without hesitation.
The Achilles heel is a tendon, an extension of the calf muscle but different from a muscle when it comes to healing of an injured tendon. A tendon is the attachment tissue between a muscle and a bone. It's a very important structure in absorbing load and holding potential energy to reproduce an explosive power. It's made from very strong Type I collagen fibers, but unfortunately the tendon is not as well supplied by blood as a muscle and therefore when it comes to injury and healing, it can be a bit more difficult to manage.
Tendons follow a continuum of healing as it can move between 3 stages depending on how we load it, namely: reactive tendinopathy, tendon disrepair and degenerative tendinopathy.
Let's look at the different stages of tendon pathology:
Reactive tendinopathy: “For every action there is an equal reaction” This might sound familiar when going back to Newton’s law. This occurs due to overuse/ overloading the tendon or direct impact on the tendon. It’s an active process (a reaction) and is a short term reaction. Due to an increase in protein production, the tendon becomes thicker and increases in stiffness. The affected tendon has the potential to revert back to the ‘normal tendon’.
Tendon disrepair: This is the tendons attempt at healing. This stage is entered when the aggravating load was not lowered and allowed to regain normality. There is an increased number of cellular and collagen productions which causes a disorganisation of the cellular matrix. Some of these changes are irreversible at this stage but can still be shifted back with appropriate rehabilitation. The tensile strength of your tendon in this phase is decreasing even more and you might start to experience more painful symptoms.
Degenerative Tendinopathy: This is the serious phase of the continuum. At this stage there is further cellular production and disorganisation of the matrix, which can lead to cellular death. You would want to avoid this stage as there is little capacity to reverse or rebuild the cells again. Getting out of this phase is very difficult. This is often seen in older individuals or in younger athletes who have continued to overload their tendon.
Early intervention and the correct rehabilitation to load and off load are key to preventing a progression of the stages of tendinopathy.
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