An Overview of Injury Rehabilitation Techniques
For any athlete an injury is a huge set back within their sporting career and it is imperative they recover as immediately as possible if they aim to stay relevant within a competitive environment. The aim of rehabilitation is to speed up this process and athletes should embrace a variety of methods to rehabilitate themselves. These methods include; medications, training programs involving strength and flexibility as well as other treatments that physiotherapy can offer such as ultrasound and short wave diathermy in order to return to optimal athletic potential.
The focus with our female sprinter is her hamstring injury; hamstring injuries are a particularly common musculoskeletal disorder and are often linked to soft tissue length, postural alignment, motor control and strength (Mason et al 2012).
“This injury usually results from a violent forceful flexion of the hip, with the knee in extension”. (Bernie DePalma cited by William E. Prentice 1994)
The severity of the strain or injury will determine the level of treatment an athlete will need to receive, for instance a minor injury where pain only occurs as a result of a vigorous sprint would require the athlete to engage in pain free stretching exercises, the use of hot packs and “hamstring muscle progressive resistive strengthening exercises” from day 1 (Bernie DePalma cited by William E. Prentice 1994). On the other hand with our sprinter, who has suffered a grade 2 hamstring strain, may have experienced a pop during exercise and find themselves unable to flex the hip and knee. In addition the athlete will experience swelling around the injury, a moderate pain caused by palpation and a limit to their range of motion.
Initial methods deliberating with injury rehabilitation contain contrast bathing: stretching, interferential, concentric and eccentric exercise, hot packs/infra-red, physical therapy, diapulse, ultrasound, and proprioceptive training serve as useful components of a rehabilitation programme.
For example, contrast bathing: is an applicable method to reducing swelling and can be applied 24-48hours post injury. It involves a heat pack being applied to the injury for as long as a minute to activate vasodilation for circulation, followed by an ice pack to activate vasoconstriction to promote drainage – the process is repeated 5 times. The benefit of this method is that it is cheap and the injured athlete can apply this method to themselves at home.
Ultrasound: is a useful piece of equipment to target soft tissue damage, regardless if the injury is acute or chronic. Ultrasound offers pain relief by inciting re-absorption of extravasation at a cellular level thereby reducing the heat associated with acute inflammation.
Hot packs and infra-red: is an alternative method which inspires pain relief, lessens muscle spasms and escalates superficial circulation by raising the temperature in the superficial structures but not deep tissue.
Diapulse: on the other hand emits pulsed electro-magnetic waves, meaning the time it would take for the tissue to initially heal would be significantly shortened. Diapulse works because the electro-magnetic waves reduce a thermal effect, common during inflammation straight after the injury has occurred (Reily 1981).
Cryotherapy (ice): applied to the affected area allows for tissue occurring, much like contrast bathing it ensures several physiological responses such as vasoconstriction, therefore lessening inflammation and promoting pain relief(Hodge et al cited by Torg et al 1987).
However rehabilitation cannot rely on these methods alone, also relying on the need for a suitable training programme to accompany these treatments. Rehabilitation can be broken by 3 stages: acute, recovery and functional. The acute stage focuses on the protection of the injury and development of flexibility and strength; recovery instigates the prep for physical activity, with long term goals for the chosen activity, whereas the functional stage is highly specific and aims to get the athlete back to their previous training routine (Kibler et al cited by Walter R. Frontera 2003).
Therefore for a grade 2 hamstring strain, during the acute phase (days1-3) the athlete should combat the strain with ice: compression, electrical muscle stimulation modalities, pain-free hamstring stretches and range of motion as well as isometric exercises. Days 3-6 the athlete should introduce hot packs: resistive strengthening exercises, hamstring curls, eccentric hamstring lowering exercises and engage in activities such as isokinetics, swimming and biking at a low intensity. From day 6 onwards moving into the recovery stage the athlete can begin with sport specific activities – being a sprinter – such as jogging and leg exercises including leg press and squats to increase the muscle’s strength (this process can last for several weeks) (Bernie DePalma cited by William E. Prentice 1994).
Rehabilitation in the form of flexibility training, runners may wish to use stretches which emphasise the iliotibial band in flexion; the iliotibial band in extension, hip flexor and quadriceps, hamstrings, and posterior calf. Whereas for strength exercises an athlete may want to try hip extensor and hamstring eccentrics with elastic band; hip abductor stabilization, hip flexor elastic band, mini squats and toe raisers (Brian R. Hoke cited by Eric Shamus et al 2001).
Therefore a prehabilitation plan for flexibility would include lying hamstring stretch; standing quadriceps stretch, leg twists for iliotibial band, and walk calf stretch or trunk sit and reach each for 3 sets and 30 repetitions. Furthermore for strength; activities such as squats, lunges with dumbbells and weighted heel rise, all at a low resistance for 3 sets and 20 repetitions would benefit the athlete in decreasing injury time and return to training (Kibler et al cited by Walter R. Frontera 2003).
(Mason et al 2012) insinuated that stretching can aid in decreasing injury time and allow for a return to full activity for elite athletes. In addition if the intensity of the stretching is increased from stretching once to four times on a daily basis hamstring rehabilitation is more effective. In spite of this (Pulse Clinical) concluded that there is, in fact, little evidence to support the claim that the rate of recovery can be enhanced with greater hamstring stretching exercises, based on 2 out of 3 trials.
In addition to training programmes and physiotherapy, the role of drugs and medications throughout injury rehabilitation cannot be underrated. Medications are used to regulate both pain and the inflammatory process. Acetaminophen and aspirin combined with opiate drugs can be treated for moderate to severe pain (Hodge et al cited in Torg et al 1987). For pain prevention, analgesics (e.g. acetaminophen) are a useful treatment, offering comfort by cutting off pain stimuli in the central nervous system. It is vital an athlete receives some method of pain relief (often with the aid of ice and elevation of the injury), as pain hints to reflex muscle splinting and therefore more pain (Hubbell et al cited in Braddom et al 1994). Nonsteroidal anti-inflammatory drugs are also common as anti-inflammatory agents and are prescribed to combat mild to moderately severe pain (Hodge et al cited in Torg et al 1987). Moreover NSAIDs have proven to be more effective than acetaminophen and aspirin in anti-inflammatory, despite being weak analgesics, and displaying varied results in a few controlled studies. Alternatively a more recent review by (Orchard et al 2005) suggests that while NSAIDs can benefit an athlete for pain relief, paracetamol can be just as effective towards soft-tissue injury and healing, while avoiding the side effects (diarrhea, headaches, rash, chest pain etc..).
However too often injuries occur and reoccur due to an athlete setting themselves targets to compete in a race or marathon without the proper preparation leading up to the event. It is essential that within a training program, an athlete’s progression is 10-15% higher in time or mileage (Shamus et al 2001) or similarly a 10-25% increase in work load than the previous week (Kibler et al cited by Walter R. Frontera 2003). Considering hamstrings are a very common injury within sport; accounting for 15% of all sporting relating injuries, following a 34% rate of recurrence (Mason et al 2012), it is vital even after recovery that an athlete is aware of the danger of recurrence. The main goal is avoidance of recurrences, not the swiftness of the recovery. If recurrence does occur within two months, it highlights only an inappropriate rehabilitation method (Tornese et al 2000).
In order to avoid further injury an athlete should continue to engage in stretching exercises, focusing on a “low-load prolonged stretch with active contraction of the antagonist” alongside a warm up jog before exercise (Brian R. Hoke cited by Eric Shamus et al 2001). Furthermore to decrease the chances of injury an athlete should utilise strengthening exercises, as runners require the constant use of the knee extensors, lateral hip and lower leg when running, they should aim to maintain their strength in these areas (Brian R. Hoke cited by Eric Shamus et al 2001).
Bibliography
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