Rehabilitation of hamstring muscle injuries: a literature review - Rev Bras Ortop. 2017 January-Feb; 52(ane): 11–16.

Dr. PT. CLEITON A. VICTORINO

Dr. PT. CLEITON A. VICTORINO

CEO na ELITE Fettle & CLINIC

Published May ane, 2017

Hamstring injuries are among the most frequent in sports. The loftier relapse rate is a claiming for sports medicine and has a great impact on athletes and sport teams. The treatment goal is to provide the athlete the aforementioned functional level as before the injury. Thus, functional rehabilitation is very of import to the success of the handling. Currently, several physical therapy modalities are used, according to the stage of the lesion, such as cryotherapy, laser therapy, therapeutic ultrasound, therapeutic practice, and manual therapy. However, the testify of the effectiveness of these modalities in muscle injuries is not fully established due to the picayune scientific enquiry on the topic. This article presents an overview of the physiotherapy approach in the rehabilitation of hamstring muscle injuries. The goals of hamstring injury rehabilitation are to achieve the aforementioned functional level observed prior to injury and to allow for the return to sports practice with minimal adventure of recurrence. At that place are two major forms of muscular injury in sports: muscle strain and contusion. Strain is the nigh common muscle injury in sports, and is classified equally follows: form i, in which in that location is minimal structural disruption and rapid render to normal function; grade two, in which there is a partial rupture, with pain and some loss of function; and grade 3, in which a complete tissue rupture is observed, with muscular retraction and functional disability. Two specific mechanisms are described for hamstring injuries, which appear to influence the location and severity of the injury. Heiderscheit et al. demonstrated that, during terminal swing phase of running, the hamstrings absorb elastic energy to contract eccentrically and promote deceleration of the limb'southward advance in training for the initial contact of the calcaneus. In this phase, muscles become more than susceptible to damage; the biceps femoris musculus is the nearly affected, as it is more active than the semitendinosus and semimembranosus muscles. Jarvinen et al. described the stages of muscle injury healing: Stride ane destruction (three to seven days) – characterized by disruption and subsequent necrosis of myofibrils by hematoma germination in the infinite formed between the torn muscle and by proliferation of inflammatory cells. Step ii repair (four to 21 days) – consists of phagocytosis of necrotic tissue, regeneration of myofibrils, and concomitant production of scar tissue, as well as vascular neoformation and nerve growth.Step 3 remodeling (xiv days to 14 weeks) – period of maturation of the regenerated myofibrils, and reorganization of the muscle functional capacity. The physiotherapist needs to empathise the healing process in order to use the adequate therapeutic approaches in the advisable period, then that rehabilitation can exist conducted properly. The traditional treatment in acute muscle injury is described by the PRiCE protocol. The well-nigh easily recognizable issue of cryotherapy is the reduction of tissue temperature. Therapy Ultrassom is a usually used resource in musculoskeletal injuries. According to Backer et al., the acoustic vibration produced by TUS induces cellular changes that changes the concentration gradient of molecules, as well equally calcium and potassium ions, which excites cellular activity. Laser Level Laser Therapy is a light source that differs from others because it is monochromatic, coherent in time and space, and collimated, which allows for a skilful tissue penetration. Manual Therapy this arroyo assesses and treats articular, neural, and muscular systems. The hand contact stimulates mechanoreceptors, which produce afferent impulses and cause neuromodulations in the key nervous system to provide an analgesic response and an improvement in muscle and joint function. Therapeutic exercises - One of the initial goals of muscle injury rehabilitation is to restore normal neuromuscular control and prevent the formation of tissue fibrosis. Therapeutic exercises, such as isometric strengthening and controlled, pain-free, low-intensity agile movements, are strategies recommended by experts to achieve these objectives at an early on stage. In an intermediate stage, an increase in the intensity of exercises is immune, with neuromuscular training at higher amplitudes and the initiation of eccentric resistance training. Askling et al. demonstrated the importance of eccentric strengthening in hamstring injuries, by comparison a protocol with conventional exercises and a protocol based on eccentric exercises with maximum dynamic stretching. Their study concluded that the eccentric exercise protocol was more effective, equally it provided a faster render to sport and a lower relapse rate. Heiderscheit et al. stressed the importance of restoring flexibility at this stage, in order to promote improve orientation of fibers during healing. Nonetheless, information technology is important to respect patient'south tolerance to stretching. In the final phase of rehabilitation, it is recommended to increase the eccentric training and the high-speed specific neuromuscular training of the sport motility, in grooming for the return to sport. The determination of objective criteria to define the appropriate time for an athlete to resume sport practice remains a challenge and an of import area for future research. Based on the all-time show available, athletes who have been authorized to return to sports activities without restrictions should exist able to perform functional skills (running, jumping, dribbling) at full speed without pain or stiffness complaints. Flexibility needs to be similar to the contralateral limb, without complaints. Regarding strength, the athlete should be able to complete four consecutive repetitions of maximal effort without pain complaints in the manual exam of human knee flexion strength. If possible, isokinetic force testing should also be performed, under both concentric and eccentric action conditions; the peak torque should accept a deficit lower than 10% when compared with the contralateral side. Proper rehabilitation must address muscular forcefulness deficits, flexibility, neuromuscular command, lumbopelvic stability, and eccentric strengthening, since these accept been shown to be important therapeutic targets for a successful return of the athlete to sports, with lower take chances of recurrence.