The remodelling process may be said to occur up to six weeks after injury and at this stage the physiotherapist can assess the patient to see whether they can contract the hamstring muscle without discomfort or anxiety against full resistance.
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The physio would then ask the patient to perform isotonic muscle contractions in the prone position, initially with a greater number of repetitions and lower weights, moving to greater weights and less repetitions if there is no discomfort. To avoid a recurrent injury or a persistent strain, it is advisable not to be too fast to raise the weight and force applied.
Concentric movements occur as the muscle shortens during its operation, and the physio can pass them on to intensify with the use of eccentric muscle activity when the patient does well with this. Eccentric muscle function, by comparison, happens as the muscle contracts and lengthens under load at the same time. Contracting muscles eccentrically against load puts the most pressure on them, so it is necessary to handle this form of exercise carefully. Patients are vulnerable to ankle weight, the starting posture is 90 degrees bent of the knees (lower leg pointing up), and in a regulated movement, the exercise action is to lower the leg to the floor.
Rehabilitation continues until the injured leg can reach output to within ten percent of the uninjured leg, as long as there are no adverse events, at which stage the program can move to a more intense emphasis. In order to ensure that soft tissue healing takes place in a lengthened posture and achieves natural muscle and tendon length, stretching of the hamstring continues throughout the entire recovery program. Depending on the level of the injury, the functional period of recovery takes place between two weeks and six months after the point of injury. At this point, without pain, the patient will have a regular walking pattern.
Fast walking should be promoted as a therapeutic target and short bursts of jogging can be added when the patient can handle half an hour without problems. Without pain issues, once half an hour of jogging can be completed, quicker running and quick sprinting distances can be incorporated into the treatment plan. It allows for a gradual increase in the sprinting force and length, introducing fast stops, twists and sprints again to more accurately represent the real world maneuvers that can eventually become more unique to the sport concerned. In order to increase the muscle and tendon stresses and deliver the speed and strength required, the physio will now incorporate plyometric exercises.
Plyometric exercises are intended to maximize a muscle’s contractile strength by stretching it until it contracts in the preparatory stage of the exercise, with common exercises involving bounding or jumping. In this way, a more efficient contraction can be built and the muscle is conditioned to cope with increased movement forces. Jumping rope or skipping is a low stress plyometric movement and physios can cautiously advance this to sideways jumping over hurdles, jumping up and down different levels and other varied work.