Rehabbing a muscle injury in theory should not be that hard.

We know how muscles work, the actions they do and even the best exercises to target and rehab specific muscle injuries…

So why is it that we see so many of them?

Injuries to the hamstring, groin, calf and quad muscles injuries are so common…

And almost as common are re-injuries to these muscle groups!

And even more worryingly, things are getting worse!

A study in 2017 by Erlund & Vieira (Link – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582808/) showed a 4% increase in hamstring incidence annually…

And highlighted that year on year we are seeing more and more hamstring injuries in training than ever before!

So despite all the evidence and medical developments over the last half century, we are actually seeing more muscle injuries.

Then add to the big problem of recurrent injuries, patients and athletes breaking down no sooner than they have been ‘fixed’… 

It is clear as a profession we are not doing doing a great job managing muscle injuries.

So what is going wrong?

Here are 3 things you need to be aware of that might be stopping you rehabbing a successful hamstring, quad or any other muscle injury…

Stop your patients and athletes breaking down no sooner than you have got them back to full fitness…

And give you more confidence with your rehab planning and prescription.

#1 Understand What The Muscle Needs To Do

Any rehab plan starts with the end goal in mind.

You might have a quad injury with a footballer or assess a 10k runner with a very similar injury in clinic.

They may even present exactly the same on the bed…

And have the same restriction in movement, strength and movement.

But their rehab, especially their end-stage rehab, will (or should) be different.

The footballer needs to have a tremendous level output and control of the rectus femoris muscle when kicking a ball.

The rectus femoris is a 2 joint muscle (it flexes the hip and it also extends the knee) and is the most commonly injured quad muscle.

In the action of kicking a ball, the rectus femoris has to shorten proximally as the hip flexes and shorten distally as the knee extends…

Post contact with the ball, this all changes, as the rectus femoris controls eccentric hip flexion and knee extension, slowing the limb down.

Whilst this same action occurs for the 10k runner when he is racing, it clearly does not involve the same speed and level of force when kicking a football.

Same symptoms, same muscle action, different requirements, equals different rehab.

#2 Advance Rehab Using One Progression At A Time 

When rehab goes wrong it is usually the case of too much too soon.

This happens all the time.

How often do you see an athlete return from injury with one problem only to break down again with another.

As an inexperienced therapist you may make the big mistake of skipping through the early stages of rehab.

Usually your just trying to do your best but you are too eager to start loading the muscle with rehab or in the gym…

Not understanding how to properly structure a step by step rehab plan…

Or not being aware of how other injuries and a patient or athlete’s past medical history can contribute to a poor recovery from injury and even be the cause of their injury in the first place.

Rehabbing muscle injuries will follow the same principles…

Early in rehab you will load the muscle isometrically.

Then introduce movement (isotonic),

Then add load and or speed.

Big errors happen when you rush this process and particularly when you progress too many things at the same time.

This might be adding a new exercise to your patients rehab programme and at the same time getting them to do this movement at a much greater speed than they have experienced previously.

This is a simple, small error, but you are setting yourself and your patient up for failure.

Because if it doesn’t go well and you irritate your patient…

You do not know what went wrong.

Was it the new movement or exercise you prescribed?

Or was the problem that they just weren’t ready to do the exercise at that speed?

Who knows?

Keep things simple, advance rehab in a sensible and logical manner, with one key progression at each stage.

#3 Understand The Limits Of ‘Rehab’

Can’t go wrong with getting strong and all that…

Unfortunately, it’s not quite as simple as that.

Just take the biceps femoris muscle, the most commonly injured hamstring.

We know most hamstring injuries involve the biceps femoris and that biceps femoris activity is highest in sprinting.

No surprise then that the majority of bicep femoris injuries happen during sprinting.

You probably already knew that but did you know…

NO exercises in the gym can replicate the forces and torque (speed) that the bicep femoris muscle needs to produce during the action of sprinting.

You can get as strong as you want in the gym but this will not carry over to sprinting.

You need to sprint to get the hamstring used to the forces required to sprint.

But this needs to be progressive and needs to be built into your rehab.

Building up strength in a muscle post injury is of course highly important but is not the be all and end all of muscle injury rehab.

All exercises have limitations.

The key with end stage rehab is ensuring that firstly, the patient or athlete is actually ready to start end stage rehab i.e.

You have restored full joint and muscle ROM

You have resorted the muscles ability to produce full motor output

You have restored the bodies ability to move in all three planes of movement…

Then added appropriate loads to these movements, if needed…

Then added in higher velocity and/or higher capacity loads as needed.

All this before giving the green light to return to higher level activities like running or sports…

And having a plan to safely progress these higher level activities. 

Hope this helps.

Andy Barker

The New Grad Physio Mentor

PS. I have just put together a special webinar all about quad and hip flexor injury management. 

I also have webinars and specific teachings on other muscle injuries like hamstring, hip and groin injuries, calf, achilles and tendon based problems including how to assess, treat and rehab these types of injuries.

If you would like to access this sort of content then head to www.newgradphysio.com/membership to find out more.