Hamstring Treatment Protocol

Hey guys, been reading through previous threads on hamstring rehab…so much brilliant stuff here (literally spent hours going through old threads-when i should have been studying-lol.)

So basically I tore my hamstring last night (grade 2/3)…swollen and limping badly today. Just wondering could you guys run the rule over my treatment protocol.

Days 0-3 - RICE
- Arnica
- Ibuprofen
- Therapeutic ultrasound

Days 4-10 - Deep tissue massage
- Light jogging & Aqua jogging
- Concentric and eccentric loading (no weights), light mobilization work.
- Laser Therapy
- Cryotherapy

Following a week of light jogging, cycling etc. I hope to progress to some short low tempo accel + deceleration runs. My goal would be to increase the tempo of these runs in the following weeks, combined with my massage etc.

I’m looking for the cause of the tear…I dont think its a pelvic misalignment (saw a chiropractor a few weeks ago), I definitely have a bit of inflexibility in the glutes/hips so that’s a possible cause. Also, I know at the site of the tear I’ve had bumpy, muscle knots (possibly scar tissue although I hadn’t injured this region before) Just wondering could this be scar tissue and should I get the PT to do some cross friction work on it or would massage suffice.

Any advice, suggestions etc would be hugely appreciated!

On a side note, I have 2 options for the deep tissue massage - I can go to a guy who I know will really get stuck in and put me through a helluva lot of pain or I can go to a guy who will put me through mild pain. What do you think, is it more pain more gain in these situations?

it is controversial whether one should use ibuprofen/other NSAIDs within the first 48-72hrs as although they reduce the inflammation at the site, they will interfere with chemotaxis of cells (towards the site) which are necessary for the repair/remodelling phase. a lot of the literature now recommends waiting 2-4 days before starting NSAID usage and then limiting their use to 3-7 days all up. if you are in pain use a paracetamol or something like that.

imo the bumby muscle knots are exactly that - not scar tissue. there may be adhesions in the muscles due to prolonged or difficult training - especially if there are technical insufficiencies with the running itself or you have been running into fatigue (i.e. lots of special endurance). as for the massage options - i would go for the gentler guy (after giving it a few days to recover) first up as the other bloke might cause more damage by going too hard too early. i think ultrasound is a good option in the first week, massage can become more of a priority later on.

I have never found ultrasound and laser threapy much effective in reducing injury time. If you have EMS, there are protocols by Charlie in the archives for injuries.

I would stay away from ultrasound for the first few days. Sorry for the late reply…probably not a big deal though.

I would question the ultrasound during the acute phase (~day 1-3). Deep tissue massage at day 4…don’t know about that either. Depends on the definition of ‘deep tissue’. Go with experience and knowledge, not whoever can go the deepest.

I would stay away from ultrasound for the first few days. Sorry for the late reply…probably not a big deal though.

I would question the ultrasound during the acute phase (~day 1-3). Deep tissue massage at day 4…don’t know about that either. Depends on the definition of ‘deep tissue’. Go with experience and knowledge, not whoever can go the deepest.

I would stay away from ultrasound for the first few days. Sorry for the late reply…probably not a big deal though.

I would question the ultrasound during the acute phase (~day 1-3). Deep tissue massage at day 4…don’t know about that either. Depends on the definition of ‘deep tissue’. Go with experience and knowledge, not whoever can go the deepest.

I would stay away from ultrasound for the first few days. Sorry for the late reply…probably not a big deal though.

I would question the ultrasound during the acute phase (~day 1-3). Deep tissue massage at day 4…don’t know about that either. Depends on the definition of ‘deep tissue’. Go with experience and knowledge, not whoever can go the deepest.

I would first do the R.I.C.E method mentioned above but after that I would see a practioner that knows how to perform A.R.T (active release technique) That said, you need to find a good manual therapist who will also take you through an assessment and determine the cause so the injury doesn’t happen again.

Gerard Mach has a 10 day protocol in his book that could be of use. Has been easily attainable online.

Depending on the laser unit, it can help reduce edema and increase blood flow to area. Once muscles are in spasm, very little laser can do. Would take incredibly high dosage to elicit a small effect in terms of looseness. If you have access to it, I would still use it.

Also, look to use the light on the hip flexor/lymph region of the affected leg. If you tell me what unit you have I might be able to help with treatment protocols.

what you are doing, minus the deep tissue. Too much pressure too soon could cause more harm than good. I still like the use of DMSO, Voltaren, and Traumeel.