Intensive physiotherapy for accelerated load capacity after hamstring injury
Is it possible? And if so, how?
57-year-old avid endurance athlete Jonathan from Belgium had an active team outing with his colleagues on 25 April. During the team-building event, they played a game where participants had to do a short sprint without warming up. Jonathan was unlucky. He was sprinting at about 80 percent of his ability when he suddenly felt a whiplash-like pain in his hamstring. A feeling he recognised from when he had torn his hamstring in 1996. With a bicycle tour of 50 km scheduled in the Flemish Ardennes for 11 May, barely 16 days later, the disappointment was immense.
Intensive physiotherapy treatment of a torn hamstring
No problem, his two physiotherapists decided. With intensive physiotherapy, they believed the tour on 11 May was a viable goal despite the prognosis of four to eight weeks before one can return to sports activities with similar injuries . Together with Jonathan, they took to work with cold packs, TECAR, electrotherapy, Kinesio taping, stretching and exercise therapy. We spoke to Jonathan about his injury, treatment and recovery. And of course about the tour; did he achieve his goal?
Jonathan, you suffered a strained right hamstring. Can you tell us a bit more about the first aid and diagnosis?
“I felt terrible pain with every movement of the leg, but I still completed the team-building event. I was limping, but did end up cycling home where I cooled for 20 minutes several times. The leg didn’t show any signs of damage, no swelling, no bruising. The only thing that stood out was that the muscle felt very tensed.
A few days later, an ultrasound revealed a 12-cm tear on the inside of one of my hamstrings, the m. Semitendinosus. The official diagnosis was 'grade 2 hamstring rupture', which means a partial tear."
Still, you had the ambitious plan to undertake a 50-km cycling tour just over two weeks later. How did your physiotherapists think they could help?
"They worked out an intensive physiotherapy programme for me, partly carried out by them and partly by myself based on their thorough instruction. The physiotherapists did the TECAR therapy and Kinesio tapingwhile I continued to cool the muscle with a cold pack every day, applied electrotherapy (microcurrent) and did the exercises.
I am a teacher and researcher, but because sitting at a desk and walking around was too painful, I was found temporarily unfit for work. This was unfortunate, but it did give me the opportunity to focus entirely on my treatment.”
Can you tell us a bit more about the treatment at the physiotherapy practice?
“I visited the practice twice a week for TECAR therapy and Kinesio taping. We started on day 3 after the injury and did a total of four 20 to 30-minute sessions.
I asked the therapist about the specifications of TECAR therapy and he said the following: 'It was a unipolar application with medium-sized electrodes, with Jonathan in prone position and the neutral electrode plate under his upper leg. We used both the capacitive and resistive method, both in the continuous mode.'
We started with the tape in week 2. According to the therapists, this involved draining tape on the calf and detonising I-tape on the hamstrings. I was wearing the tape almost permanently, only taking it off for a few hours every now and then to relieve the skin. It was no problem to combine this with electrotherapy; the electrodes were simply placed in between the tape.”
You mentioned using a cold pack, electrotherapy and exercises. Can you tell us more about that?
“I applied an ice pack several times a day for 20 minutes for the first 6 days. After day 6, I stopped using the ice pack completely. I did apply the electrotherapy, more specifically the micro current, every day for the entire period. Following the therapists' advice, I would place the electrodes on the front and back of the leg, but I had to alternate the exact positions in order to send thecurrent through the lesion three-dimensionally, in all directions. In terms of settings, they had advised me to go for a wide pulse width at 0.5 Hz and 600 μA. The device was on 6 to 8 hours a day for the first week and 4 hours a day in the second week.
The last four days of rehabilitation were all about the exercises. I would stretch my hamstrings around 20 times throughout the day. First, I would briefly flex the muscles, then relax an stretch to the pain limit (the hold-relax-contract technique from the PNF, according to the physiotherapists).
They also taught me how to best train my hamstring. The exercise is to bring the foot to the buttock with the help of a strap and then gently lower the lower leg again, guided by the flexed hamstrings. I would do this exercise around 20 times a day.”
Was that the entire treatment? Or did you do more?
“I did not use crutches or medication. I did take Traumeel, a homeopathic substance to fight inflammation and pain and promote the healing process.”
Can you tell us how the healing process went and, of course, whether you were able to do the cycling tour?
“For the first couple of days after the injury, I scored my pain level an 8/10. After five days, the pain started to subside to a score of 1/10 on the day of the cycling tour on 11 May. That day, I was on my bicycle for the first time since the injury and felt physically ready.
A half hour before the start, one of the physiotherapists applied some new tape and I did a small warming-up lap. During the tour, which featured cobblestones and several climbs, my pain went from 1/10 back to 7/10. Nevertheless, the load capacity of my hamstrings had apparently recovered sufficiently for this particular effort, as I was able to cycle the 50 km in full, barely two weeks after suffering a 12-cm tear in my hamstrings. I do not believe this had been possible without the intensive therapy and guidance. I am incredibly grateful to my physiotherapists."
More information about TECAR or electrotherapy
The story of the unfortunate muscle tear had a happy ending for Jonathan. Athletes are keen to resume their activities as soon as possible and therefore benefit from guidance from a specialised physiotherapist who does not shy away from using different therapies and treatment options.
If you have any questions about the treatment of sports injuries with TECAR therapy and electrotherapy, please feel free to contact us.