The second edition to Holly’s muscle tear series. The biggest risk of tearing a muscle is having had a previous tear and often this is due to poor rehabilitation. Holly’s article once again gives us a snapshot of what’s happening at the cellular level and how it corresponds to what rehab you should be doing to help the process along.
Summary Week 1: The inflammation stage has passed, the gap between the damaged fibres has almost closed and treatment is all about starting to gently stretch the scar tissue and do some gentle strengthening to maximise healing without damaging the newly regenerated fibres.
By Day 10 although the muscle is nowhere near its pre-injury strength levels, scar tissue formation has reached maturation and is no longer the weakest point in the muscle.
This means that active resistance strengthening can commence. You should also now be able to walk or move normally and perform a contraction of the injured muscle pain free. Things are feeling much better now and this is almost always the point where because pain has gone, without an understanding of what’s going on under the surface people go back to sport or activity only to re-tear the muscle or feel it’s healed and ok to stop rehab. Read on and you’ll know why you need to rehab it more…You’ve been warned!!
A few muscle fibres now extend across the gap with little scar tissue evident. These fibres are generally disorganised and their orientation is irregular. i.e. the muscle looks more like a spider web instead of a packet of uncooked spaghetti.
Exercise is key here as the mechanical loading helps these fibres to align more to look like the uncooked spaghetti. This is important to prevent future injury as a bunch of fibres all pointing in the same direction provide a stronger resistance to the tensile force put on muscles during exercise making it less likely to tear.
You should now be able to jump or throw pain free. A walk/run program can be started for lower limb injuries and some sports specific practice drills can also be commenced.
There is now resolution of scar formation and the fibres are becoming more uniformly aligned with the strength exercises you have been doing. This can continue for another 6- 8 weeks (so don’t stop when the pain does!) Most people are back to normal everyday activities.
Exercises can now be progressed towards pre-injury training levels and dynamic exercise such as hopping can be performed pain free.
Sports specific training can be taken to about 80% of maximum speed with incorporation of co-ordination, skill patterns, power and agility progressively incorporated into the drills.
Plyometrics (power based exercises which involve lots of jumping) are introduced late in the rehabilitation phase and improve proprioception, power and athletic performance and can begin now.
Fitness training can recommence at 100% and sports players are now able to participate in smaller scale practice games building to full match practice.
The athlete is encouraged to come off early if he feels fatigued as fatigued muscles are less able to absorb energy thus more likely to be injured.
Practice in skill technique and game strategy should increase this week as conditioning work decreases with return to full fitness and match practice with the aim to return to sport and normal activity.
You have now done everything possible to aid your return to sport and minimise your risk of re-injury. Well done for getting to the end of this article and next time you tear a muscle you’ll know why we do what we do and why it’s so important to understand what’s happening in the muscle itself.