Category Archives: Hamstring strain

Hamstring Strain

Treating Tennis Injuries and Tendinopathy: Advice From an Expert

By:  Lisa Chase, PT, OMPT

Tennis elbow, plantar fasciitis and rotator cuff tendinopathy are common injuries that can plague a tennis player. The last thing an athlete wants to hear is, “You must rest and stop playing tennis.”  Soft tissue injuries can be painful, limiting conditions that are slow to heal, which is particularly challenging to a tennis player who wants to get back in the game.

Many athletes seek advice from primary care and sports medicine physicians when they have tendon pain and then are often offered anti-inflammatories, injections, and told to rest.  Typically, this common regimen only offers temporary relief and may not be the best method to heal a tendinopathy. Astym therapy targets the underlying cause of many soft tissue problems, rather than just trying to relieve symptoms.  It is unmatched in its ability to resolve tendinopathies, and often works even after other approaches fail.

WHAT IS THE DIFFERENCE BETWEEN TENDINOPATHY, TENDINITIS AND TENDINOSIS?

The word “tendinopathy” actually means “disease of a tendon,” and is a broader term for two conditions known as “tendinosis,” or degenerative tendinopathy, and “tendinitis,” or acute, inflammatory tendinopathy. Although “tendonitis” is used often, most cases of tendinopathy are not associated with significant inflammation and thus don’t respond well to anti-inflammatory medications.

WHAT CAUSES TENDINOPATHY?

Tendinopathy can be caused by overuse or improper loading of the muscle-tendon unit. It can also be caused by degeneration of soft tissues due to injury, age or other reasons. Repetitive strain on a tendon may cause tiny tears that accumulate over time. These tears may result in pain and can eventually change the structure of the tendon resulting in acute inflammation and/or degeneration that can lead to pain, tissue adhesions, movement impairment and eventually loss of function.

HOW PHYSICAL THERAPISTS HELP HEAL TENDINOPATHY

ADDRESS THE CAUSE

  • Astym therapy addresses the underlying cause of tendinopathy and other soft tissue problems by engaging the body to regenerate healthy soft tissues (muscles, tendons, etc.), and eliminating unwanted scar tissue that may be causing pain or movement restrictions.
  • Correct poor footwear
  • Assess or change equipment, for example choosing a racquet with a larger sweet spot will help reduce load on the arm.
  • Correct stroke mechanics, for example bending knees at least 10 degrees during the service motion will lessen the load on the shoulders and elbows.
  • Identify proper training loads and recovery to avoid overuse injuries.
  • Incorporate proper warm-up or cool-down for tennis.
  • Develop a balanced training program for tennis to include stretching, strengthening, speed, core stability, agility, balance and coordination.

WHY ASTYM THERAPY IS SO SUCCESSFUL

Astym therapy, evidenced to engage the regenerative mechanisms of the body and promote the healing of soft tissues, has repeatedly been shown safe and effective in controlled clinical trials, clinical study, and large population outcomes data.  A new approach to soft tissue treatment, Astym therapy resulted from a large, groundbreaking research endeavor supported by major hospitals and universities.  It is used in settings ranging from therapy clinics to hospitals to industrial rehabilitation to elite/professional athletics, and has been proven to be more effective than other available treatments.

Astym-certification is advanced training and not everyone is qualified to perform this higher level of care.  In order to become Astym-certified, a clinician must undergo intensive training and testing.  Doctors often prescribe Astym therapy for their patients because it is safe, high quality care that has been proven to be effective.  To find or confirm a clinician is certified in Astym therapy, visit the Find a Provider section of the Astym therapy website.

Lisa Chase

Lisa Chase, PT, OMPT, Astym Cert is an internationally recognized physical therapist, educator, lecturer and published author with specialty in rehabilitation and wellness. She received her Bachelor’s Degree in Physical Therapy from the University of Pittsburgh in 1991, a postgraduate certification in advanced orthopedic manual therapy in 1995. She is Polestar Pilates trained, Certified Kinesio Tape Practitioner, Certified MELT Instructor as well as Astym Certified.  She currently runs her own practice Back 2 Normal Physical Therapy, Inc. where she provides expertise in integrative physical therapy with particular interest in comprehensive and holistic manual physical therapy treatments and prevention of spine, sports and orthopedic injuries.

Lisa has worked one-on-one with world-class athletes, coaches, medical and fitness specialists around the world to help prevent injuries, decrease recovery time and optimize performance. She has brought her expertise to WTA Tour (Professional Women’s Tennis Association), ATP Tour (Professional Men’s Tennis Association) AVP U.S. Pro Beach Volleyball, LPGA, Major League Baseball, the English Premier Soccer League and covered the 2004 Olympics in Athens Greece.

Lisa lectures nationally and has been an Adjunct Clinical Professor at Michigan State University, in the College of Osteopathic Medicine, since 1998 and Assistant Instructor for SFMA and FMS Systems since 2010. She is a published author of several books on aquatic rehabilitation and published coauthor in the British Journal of Sports Medicine. Lisa is also the founder and co-owner Rehab Links, a unique exercise software for medical, health and fitness professionals.

 

 

What is Astym treatment?

Astym treatment is a physical therapy treatment that regenerates healthy soft tissues (muscles, tendons, etc.), and eliminates or reduces unwanted scar tissue that may be causing pain or movement restrictions.

Astym treatment is highly effective for restoring movement and reducing pain from soft tissue injury/dysfunction, and Astym even works when other approaches routinely fail.  One of the main reasons for this is that Astym was designed to target the underlying cause of many soft tissue problems, rather than just trying to relieve symptoms.  Here are some of the diagnoses where patients have demonstrated excellent clinical results when treated with Astym:

• Lateral epicondylosis, chronic lateral epicondylitis
• Carpal tunnel syndrome
• DeQuervain’s tenosynovitis
• Wrist sprain
• Plantar fasciopathy/heel pain/chronic plantar fasciitis
• Achilles tendinosis and chronic achilles tendinitis
• Shin splints
• Patellar tendinosis, chronic patellar tendinitis/tendonitis (jumper’s knee)
• IT band syndrome
• Chronic hamstring strain
• Joint contractures
• Overuse injuries
• Pain or loss of motion & function following surgery, trauma or overuse injury

Here is a full listing of diagnoses that have been monitored and the outcomes (treatment results) tracked.

Astym treatment is non-invasive, which means there are no injections or incisions.  Instruments are applied topically (on top of the skin) to locate dysfunctional (unhealthy) tissue, and to transfer mild to moderate pressure to the underlying soft tissue structures.   Astym treatment stimulates tissue turnover, scar tissue resorption, and the regeneration of tendons, muscles and other soft tissue structures.

Astym treatment  is typically provided twice weekly for four to five weeks (about 9 total treatment sessions) and is done in conjunction with eccentric loading, stretching, and functional exercises. Unlike other treatments, Astym encourages patients to active, workers to stay on the job, and athletes to stay in their sport during treatment. The Astym process actually makes the tissues of the body stronger, and allows a patient’s body to become adapted to greater stress without injury.  Patients are very satisfied  and enthused with the results they see from Astym

Astym is used in settings ranging from therapy clinics to hospitals to industrial rehabilitation to elite/professional athletics. This highly-effective, proven treatment helps countless patients every day. Astym is scientifically based and supported by clinical research and extensive outcomes.

What is Astym treatment?: Astym Definition, Part II

Astym treatment is effective in resolving many soft tissue problems, including chronic tendinopathies, tendon pain, tendon injury, stiffness, restricted movement, limited function and other conditions associated with adhesions or scar tissue that can occur after trauma or surgical intervention. It is also quite effective on sprains, strains, and other acute and sub-acute soft tissue injuries.  Continue reading What is Astym treatment?: Astym Definition, Part II

A Miracle: chronic hamstring problem cured with Astym therapy

I had a chronic hamstring pull for over 25 years. As a runner, it was extremely difficult to run with any regularity. I visited a sports medicine physician and he recommended Astym therapy. I had six treatments and my chronic hamstring problem disappeared. This was three years ago and I’ve had no recurrence of any hamstring problem.

Henry Runner, Boca Raton Florida
Clinic: Center for Physical Therapy and Exercise, Poway, California,  Website:  Arch Health Partners

Hamstring Strain and Injury: Advice From The Experts, Part I

Hamstring Strain and Injury:  Advice From The Experts, Part I

Those of you who suffer from chronic hamstring strains know how frustrating this recurrent injury can be.  Hamstring strains and injuries typically occur with high-speed activities such as sprinting, soccer, or tennis.  As physical therapists, we treat an increased number of hamstring strains as recreational league softball gets into full swing.  Many “weekend warrior” athletes are not adequately conditioned or prepared for the quick starts and change of directions required for these sports.  Minor muscle strains may resolve with rest, gentle pain-free movement, and ice over a couple weeks.  More serious hamstring strains may cause swelling or bruising and can take several weeks to months to resolve.  Strains that occur where the hamstring muscle attaches at the “sit bone” tend to take longer to resolve than strains that occur in the muscle belly.

If a muscle strain is not treated appropriately there is greater chance for another strain to occur leading to a chronic injury.  The hamstring may not be painful with typical everyday activities, but can be aggravated as the athlete returns to running or sports requiring quick movements.  Residual scar tissue at the injury site and persistent muscle weakness are two common reasons for the increased re-injury rate.  As the muscle remodels itself following a strain, scar tissue forms at the injury site.  Early, pain free movement can help reduce the formation of scar tissue.  However, excessive hamstring stretching should be avoided as it can result in dense scar tissue formation.  As the muscle continues to heal and pain decreases, specific strengthening exercises called eccentric exercises should be included in the rehabilitation program.  Eccentric exercise involves slowly straightening your knee against resistance (working your hamstring muscles) so that the muscle is engaged while it is lengthening. Your physical therapist can show you how to perform these exercises.  Part II of this entry will provide more detail on rehabilitation exercises following a hamstring strain and tips for preventing hamstring injuries.

Even if you have suffered from a chronic hamstring strain for years, there are pulled hamstring treatments that can reduce the residual scar tissue, improve your strength, and get you back to full activity pain-free.   The scar tissue that forms around the injured muscle can create a knot in the muscle known as a trigger point.  While massage can effectively release these trigger points, a technique called trigger point dry needling can be more effective because the muscle can be directly treated at a deeper level by penetrating the skin with a fine needle.  Trigger point dry needling uses fine filament type needles to release the trigger points in the muscle.

The scar tissue can be effectively treated with Astym treatment.  With Astym your therapist will use instruments instead of her hands to engage the scar tissue and induce its resorption by the body.  Also, Astym will help regenerate any degenerated soft tissues in the area and stimulate the muscle and/or tendon to remodel itself.  A key part of the remodeling process is to apply controlled stress to the healing tissue with specific stretching and strengthening exercises.  Astym and controlled stress will help the muscle remodel and become stronger, and help prevent scar tissue from forming.  Your physical therapist can help you determine the appropriate exercise to stress the muscle enough to make it stronger while not causing damage.  So remember the good news if you continue to be plagued by a chronic hamstring injury…you can get back to the activities you love pain-free!

Dr. Tim Flynn and Dr. Terry Gebhardt are physical therapists and owners of Colorado Physical Therapy Specialists in Fort Collins, Colorado, the website of their practice is www.colpts.com.

 

Meet today’s guest bloggers:

Dr. Timothy W. Flynn, PT, PhD

Dr. Timothy W. Flynn, PT, PhD
Dr. Flynn is board certified in Orthopaedic Physical Therapy (OCS), a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT), and a frequent research presenter at state, national, and international meetings. Dr. Flynn is widely published including 5 textbooks, 6 book chapters, over 50 peer-reviewed manuscripts on orthopaedics, biomechanics, and manual therapy issues. He was the editor and author of The Thoracic Spine and Ribcage – Musculoskeletal Evaluation & Treatment and The Users’ Guides to the Musculoskeletal Examination, and the author of 3 educational CD-ROMs on Orthopaedic Manual Physical Therapy. Dr. Flynn has received numerous research grants. Awards include the James A. Gould Excellence in Teaching Orthopaedic Physical Therapy, the Steven J. Rose Excellence in Research (twice), the AAOMPT Outstanding Research Award (twice), and the Distinguished Alumnus- Marquette University Program in Physical Therapy. Dr. Flynn continues to maintain an active research agenda in the areas of spinal and extremity manipulation, low back disorders, characterization of spinal instability, and the development of clinical prediction rules. Continue reading Hamstring Strain and Injury: Advice From The Experts, Part I

Hamstring Strain and Injury: Advice From The Experts, Part II

Hamstring Strain and Injury:  Advice From The Experts, Part II

In Part I of this entry, we discussed some of the most effective treatments for chronic hamstring strains and injuries.  Despite being pain-free with typical daily activities, many athletes continue to have pain with their sport several months and even years after a hamstring injury.  Unfortunately, there is a high recurrence rate of hamstring strains because of incomplete rehabilitation or returning to sport too soon.  Residual scar tissue and persistent muscle weakness are two common reasons for the persistent pain and high recurrence rate following a hamstring strain.

Fortunately, regardless of how long the injury has persisted, Trigger Point Dry Needling and Astym treatment can help  reduce or eliminate scar tissue and knots in the muscle called trigger points.  These hands-on treatments combined with the appropriate exercise routine can help resolve even the most chronic hamstring strains.

Considering there is such a high recurrence rate of hamstring strains, many have asked what can be done to prevent these injuries from recurring  and even better, prevent them from happening in the first place.  Although hamstring stretching is commonly recommended for injury prevention, a hamstring flexibility program has not been shown to reduce the incidence of hamstring injuries and in fact it may lead to what is called stretch weakness, where the muscle is highly flexible but weak and prone to injury.  In contrast, several studies have found the incorporation of specific strengthening called eccentric exercises into a training program can significantly reduce  hamstring strain injuries.  Eccentric exercise involves slowly straightening your knee against resistance (working your hamstring muscles) so that the muscle is engaged while it is lengthening.  If you are recovering from an acute or chronic hamstring strain, your physical therapist can help you determine when it is appropriate to begin eccentric training.  It is important to start slowly when beginning an eccentric strengthening program, as there tends to be greater muscle soreness associated with this type of strengthening.

In addition to eccentric training, exercises that focus on neuromuscular control of your core muscles and lower extremities have been shown to accelerate injury recovery and prevent re-injury.  Think of neuromuscular control as the system that creates coordinated movement.  This control system frequently “shuts down” following injury.  Simply strengthening the muscles is usually not enough to restore neuromuscular control.  Exercises to re-establish the motor control are critical in preventing injury recurrence.   Examples of such exercises following a hamstring strain include high knee marching, skipping, and explosive running starts with a focus on leg power development.  Finally, a program emphasizing varying trunk movements during running (e.g. upright posture, forward flexed and forward flexed and rotated) has been shown to reduce hamstring injury recurrence by 70%.

If you participate in sports where hamstring injuries are more common such as running, soccer, softball, and tennis, remember to include exercises similar to those listed above to reduce your risk of hamstring injury.  Your physical therapist or personal trainer can help you develop the optimal training program.  If you happen to be one of the unfortunate ones who is still suffering from a chronic hamstring injury, remember you do not need to put up with the pain.  There are effective treatments available to help you return to the sport you love.

 

Meet today’s guest bloggers:

Dr. Terry Gebhardt, PT, DPT

Dr. Terry Gebhardt, PT, DPT
Dr. Gebhardt completed his Master of Physical Therapy at the U.S. Army-Baylor University Graduate Program in 1998. During Dr. Gebhardt’s 7 years of physical therapy practice in the Army he specialized in treating a broad range of musculoskeletal injuries. He has worked extensively with injury prevention initiatives and has been a leader in the development of training programs designed to maximize fitness while preventing injury. Dr. Gebhardt relocated to Colorado in 2004 to complete his Doctorate of Physical Therapy degree and Fellowship in Manual Therapy at Regis University. His areas of clinical expertise and interest include spine and sports rehabilitation where he incorporates his passion for fitness with physical therapy. Continue reading Hamstring Strain and Injury: Advice From The Experts, Part II