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Greetings
returning to training after a tendon strain injury
You have had a good warmup, had a couple turns up the silks, and on your third turn you wrap in and drop into a front split. Just before you hit your max stretch you feel an uncomfortable and maybe painful pull at the top of your hamstring. Since you are used to the odd ache and pain during training you shrug side this acute sensation thinking “I’m sure that was nothing”. As you pull yourself out of this position and make your descent to the ground you realize that sudden pain has developed into a deep ache in the back of your buttock and high in the hamstring.
High hamstring injuries are very common in athletes that require quick lengthening of their muscles and tendons especially when that same tissue is under an eccentric load. An eccentric load occurs when a muscle such as your hamstring is contracted to stabilize the hip and pelvis while it lengthens into motions such as a penché, or splits in the silks. If the tissue is lengthened further that its normal ability or the strength of the tissue is decreased due to fatigue of the hamstring, the muscle tendon fibers will tear or at the very least lose some structural integrity. The body creates inflammation which results in pain.
With a twenty-year career as a dancer and ten of those years as an aerialist, believe me, I’ve seen and done some silly things in regards to strains mostly likely due to impatience. So, I’ve learned first hand what not to do. For most athletes, inappropriate management of these injuries comes from a lack of understanding of how long this tissue takes to heal and when each form of rehab is appropriate.
The question is, what does the aerialist do next? Here is a step by step approach to handling this situation:
1) Stop training immediately and ICE for 20 minutes. Research is back and forth on if and for how long icing should be done especially since it’s the body’s natural inflammatory response that starts the healing process. That being said, any injury I’ve ever managed that I have ICED within a couple of hours after the injury always seemed like less of an imposition the next day.
2) Generally, the protocol for icing is 3-5X/ day for 2 days then contrasting heat and cold for another two days to promote blood flow/ circulation.
3) DON’T keep stretching the injured tissue or even test it for a couple of weeks. Each time you push the tissue the muscle fibers that are trying to heal are being pulled apart, and likely increasing the healing time and furthering scar tissue formation.
4) Have your injury assessed. Knowing which structure is injured is important. Is it one of your hamstring muscles, or is it actually an adductor muscle issue? Chiropractors, Physio/Athletic therapists, and certain massage therapists will have the experience to assess and give you a treatment plan that will most likely include hands-on therapy such as (ART ®, massage, laser, acupuncture, Graston etc…). As the tissue can handle more load, core strengthening, glute and hamstring strengthening for both concentric and eccentric loads will be prescribed.
Your flexibility will resume slowly assuming you don’t go too hard, too fast. Usually, premature aggressive stretching leads to more pain, dysfunction and subsequent injury along the same fascial pathway. A question that I am asked often is “How could this happen if I was warm before I started training?” There are a few possibilities. The body’s core muscles may have been fatigued from the previous day’s activities, or perhaps the tissue had been mildly strained on another training day but below the threshold to be aware of it. This is why periodization within training (appropriate rest) needs to be scheduled during training. Age and nutrition will also affect the pliability of our tendons. Micro injuries over the decades causes the tendons to slowly become less supple which means it will take less force to cause damage compared to a young athlete.
Dr. Amber Wiens is a Chiropractor in Calgary AB treats dancers, gymnasts and aerialists in her practice. For more information about Dr. Wiens visit www.ayhcalgary.com