Hamstring injuries: prevention and treatment — an update (Peter Brukner, 2015)
An essential part of diagnosing and treating sporting injuries is navigating a successful return to play. If you're a footballer, this means your first game back. If you're a runner it might mean returning to full training volumes.
It’s theoretically possible to return to play as soon as you’re able to stand up again, but obviously there’s a high chance of injury aggravation &/or recurrence. So, successful return to play isn’t just getting back on the field, but also doing our best to make sure:
For a lot of injuries we can agree on a rough timeframe of recovery based on our previous experience with similar injuries, and a known pattern of tissue healing. However, time alone is only a small component in determining successful return to play.
This article (Creighton, 2010) outlines the extensive range of other considerations for negotiating a successful return to play:
After assessing an injury I like to outline the milestones that are necessary to achieve a successful return to play.
Physical factors may include:
This guides our treatment & gives us goals to work on with rehab, which may include:
Functional milestones need to be achieved sequentially. You need to pass one level to get to the next.
Roughly, this might look like:
Progression through each of these functional stages may include:
By the time we return to the playing field we have confidence in the injury because we’ve done the work. Doing the rehab in a graded, progressive manner serves two purposes:
1). The exercise is conditioning, or “mechanotherapy”, to aid recovery.
2). It serves as a screening program, answering the question “am I OK to return to play?”.
Doing the rehab gives us confidence that you’re OK to do “Z” because you’ve successfully completed “W”, “X”, & “Y”.
Here is a graded, progressive running program I like you to progress through before returning to training.
Here is a graded, progressive rehab programs for throwing & a similar rehab program for kicking.
Successful return to play isn’t just about getting back on the paddock.
We know the biggest risk factor for any injury is a previous history of the same injury. That means once you’ve had an injury, you’re at risk of re-injury.
So successful return to play must include rehab aimed at preventing the same thing happening again. This might include specific stretching, strengthening, taping, bracing, proprioception, or skills. The job is only half done if you’re still at risk.