Physiotherapy to avoid Hamstring Injuries

 Top 10 Stretches & Exercises To Avoid Hamstring Injuries

Hamstring injuries are common in athletes and often become a troublesome chronic condition. These injured muscles are more prone to re-injury, because of inadequate rehabilitation.  So, to prevent hamstring injury, one should always build up strength, balance, and adequate flexibility of this muscle group. This can be achieved with the help of your physiotherapist who designs a proper regimen to prevent the injury.

Mechanism of injury:

The most common causes of hamstring injury are:

·         Previous injury

·         Lack of muscle strength

·         Lack of flexibility

·         Lack of adequate warm-up

·         Fatigue

·         Imbalance

Hamstring injuries are common in all athletes, especially those who participate in kicking, running, and jumping. Usually, the injury occurs during high-speed exercises. Most hamstring injuries occur when the athlete experiences a sudden onset of pain in the posterior aspect of the thigh during strenuous exercises. The patient may describe an audible pop and pain, which refrains the athlete from participating in sports. In more severe injuries, the patient may describe falling to the ground. Milder injuries are often described as a pull or tightness in the posterior aspect of the thigh during exercise.

Prevention of hamstring injuries:

The emphasis is placed on the prevention of the injury which is achieved by following a proper regimen designed by your physiotherapist. The regimen includes

Hamstring stretching regimen

·         Single-leg hamstring stretch

Lie supine(lying on the back with face upward) with both legs flat on the bed. Loop the towel around the foot and hold the ends of the towel with your hands. Keep the knee straight and the foot pointing towards the ceiling. Pull until you feel a stretch in your back of the leg.

·         Straddle groin and hamstring stretch

Sit on the floor with both the legs straddled. Keep the knees straight with the kneecap facing the ceiling and the feet pointing towards the ceiling.  Reach forward until you feel the stretch in the hamstrings. Be careful to keep your back straight.

·         Sidesaddle and hamstring stretch

Sit on the floor with the injured leg straight, keeping the knee cap facing the ceiling and foot pointing towards the ceiling. The uninvolved leg is relaxed with the knee bent. Reach the injured leg’s ankle until a hamstring stretch is felt.

·         Pelvic tilt stretch

Sit on the edge of the chair with the injured leg resting straight. The uninjured leg is bent at 90⁰. Rest your hands on your thighs for support. With your back straight, bend forward at the hips. Lean forward until you feel the stretch.

·         Standing hamstring stretch

In a standing position bend slightly forward from your hips keeping your one heel on a small brick size block (knee of the same leg should be kept straight) and the other heel on the floor. Now bend forward and feel the stretch.

Hamstring strengthening regimen

·         Isometric hamstring curls

Sit on the floor with the uninjured leg straight. The involved leg is bent with the heel on the floor. Push the heel into the floor and then pull towards the buttocks to tighten the hamstring muscle.

·         Prone hamstring curls

Place an ankle weight on the involved leg. Lie prone, placing a pillow under the involved knee. With the foot in position, bring the heel toward the buttocks in a slow controlled manner.

·         Standing hamstring curls

Place an ankle weight on the involved leg. Stand with the feet shoulder-width apart. Holding onto support, curl the heel towards the buttock in a slow controlled manner.

·         Hamstring curl Theraband

The exercise can be performed on a prone or a standing position against Theraband resistance. The weight will be at the ankle. Curl the leg against resistance put by the Theraband by bringing the heel towards the buttock.

·         Hamstring roll-outs

Lie on your back with heels on a stability ball. Attain a bridge position by raising your hips up by pushing your heels into the ball and squeezing your gluteus muscle. Now straighten your knees and roll the ball away from your body, the shoulders, hips, knees, and ankles should be in a straight line, and then bring the ball back towards your body by bending your knees.

The regimen helps in the restoration of strength and flexibility of the hamstring muscles, which is essential for the prevention of injury.

 

Pathology of Osteoarthritis

How Osteoarthritis affects the body? Pathophysiology of Osteoarthritis

Do you suffer from swollen, painful, and restricted joint movements? Are you diagnosed with Osteoarthritis? If yes, then you should start taking treatment and should also self-educate yourself regarding this condition. After reading this blog you will be certainly able to answer the queries that you might have in your mind regarding osteoarthritis.

What is osteoarthritis?

Osteoarthritis is a chronic progressive degenerative condition of the joints, meaning that the condition will deteriorate over time as it is a continuous process. Osteoarthritis affects mainly the articular cartilage of the big weight-bearing joints of the body mainly in aged individuals. It can be broadly classified into two types.

• Primary Osteoarthritis
• Secondary Osteoarthritis

Primary osteoarthritis is due to the wear and tear changes occurring in old age in which weight-bearing joints like the hips and knees are more commonly affected. It is uncommon in non-weight-bearing joints like the shoulder and the elbow.

Secondary osteoarthritis is due to abnormal wear and tear in a joint, caused by mechanical incongruity (lack of symmetry) of the articular surfaces. This incongruity may be the result of a preceding fracture involving the articular surface or partial destruction or deformity due to a previous disease. It can arise as a consequence of other conditions such as hyperthyroidism, dislocation, hemophilia, infection (tracking into a joint from an open wound) or tuberculosis of a joint, etc.

An osteoarthritic joint might be

• Painful
• Swollen
• Stiff
• Tender on restricted movements
• Crackling or grating sound
• Bowlegs deformity (in later cases)

What changes take place in our joints due to osteoarthritis?

• Articular cartilage of the surface

The place, where 2 bones meet, is normally covered with a rubbery material called cartilage. This material allows the bones to slide over each other without causing pain. When osteoarthritis sets in, the cartilage begins to break down and undergoes degeneration. As it is cyclically loaded during movements of joints, it undergoes fatigue failure leading to the fragmentation of the surface and fibrillation (cracks and fissures). In the later stages, the cartilage gets completely eroded, exposing the sclerosed or eburnated (hard and thick) bone and the subchondral cyst is also formed (Subchondral is the layer of bone just below the cartilage in a joint, chondral refers to cartilage. Subchondral bone is a shock absorber in weight-bearing joints. It has many blood vessels supplying it with nutrients and oxygen and taking away wastes).

• Bone

The bone surfaces become hard and polished as they lose protection from the cartilage. Subchondral cysts and cavities are formed as the eburnated bones are brittle. Blood flow may be reduced by venous occlusion (blockage of a blood vessel) and the development of microemboli (small particle often a blood clot) in the subchondral vessels occurs.

And microfractures occur allowing the passage of synovial fluid into the bone tissue. There can be venous congestion (when arterial inflow is greater than venous outflow) also. The bone undergoes hypertrophy (increase in no and size) forming peripheral osteophytes (bony projections)

• Synovial membrane

The synovial membrane undergoes hyperemia (excess blood in the vessels) dry and reactive inflammatory thickening. Reduction of synovial fluid secretion results in loss of nutrition and lubrication of the articular cartilage.

• Capsule

There is degeneration of the capsule along with chronic inflammation.

• Ligaments

Ligaments become contracted or elongated.

• Muscles

Muscles undergo atrophy meaning muscle wasting due to loss of movement and function, as a result of pain

• Joint space

Joint spaces become narrow and joints become stiff. The stiffness is maximum at the end of a long rest period and loosens for few minutes during activity.

There is no permanent cure for osteoarthritis but with a good diet and exercise, you can stop the condition from progressing further. The management involves the role of Doctors, Dieticians, Pharmacists, Occupational therapists, and Physiotherapists.

 

postnatal care and recovery: physiotherapy exercises after pregnancy

Post Natal Care & Recovery: Physiotherapy Exercises after Pregnancy

Almost within 48 hours of delivery most of the mothers are at their homes and the time taken to return to fitness varies according to the lifestyle and the type of delivery. It takes longer to recover from a cesarean section than from an uncomplicated delivery, the recovery also depends upon the fitness level of the woman. Besides visiting an obstetrician, the women should also be visiting a physiotherapist (the professionals trained in women’s health and incontinence). A physiotherapy session should be attended within the first 6 weeks. The physiotherapist plans designs and repeats the body movements to ensure fitness.

Why should we exercise after Pregnancy?

Doing exercises during the postpartum phase of pregnancy provides the following benefits;

• ·         Provides post-operative care for a cesarean section.
• ·         Strengthens the pelvic floor muscles.
• ·         Relieves perineal pain.
• ·         Strengthens abdominal muscles.
• ·         Prevention of back pain.
• ·         Improves fitness and decreases weight.

Exercise techniques used by the physiotherapist during the post-partum phase:

Breathing exercises.

Deep breathing, huffing, and coughing exercises are used to prevent pulmonary complications. Coughing is difficult because of incisional pain, an alternative method is huffing. Huffing must be done quickly with the pillow or hands held over the incision and say ' ha ' forcefully and repetitively while contracting the abdominal muscles.

Rom exercises

Initiate ankle pumps, active lower extremity ROM exercise, walking to promote circulation and prevent venous stasis. Bed mobility- rolling into and out of the bed should be taught.

Pelvic floor muscles

It is important to start Pelvic floor exercises within 6 hours of the delivery to regain the strength of these stretched muscles. The contractions should be done four to five times at frequent intervals throughout the day. The exercises are done to treat stress incontinence. The exercises increase circulation, promote healing, decreases inflammation thus relieving pain. Interferential therapy is used to re-educate the pelvic floor muscles. Initiate pelvic floor exercises to regain tone and control the muscles of the perineum.

Abdominal muscles

Abdominal exercises are important to maintain mobility and increase circulation to promote healing. Initiate non-stressful muscle setting techniques and progress as tolerated. Avoid activities like lifting heavy objects, avoid straight sit-ups, bed mobility – rolling onto the side to get out and into the bed should be practiced, because normal support of the abdominals for the lumbar spine is diminished and due to the ligamentous laxity the lumbar is prone to strains.

Diastasis recti

Diastasis is more common in women who have had several pregnancies.  Check for diastasis recti and protect the area of the incision as with diastasis exercises. The abdominal muscles should be contracted and released slowly at first and jerking must be avoided.

Relief of perineal pain

A ring cushion can be used for sitting so that pressure on the perineum is relieved. Side sitting or side-lying may be tried for breastfeeding. Prone lying with pillows under the lower legs and the abdomen to relieve pressure on the breasts may be restful. Cryotherapy can be applied for 4- 5 minutes twice a day. Ultrasound can be used around the scar to soften the tissue.

Postural correction

Retrain postural awareness and help realign the posture. Develop control of the shoulder girdle muscles which often get stressed due to the increased stress of carrying the new baby. Instruct to stand straight, stretch tall tighten buttocks, walk tall to prevent backache. During lactation, the mother should take care of her posture. Pillow should be kept under the thighs to prevent sliding and another pillow under the knee on the side of feeding.

Exercises after 6 week

The exercise regime should be continued and progressed to enable the mother to return to her normal activities.

• Hydrotherapy exercises can be done to strengthen the abdominal and pelvic floor muscles.  General trunk, leg, and arm movements can be done.
• Sit-ups, leg lifts,
• Abdominal and pelvic floor contractions and pelvic tilting can be performed during activities such as washing dishes or standing in a queue in the market places.
• Crook lying exercises can be performed by making the baby lie prone on the mother's tummy and chest
• In prone kneeling, the baby can lie between the mother’s arms.
• Other exercises are back humping and hollowing, pelvis swinging from side to side, alternate leg stretching backward with abdominal contractions.
• In standing, the baby can be held in arms and the mother bends and stretches the knees and hips with her back against the wall.