Rehabilitation is a process which aims to put an athlete back on the field as quickly as possible. However, to ensure that an athlete will not worsen their condition as they begin playing their sport again, “Return to Play” strategies should be implemented. A hamstring tear involves a rip in the muscles surrounding the hamstring area and happens when a resistance/force over-stretches the muscle, causing it to tear. There are a number of rehabilitation procedures that an athlete can implement which can be followed by “Return to Play” strategies once they begin playing their sport.
Progressive mobilisation is a process where the range of movement of an athlete is gradually increased over time until the full range of movement is restored. For example, a person with a hamstring injury could flex/extend the knee until a full range of motion is restored. This can be done either actively (injured person performs movement) or passively (physiotherapist/coach), and should be done under professional supervision to ensure that further damage is not sustained to the muscle. This is highly because of the tightening and stiffening that occurs of the hamstring muscles after a sufficient time of inactivity, which can further increase the chances of injury once the athlete returns to their sport.
Additionally, an athlete can employ graduated exercises to ensure that fitness is maintained yet the chances of injury are eliminated. Conditioning involves strengthening muscles surrounding the injured area through applying the principles of specificity and progressive overload. For example, a rugby player with a hamstring tear may focus on lightweight leg curls to prevent muscle atrophy during their time away from sport. They may also focus on maintaining total body fitness if cardiovascular endurance and strength in areas other than the hamstring is required. This will ensure that athletes will be able to focus on actions requiring the use of the hamstring muscles (e.g drop kick) as opposed to focusing on the other fitness components.
Once the athlete has got their full range of movement back with a stretched and strengthened area, they can return to training. To reduce the chances of further injury, an athlete should only gradually increase involvement until full confidence is resumed. For example, a rugby player will likely avoid rushing into taking free kicks, as they should take this time to reestablish skills, coordination and confidence in a competitive environment without pain. They may also use heat to increase the flexibility of their muscles, allowing them to stretch further than normal to reduce the chances of injury returning. If pain arises, cold packs can be used to decrease levels of pain, swelling and inflammation.
Return-to-play indicators involve the signs that an athlete is ready to return to their sport after recovery, and is extremely important in ensuring that no further damage will occur when they begin playing. An athlete should ensure that they have full mobility of their joints as it can be an indication of whether the muscle is still damaged. An athlete may test this by doing a straight leg raise in both legs and look for feelings of resistance in the injured leg. Also, there should be no pain, as this indicates that an injured site has not completely healed and requires further recovery or care when being used in their sport. An athlete can also use a cybex machine to compare the strength of one leg to another. If the injured leg has considerably less strength, they should consider doing conditioning training before resuming their sport. Once there is a balance, they can return.
Monitoring progress can be done through comparing test results, and is important so that pre-injury levels can be compared to post-injury levels. Sporting professionals such as sports scientists are able to use equipment like measuring wheels to analyse values such as the distance a football is kicked. For example, if a rugby player’s kicking distance is measured to be 60m, their kicking distance post-injury can be compared. If an athlete lies within 10% of their pre-injury score, then they should be able to return to play. However, a lower value may indicate that an athlete needs to further improve their strength in their injured leg through rehabilitative procedures.
Psychological readiness relates to a player's level of confidence and positive outlook on their sport. Since an athlete would have likely been out of their sport for a while, they may be anxious when training and playing and have decreased levels of confidence. A lack of confidence is detrimental to an athlete’s performance and may make them “hold back” from attempting skills. A rugby player, for instance, may be reluctant to follow through with a free kick at full force, altering their performance and value on the pitch. To counteract this decrease in confidence, an athlete can tape the injured area, which can also act to decrease the probability of a hamstring tear through limiting the rate of deceleration of the joint after the kick.
Finally, return to play policies and procedures should be followed by an athlete to determine whether they are ready to return to their sport and are free of injury. A typical protocol for athletes can involve consultation with physiotherapists, review of ultrasounds and fitness assessments. A physiotherapist, for instance, may conduct an ultrasound by scanning the area post-injury to ensure that there are no visible signs of tearing. This will ensure that unhealed parts of the injury will not go undetected, and appropriate measures can be taken such as playing at a lower intensity to ensure the injury does not get worse.