| Phase/Programme description |
Acute Phase
(Days 1-2) |
Sub-acute Phase A
(Days 3-7) |
Sub-acute Phase B
(Days 8-15) |
Physiotherapy Objectives
|
1. Swelling – Hematomastabilization
2. Prevention of relapses
3. Painreduction
4. Initializing-Acceleratinginflammatoryrehabilitationprocess
|
1. Reducing/removing hematoma - swelling
2.Initializing alignment and reattachment of muscle fibres
3. Minimizing development of scared tissue
4. Reduce pain
5. Regaining strength and agility |
1. Achieving elasticity of the scar tissue
2. Regainingfunctionalmuscleability (agility-strength-endurance-proprioception)
|
Aggressive Physiotherapy
Techniques
|
1. Cryotherapy
2. Elevation
3. Immobilization
4. Useofcrutches
5. Compression (Soft-wrapped bandage)
6. Therapeutic non-warm ultrasound
(0.5 W/cm2 /1- 3-MHz/10΄) |
1. Diathermy (10΄)
2. Massage (15΄)
3.Cuppingmassage (8΄)
a) Static application on the injury site (5’)
b) Dynamic application with cups motion towards the core(3’)
4. Strippingmassage (5΄)
a) centrally to injury site
b) directly upon injury site with direction towards the trank
5. IASTM Stripping massage (2’) (application same as above)
6.Cryotherapy (20΄)
7. Cryokinetic
Isometric exercises of hamstring muscles
(4 setswith 10 isometric contractions) (6΄΄of progressive contraction -2΄΄ break)
8.Cryostretching
Stretching through active motion -Stretching of antagonist muscles (12΄΄ stretch -12΄΄ relaxation)
9. Electrotherapy
Therapeutic Ultrasound-
ΤΕΝS
10. Core stabilisationexercises (planks in supine - lateral and prone position) |
1. Diathermy (15’)
2. Massage
2.1. Strippingmassage (5΄)
a) centrally to injury site
b) directly upon injury site with direction towards the trank
2.2 Strippingmassageincombinationwithgentleeccentrichamstrings’contraction (with elastic band/5’)
3. Cryotherapy (20΄)
4. Cryokinetic
Isotonic- concentric contraction of hamstrings with the use of elastic bands
(4-5 sets 10-12 repetitions)
5. Cryostretching
2 setsx 5 stretchingrepetitionsfor 30΄΄ (1 setwith extended knee – 2ndset with flexed knee)
6. Electrotherapy
Τ.Ε.Ν.S ,Therapeutic Ultrasound
7. Core stabilisationexercises (planks in supine - lateral and prone position)
8. Balanceexercises |
| Home-based Rehabilitation |
Rest/ Cryotherapy (Continuous application 20΄-30΄ with a 90΄ break.) |
1.Hamstrings’ stretching (2 sets of 7 repetitions for 30΄΄ with extended and flexed knee position)
2.Isometric exercises (4 sets of 10 contractions (6΄΄of progressive contraction-2΄΄ of relaxation)
3. Low resistance exercises in a pool – swimming |
1. Hamstrings’ stretching: 2 setsof 7 repetitionsfor 30΄΄ (with extended and flexed knee position)
2. Strengthening with elastic bands : (daily 6-7 sets of 10-12 repetitions in sitting and standing positions)
3. Myofascial release exercises with Foam roller on hamstrings (10 repetitions for 1΄ with a 1΄ relaxation break) |
| Functional rehabilitation in the field |
|
1. Trunk and upper limbs strengthening exercises in the gym
2. Upper body ergometer
3. Afterday 4, beginningorganized gait (forward and backward)
5thday - walking 10΄
6thday- walking 15΄
7th day - walking 20΄ (2x10΄) |
8th-10th Days
Aerobic training: Running (2x10΄/ 30-40% Vo2max)
Skipping routines/Stretching
Trunk-pelvis stabilisation exercises
Combinedexercises (proprioception-agility-balance)
11th -13th Days
Aerobic training: Running (2× 10΄/ 50% Vo2 max)
Skipping routines - Stretching/pelvis stabilisation exercises
10x50m (60% Vo2 max) / 5x100 (60% Vo2 max)
Ballistichipexercises (dynamicstretching)/10x50m (60% Vo2max) /5x100 (alternating intensity rhythm: 50m at 50% and 50mat 60-70% Vo2max)
14th -15th Day
Aerobic training: Running (2x10΄/ 50% Vo2 max)
Isokinetic strengthening (concentric –eccentric contraction)/ Skipping routines – Stretching/ Pelvis stabilisation exercises / Ballistic hip exercises/5x100m (70% Vo2 max)
Dynamic proprioception exercisesof lower limbs
5x100 (alternating intensity rhythm: 50m at 60% and 50m at 70-80% Vo2 max)/10x40m (alternating intensity rhythm: 20-20m at 60%/80-90% Vo2max) Soccer mimetic exercises- plyometric strengthening |
| Precaution - rehabilitation |
|
Kinesiotaping |
Kinesiotaping |
| Criteria for progression to the next phase |
|
1. Swelling – pain minimization
2. <5οrange of motion deficit
3. Minimumpain (2-3 VASSCALE) during compression of the area |
1. Isokineticstrengthsymmetry (concentric 60ο /180ο /300οsec.-eccentric 60/180osec)
2. Fullrangeofmotion
3. Performingsoccerburstexercises (changing direction-sprint etc.) without discomfort
4. Goodpsychological state -confidence of the athlete |
