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In place where I work there is a rule - in so called acute phase of hamstring strain (no matter what stage) we are not allowed to prescribe our patients exercises where hamstrings contract concentrically, our patiens shoudln't do squats especially with externall load no matter how strong they are and how they feel the movement. What are your opinion on this topic?
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Hey Cheezus - thanks for the questions. There are some layers to this discussion that would likely influence a response. Generally speaking though, these scenarios involve building back to baseline with active range of motion, loading to tolerance, and progressing back to dynamic/sport specific activities. I don't have contraction types I avoid in these scenarios but dosage is what matters. I wouldn't likely recommend blanket avoidance of a movement for everyone (as you are describing for squats). Concentric avoidance is interesting given muscle injuries in this context typically occur via eccentric overload. I would be curious to hear their rationale. Sounds like you may not be provided freedom to challenge their stance and/or program as you see fit? Which obviously complicates the situation. -
MIchael Ray So how do you determine wheather the dosage is appropriate? Is it based on pain scale? RPE? If so, how much pain during exercises is acceptable with respect to healing processes of the tissue?
Sounds like you may not be provided freedom to challenge their stance and/or program as you see fit? Yeap, unfortunately.Comment
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Much of this is individual and context dependent, so a general response here is difficult beyond what I supplied above. However, I'm ok with folks experiencing symptoms to tolerance provided they don't feel debilitated during or after activity (we've discussed this concept in a few locations on the website). Additionally, assessing ROM and strength deficit subsequent of strain would be appropriate to then use to guide the progressions of the rehab process. I do tend to use RPE as an all encompassing scale (fatigue, difficulty, and symptoms) but not in an attempt to objectify the experience. We also have a fairly good understanding generally speaking of the usual physiological healing process that needs to occur so with this in mind, dosage is stipulate on tissue recovery as well as what's already been mentioned.Comment
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