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Pulled-Hamstring-Part-2-Essential essential skills BY BEN E. BENJAMIN 94 massage & bodywork november/december 2011 088-107 MNB ND 11.indd 94 9/23/11 2:02 PM PULLED HAMSTRING, PART 2 In Part 1 of this article, we The entire healing process should take between 1–6 weeks, began our discussion of the depending on the severity of the injury. If self-treatment does not hamstrings by taking a look help within two weeks, professional treatment should be sought. at the anatomy, how and why Friction TheRaPy these muscles are frequently These treatments are very effective for reducing adhesive scar tissue and injured, and how to assess inhibiting re-formation of poorly formed scar tissue. I will describe precisely where the various friction massage for the three most Semimembranosis injured areas: the muscle belly, the common tendon at or near the ischial hamstring injuries occur in the Semitendinosis tuberosity, and the distal portion of Biceps Femoris posterior thigh. Now, in Part 2, the hamstrings behind the knee. we’ll cover the specific friction Friction therapy to the muscle belly. When treating the muscle belly, there therapy treatment techniques is often a broad area of adhesive scar tissue that requires treatment. With and rehabilitation exercises. the client lying prone, the practitioner stands facing the injured thigh. Depending on the size of the area that TREATMENT CHOICES needs to be worked, the practitioner Self-TReaTmenT may use just a few fingers to friction Whenever possible, it is important Sobotta: Atlas der Anatomie des Menschen the injured portion of the muscle or to avoid activities that create pain. @Elsevier GmbH, Urban & Fischer Verlag all of the fingers of both hands. Place The client should not stretch, except Munich. the fingertips on the medial side of as described in the exercise here, or the painful area and anchor the hand until he or she feels no pain for two by resting the thumb of the working weeks. Even then, stretching must hand(s) on the lateral aspect of the thigh be done gently at first. The use of ice (Image 1). Press downward into the for 15 minutes at a time throughout thigh and pull the fingertips toward the day may also be helpful. Flexing you, moving horizontally across the and extending the knee of the hamstring muscle. Do not move over injured leg 10–15 times right after the skin as you would when using oil; icing helps to prevent the formation just move as far as you can, taking of new, unwanted scar tissue. the skin with you as you friction the muscle fibers. Always begin gently and increase your pressure as the tissue becomes less sensitive. Pressure may be increased over the course of 5–10 minutes or over several weeks tune in to your practice at ABMPtv 95 088-107 MNB ND 11.indd 95 9/23/11 2:02 PM ESSENTIAL SKILLS If you would like to learn the in more severe cases. Friction for 5–6 friction therapy techniques on yourself right now as you sit in a minutes, take a rest, and repeat the and protocol guidelines chair. If your knee is bent and you sequence in the opposite direction. in two brief videos, go to place your fingers behind your knee, Practitioners often go to the other you will feel the hamstring tendons side of the table to reverse direction, www.benbenjamin.com/ as they transition from the muscle because pulling toward yourself is HamstringFriction and across the posterior knee to their easier than pushing medially away from www.benbenjamin.com/ attachments. See if you can identify all yourself. After the friction massage three. When this part of the tendon is is done, apply deep massage to the FrictionGuidelines. strained, it is often a smaller segment hamstring muscles for 8–10 minutes. that is affected. If the strain is in the biceps femoris tendon, the precise area Friction therapy to the promimal of the injury is usually easy to locate. attachment. To effectively friction When the injury is located on the the superior portion of the tendon or medial aspect of the thigh, however, the common tendon attachment to the it is more challenging to differentiate ischia, the hamstring is best treated whether it is the semimembranosis in a slightly stretched position. To or the semitendinosis. They are accomplish this, the client should be right next to each other with the lying supine with the knee and hip semimembranosis being most medial. joint bent at a 90 degree angle. Several pillows should be placed on the table exercise so that the calf can rest comfortably, This five-part program is very effective supporting the leg in this position in accelerating the healing process. (Image 2). The practitioner then sits It is done once a day for the first two on a stool or chair to be at the proper weeks, then twice a day for six weeks, height for better body mechanics. The and is designed to help the muscle practitioner may also sit on the table and the tendon repair without the re- and place the client’s ankle on his or formation of adhesive scar tissue. The her shoulder to maintain the 90 degree length of the program will, of course, angle at the knee (Image 3). Using the vary depending on the severity of the thumb or fingers, whichever is more condition, but in general it should be comfortable, friction the precise area followed for 6–8 weeks and up to at of the tendon that is painful. This may least two weeks after the cessation of be right against the ischial attachment pain. Remember to check if giving if the injury is at the tenoperiosteal exercises to clients is within your scope junction or slightly distal in the tendon of practice of massage therapy in the body. The scarred, painful area is state where your practice is located. usually easy to find in this position. Friction, as described above, then 1. Warm-up. The client gently proceed to deep massage of the thigh. bends and extends the injured knee for 2–3 minutes in a range that is Friction therapy to the distal tendon. comfortable. No pain should be If the distal portion of the tendon is felt while doing this movement. injured in the lower thigh or in the area behind the knee, the client lies prone 2. Stretch. To stretch the hamstrings, and friction is applied, as described, the client lies on his or her back and in the belly muscle above using one or wraps a towel, strap, or rope around the several fingers (Image 4). This depends foot. With the knee straight or slightly on the portion of tendon in need of bent, the client pulls the leg up into the treatment. Try finding the tendons tune in to your practice at ABMPtv 97 088-107 MNB ND 11.indd 97 9/23/11 2:02 PM For access to free vIdeos and articleS and The LaTest news On upcomIng FREE CE HOUR traInIngS, join Ben BenjamIn On FaCebook aT FaCebook.com/drbenBenjamIn. All ABMP members receive a complimentary course, “Experience ABMP’s E-Learning While Discovering Myofascial Massage.” Take this class and earn 1 CE hour. air, stretching the hamstrings (Image or when there is no fatigue in the 5). If he or she feels a stretch directly third set of 10, increase the weight by behind the knee or at the ischium, the 1–2 pounds. Over the 6–8 weeks, the AFFORDABLE knee should be bent until the pull is felt amount of weight gradually increases. ABMP members receive substantial discounts throughout the muscle. The stretch can on these NCBTMB-approved courses. also be done while sitting on the floor 4. Stretch. Repeat step 2. with the legs spread about two feet apart and stretching forward to touch the foot 5. Recovery. Use ice or heat on of the affected leg, again, bending the the injured area for 5 minutes after CONVENIENT knee slightly if the stretch is felt only at completing the final set of stretches. Learn at your own pace, on your own the distal or proximal ends. Each gentle (Be sure to instruct the client in schedule, from home. You can even start stretch is held for 30 seconds and is the proper use of ice. Remember a course and fi nish it at a later time. repeated five times with a 5–10 second there are certain conditions when rest between each stretch. There should ice is contraindicated or must be be no pain, only a pulling sensation. used with great caution, for example diabetes or Raynaud’s disease.) FREE WEBINARS 3. exercise. The most important part From Ben Benjamin to Thomas of this exercise program is determining Ben E. Benjamin, PhD, holds a doctorate in Myers and Diana Thompson to the appropriate starting weight for education and sports medicine, and is founder Ruth Werner, the profession’s the exercise segment. The client is of the Muscular Therapy Institute. Benjamin going to complete three sets of 10 has been in private practice for more than leaders share their expertise repetitions for a total of 30 repetitions. 45 years and has taught extensively across on topics you want. If the correct weight is being used, the country on topics including orthopedic the person feels a sense of stress or massage, Active Isolated Stretching and fatigue somewhere during the third set Strengthening, and ethics. He is the author INTERACTIVE FUN of 10. If nothing is felt, more weight of Listen to Your Pain (Penguin, 2007), Are Enjoy audio presentations, video is necessary and an adjustment should You Tense? (Pantheon, 1978), and Exercise be made the next day.
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