Week 4 - Respect the process
I’m sure you have heard the word “inflammation” in the past. It is thrown around radically on social media platforms, the health world, and by diet influencers. Inflammation plays a valuable role in the healing phases of our body - it’s not all bad. Too much, however, and we can tip the scales.
April 9th marks 4 weeks from my medical intervention to reattach my hamstring. In that time I have been healing.
There are different phases that the body goes through in order to heal. In my profession this is essential to understand and apply in order to progress patients through rehabilitation successfully.
For you, this could be helpful to understand the body’s natural physiological response to injury, whether a chronic injury (repeated insults) or an acute injury (abrupt and not long lasting).
Phase 1: Haemostasis
This happens right at the time of injury as a result of increased blood flow to an area in response to ruptured vessels (a tear or a cut). If you tear a muscle the ruptured vessels in that area result in increased blood flow. Platelets in the blood are triggered to coagulation and vessels constrict in order to close the site of injury.
Example: A cut on the skin for most of us will stop bleeding in a short amount of time. This is the result of platelet coagulation to prevent further blood loss.
Phase 2: Inflammatory Phase
Occurs immediately after the injury (within 24-48 hours) and lasts approximately 7 to 10 days. The platelets from above trigger the release of growth factors in the area. A cascade of inflammatory factors and cells that help to close and repair the wound as well remove debris, bacteria, and dead cells from the area.
Within the inflammatory phase there chemical processes that occur (we will not go into here). This stage is often accompanied by edema, or swelling.
Phase 3: Proliferative Phase
This is where tissue reformation starts. Fibrous tissue is laid down to reform the tissue that has been injured via fibroblast activation and collagen synthesis here (think about the fascia!!).
The body is trying to repair the injured site to make it stronger. This phase starts around day 10 and can lasts generally up to six weeks depending on the size of the injury and the individual’s health history.
Phase 4: Remodeling Phase
This is where the wound or injury achieves maximal strength. The remodelling phase can last up to one year.
An optimal wound environment can optimize this phase of healing.
Here we will have increases in scar formation and the collagen that is specific to our tissues (again - think about the fascia!!). This new tissue is inferior to the original.
Hands on manual work, as well as other interventions, help within the remodelling of the scar tissue, and therefore the strength and quality of the tissue.
There is an image on Clinimed that shows nicely in a diagram how the phases of healing overlap.
The phases of healing depend greatly on the individual, their age, health status, activity levels, and other factors that could interfere with these healing stages.
Currently, I am in the proliferative phase, entering the remodelling phase of healing. Remember, these phases are not discrete. There is overlap between the end of one and beginning of another (see in the image above).
The exercises I have been concentrating on have been:
Walking - 90 to 105 minutes. At this time my weight lifting is put aside. I go on longer walks with my pup Dozer.
While walking I focus on a key activity - push off the ground using my big toe. This essential movement helps to activate the flexor hallucis longus, entire foot musculature, and posterior fascial chain of which my hamstring lies in.
Walking is a low impact exercise that has numerous total body benefits.
Exercise challenge:
1) Identify which foot you want to focus on. This may be a weaker foot.
2) Go for a walk. When you are pushing off the “weaker” foot, concentrate on pushing through the big toe
3) Notice that with increased drive through the big toe when pushing off of the ground, the body will respond with a longer stride length with the “good” leg that is forward.
I started walking around Day 10 (15 to 20 minutes only) and have been progressively increasing. This past week I was able to tolerate 90 minutes without soreness in the hamstring!
If I chose not to listen to my body and participated in too much activity too quickly, I could've stayed in compensation and I risked keeping my body in the inflammatory phase of healing.
Other exercises I am doing at this time:
Foot exercises:
While standing, lifting all five toes off of the ground.
Spreading the toes so that all toes lie flat on the ground.
Single leg balance - while moving the leg that is in the air around dynamically and not falling over. About 2 to 5 minutes at a time on each leg.
Single and double leg heel raises - 15 repetitions on one leg, 30 repetitions on two legs.
Next week I will introduce balancing on the Gibboard! I have waited until week 5 to try this in order to not place too much tension through the hamstring tendon too early on.
Hamstring Specific Exercises:
Lying bridges 10-12 repetitions, 2 legs only (single leg creates too much hamstring pressure at this time).
Prone knee flexion or standing knee flexion, leg weight only, 10 repetitions.
Avoiding: Stretching the hamstring, squat positions, and weighted contractions. This is too much load through the tendon. If we are considering the phases above, calculated progressions are necessary.
Aside from the above I have been working on upper body weighted exercises including over head snatch positions, weighted arm bars, pull-ups, dips, the list goes on….
With regards to healing my hamstring it is essential that I work according to these phases of healing. I may feel great, and my tissue stronger, however I'm quickly reminded where I am at when I have to reactively catch myself from slipping on a carpet in the house.
Respect the process.
Kindly,
Tiana
