The basic approach for mild to moderate muscle strains and tears is essentially the same depending on the severity, location and stage of healing. This includes:

  1. Acute Phase – Rest, Ice, Compression, Elevation and other efforts to reduce inflammation and promote tissue healing
  2. Subacute Phase – Light Stretching with return to some activity and other efforts to improve flexibility
  3. Rehab Phase – Light Strengthening with return to most/all activity and other efforts to improve re-conditioning

In all of these phases, care revolves around improving body balance and proprioceptive feedback, as well as exercise prescription and lifestyle advice.

Strains are typically graded according to severity:

  • Grade I: Minor strain with minimal tearing; pain, but still with full muscle function
  • Grade II: Moderate strain with more significant tearing; pain with moderate loss of muscle function
  • Grade III: Complete rupture of muscle and severe or complete loss of muscle function
  • Achilles Tendinopathy

    ACHILLES TENDINITIS (TENDINOPATHY)

    The Achilles tendon is the extension of the calf muscle (gastrocnemius and soleus) as it attaches into the back of the heel. This tendon can tear or rupture as a result of a traumatic stretch. An Achilles that has a significant or complete tear will usually require surgery and plaster casting.

    More commonly the tendon becomes inflamed due to overuse – seen often with runners. Achilles tendinitis is differentiated from another common Achilles tendon condition called Achilles tendinosis. Patients with Achilles tendinosis have chronic Achilles swelling and pain as a result of degenerative, microscopic tears within the tendon.

    Common causes of Achilles tendinitis include:

    • Lack of flexibility – hence the condition is more common in middle aged athletes
    • Recent increased distance or hill training
    • Over-pronation/Flat feet

    The most common symptom of Achilles Tendinitis is pain – especially 2-4cm above the contact into the heel. This ‘watershed zone’ is susceptible due to its poor blood supply.

    MANAGEMENT

    ACUTE PHASE

    • Rest to allow inflammation to settle – crutches and immobilization in severe cases
    • Ice – for 15min each time – especially after activity
    • Heel lifts – these reduce the stretch on the Achilles and should be worn in both shoes, not just on the painful side
    • Gentle stretching if tendinitis mild-moderate
    • Gentle soft tissue techniques to improve circulation and healing
    • Spinal/pelvic/lower limb chiropractic adjustments to improve balance and muscle tone

    REHAB PHASE

    • Gradually increase activity
    • Ice after activity if required
    • Stretching and strengthening exercise
    • Deep soft tissue techniques
    • Spinal/pelvic/lower limb adjustments to improve balance and muscle tone

    If medical treatment is also required this may include Non-Steroidal Anti-Inflammatory Drugs or Cortisone Injections.

  • Adductor Strain

    ADDUCTOR STRAIN

    The adductor group of muscles makes up the groin and inner thigh. When they contract the adductors pull the legs together.

    It is not uncommon for adductors to be injured with sudden side change of movement, such as football or soccer.

    Symptoms of adductor strain includes groin pain that worsens with movements, especially with running or side to side movements

    MANAGEMENT

    As per the approach to all mild to moderate muscle strains the approach begins with RICE, then graduates to stretching and strengthening training.

  • Calf Strain/Tear

    CALF STRAIN/TEAR

    The calf is made up of the superficial gastrocnemius muscle, which attaches immediately above the knee, and the deep soleus muscle, which attaches below the knee. Both muscles merge to form the Achilles tendon as it inserts into the back of the heel.

    The gastrocnemius is more involved with movement (especially jumping, walking and running), while the soleus is more important as a postural muscle.

    The calf can tear suddenly as a result of a large force, such as that when suddenly lunging forward or jumping. They also occur gradually as a result of repetitive stress. This is often seen if athletes increase running intensity or perform more up hill running.

    SIGNS AND SYMPTOMS

    Sharp pain is felt, especially in running up hill. If strain is more severe individual may walk with a limp with toes pointing down. Swelling and tenderness on tear sight may be present.

    Certain factors increase your risk of calf strain. These include:

    • Poor flexibility
    • Poor preparation or inappropriate exercise
    • Foot over pronation
    • Biomechanical imbalances in the low back or lower limb
    • Previous calf injury
    • Over-weight or general poor condition
    • Older individuals

    DIAGNOSIS

    This is usually clear from clinical examination and history. In some cases and ultrasound may be required to rule out deep vein thrombosis (DVT).

    MANAGEMENT

    This is similar to managing an Achilles tendinopathy.

  • Hamstring Strain/Tear

    HAMSTRING STRAIN/TEAR

    The hamstring is a large group of 3 muscles located in the back of the thigh. It originates from the ‘sit bone’ in the buttock (ischial tuberosity) and inserts either side of the leg, just below the knee. When the hamstring contracts it straightens (extends) the hip and bends (flexes) the knee.

    It can be injured by sudden contraction or stretching of the muscle. This is commonly seen in football, soccer and basketball.

    MANAGEMENT

    As per the approach to all mild to moderate muscle strains the approach begins with RICE, then graduates to stretching and strengthening training.

    RESEARCH

    A recent Macquarie University1 study has shown how chiropractic care can assist athletes with hamstring injuries.

    The study involved two semi-elite Australian Rules Football teams from the Victoria Football League (VFL). The study was undertaken by sports chiropractor Wayne Hoskins and has been published in the journalBMC Musculoskeletal Disorders.

    Dr Hoskins’ study strongly supported the inclusion of chiropractors in the management of hamstring and lower limb injuries.

    The study took place over an entire season involving 59 players that were randomly allocated to an intervention (n = 29) or control group (n = 30), being matched for age and hamstring injury history. Both groups received medical and sports science management, but only the intervention group received chiropractic care.

    Minimum scheduling for chiropractic care was: 1 treatment per week for 6 weeks, 1 treatment per fortnight for 3 months, 1 treatment per month for the remainder of the season (3 months).

    Over the course of the year, only 4% of the chiropractic group had a hamstring or lower limb muscle strain. The control group had 17% hamstring injury and 28% lower limb muscle strain.

    The chiropractic group missed just 4 matches during the season with hamstring and lower limb strains. The group not receiving chiropractic care missed 14 matches through hamstring injury and 21 matches through lower limb muscle strain.

    In addition, the group receiving chiropractic care also had significant reductions in non-contact knee injuries, low back pain and improvements in physical components of health, despite the fact that these were not the goals of treatment.

    This study shows put forward a very strong case for the inclusion of chiropractors on the medical staff of AFL clubs.

  • Hip flexor Strain/Tear

    HIP FLEXOR STRAIN/TEAR

    The hip flexor refers principally to a group of three muscles called iliopsoas. These muscles originate from the front of the lumbar vertebrae and discs and the inside of the pelvic bone (iliac fossa). From deep in the abdomen the muscle runs forward and out to attach on the lesser trochanter immediately below the hip joint.

    Hip flexor strain occurs commonly in athletes involved in sprinting and kicking. This can be a sudden (acute) injury/tear or a repetitive (chronic) strain.

    An iliopsoas imbalance is very common. This is a muscle that is regularly checked and treated, even if a genuine strain has not occurred.

    You have an increased risk of hip flexor strain if you have:

    • Muscle imbalance
    • Pelvic tilting (possibly due to a short leg)
    • Prepared poorly for exercise or perform inappropriate exercise
    • Lack of fitness or fatigue

    SIGNS AND SYMTOMS

    These muscles are situated in the area of the groin and injury to these muscles commonly gives:

    • Groin pain made worse by running or kicking
    • In more severe strains difficultly walking, or walk with limp
    • Weakness of hip flexion (curling knee towards abdomen) – therefore difficulty kicking or walking up stairs
    • Hip stiffness
    • Tender groin

    DIAGNOSIS

    This is usually clear from clinical presentation, but sometimes X-rays, ultrasound or MRI are needed to rule out other possible causes of groin pain.

    MANAGEMENT

    ACUTE PHASE

    • Rest to allow inflammation to settle – crutches and immobilization in severe cases
    • Ice – for 15min each time – especially after activity
    • Gentle stretching if easily tolerated – begin with side-lying stretches rather than lunge stretching
    • Gentle soft tissue techniques to improve circulation and healing
    • Spinal/pelvic/lower limb chiropractic adjustments to improve balance and muscle tone

    REHAB PHASE

    • Gradually improve activity
    • Ice after activity if required
    • Lunge stretching and strengthening exercise
    • Deep soft tissue techniques
    • Spinal/pelvic/lower limb adjustments to improve balance and muscle tone