It's really important to keep the healing process in mind when you think about treating your
hamstring strain or a hamstring strain. So, what happens is: Day of injury, you pull the hamstring.
You’ve actually torn some of the muscle fibres in there. So, even if it's a very mild strain,
you've still torn a few of the muscle fibres or the muscle cells. If you've got a severe strain,
you've torn quite a significant portion of them. Now, the first thing that has to happen is that
those broken cells – the debris of the injury – have to be taken away so that the new ones can
form. And what happens is, because you've got bleeding in there, a clot forms. So,
think of it as an internal scab, nearly, of that area. And you have loads of little inflammatory
cells that come in. And inflammation is the way that the body gets rid of the debris. So, the
inflammatory cells absorb all the broken cells, and that's why inflammation is actually a really
important part of the healing process, and you shouldn't be taking anti-inflammatory medication
within the first three days, three to five days of sustaining a muscle injury. There is some research
out there to show that if you heavily suppress the inflammatory phase with anti-inflammatories during
that first period, you can actually slow down your healing process or make it sub-optimal healing.
On that note, people always ask me about … ‘What about ice? Because ice also
decreases inflammation.' Ice has a very short action when it works, and ice also,
in the acute phase, you use it more to stop the bleeding. Because if you get excessive bleeding,
you can actually get more damage. So, you don't apply ice for hours on end, where
anti-inflammatories are in your blood for six to eight hours. So, there's a big difference between
the two. It's safe … a lot safer to use ice for stopping the bleeding and stuff and limiting the
extent of your injury, but try to stay away from anti-inflammatories. If it's really,
really painful, maybe ask your doc if you can use paracetamol or something like that instead,
because it's not an anti-inflammatory action. But that's enough about that now. Okay, so you've got
your inflammatory phase for the first three to five days, and during that phase they're just
cleaning up the building site basically, and the blood clot forms in there, and that blood clot
is gonna act as scaffolding for the new cells to come and attach to. So, during that phase,
you can imagine that this injury site is quite sensitive. So, if you're gonna over stretch it
or you're gonna be too rigorous and try to really strengthen it up in that first period, you're just
gonna injure it, because it's pretty weak at that point. Now, how long this inflammatory phase lasts
for really depends on how big an injury you've got. So, if it's a mild strain, that you could
continue jogging with lightly or pretty much walk as normal afterwards, it'll only be a day or so,
but if it's one with ... makes you limp and five days later you're still struggling to move,
it can last five days or so. Okay, so then, after that … after day three to five, your body
starts forming new cells and these cells come and attach to that scaffold in there – the blood clot.
But these cells are not strong yet, and they are not orientated in the correct way. Because when
we think about the cells in the muscle, they've got to be aligned parallel in the direction of
force where they're going to work – that's what makes them strong. So now, they are kind of being
laid down as spaghetti, and that's a scar tissue for you. But now, if you tension that scar tissue
carefully to show it in which direction you want it … So, for instance, imagine this is my leg and
this is my hamstring … If I say to it ‘Come on, I'm just moving my leg gently in this direction.’
So, we're putting the muscle under a little bit of strain there. It's telling the muscle fibres
to align in the direction that you want to use them and that's how you create a strong scar. So,
from day three to five new cells form, for about three weeks, that process takes. And loads of
new cells are created in the area. But also, the third phase is remodelling – getting them aligned
in the right direction that you want them, getting them strong enough for what you want them to do.
And that remodelling phase can last anything from a few weeks to a few months, depending on how bad
your injury was again. And during the remodelling phase, that's where rehab really is important,
because you're aligning the cells in the direction you want them to be,
but you also ... Think of them as little skinny things that's formed at first, and then
the progressive rehab program, every time you do an exercise that's a tiny bit harder than what
it's used to, but not too hard, the body goes ‘Oh, you actually want them to be stronger!’
and it rebuilds them fatter and stronger, and it can cope better.
And then, as soon as you're used to that level of rehab, we up the rehab a tiny bit,
and the body goes ‘Oh, you actually want them to have better endurance and be a bit stronger
still!’ and it makes it stronger. So, that's the process why it's important to have a progressive
rehab program, where you start with very gentle exercises, sometimes just range of movement,
getting it going, and eventually ending with quite strong things. Because you can't go from
doing nothing to strong. That's why rest doesn't work, because you need this bit in the middle
to slowly and progressively strengthen those new cells that are being formed.