How much rest does grade 1/2 hamstring tear need

[2laptango]

Hi I am hoping someone can help me. I have a patient who has pinpoint tenderness in the belly of the hamstring. She felt the pain after a running session and came to me about 4 days after the event. She has a lump in her hamstring but is unsure if she always had this. I did some work and she responded very well. After 10 days she went back training but as the intensity increases she would get pain again.
This cycle has gone on for 3 weeks now, get treatment and have no more symptoms and then later in the week hurt her leg. My question is this how much rest does this athlete need and what type of treatment to remove the pain and the strong chance of reoccurence?

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[gcoe]

Hi 2laptango

My question is this how much rest does this athlete need and what type of treatment to remove the pain and the strong chance of reoccurence?

Two things come to mind:

* If your diagnosis is right then perhaps she is more at the grade 2 than grade 1 end of things. In which case the you are looking more at 3 weeks of rehab and perhaps you are letting her overload the muscle. You keep setting back the clock if you do this. What have you done for her sofar?

* Your diagnosis is may be wrong. what is the basis of the diagnosis part from focal tenderness and presence of a lump? could it be more of a myofascial triggerpoint? How does it respond to treating the TP? Have you ruled out the back?

* Have you looked at other important factors that go hand in hand with hamstring tears? - often need to be addressed if you aren't making progress:

• Lumbar degenerative joint disease - check out the back and also the extensibility, often diminished
  
• Biomechanical issues - excessive anterior pelvic tilt alters the length relationship (too long), what about runners, leg length inequalty
  
• Anterior tilt of the innominate bone on the injured side increases muscle tension in the hamstrings due to increased length between origin and insertion and may result in decreased hamstrings. Appropriate manipulation of the SI joint to correct the rotation of the inominate can improve hamstring strength http://physicaltherapyjournal.net/cg.../66/8/1220.pdf
  
• Muscle imbalance issues eg short hip flexors and erector spinae and weak glut max and abdominal muscles