Soft tissue injury scar removal, hamstrings

Date: 1/13/2002
"I'm a university student with a fair amount of scar tissue development on a few 2nd degree hamstring tears. I can't afford massage therapy and physiotherapy more than once every one or two weeks. What can I do at home or at the gym to help speed up the scar tissue removal process?

Thanks,

Chris"

Hi Chris;

“RayMac” had some interesting suggestions for you to try. He uses balls for compression on trigger points in his hamstrings and gets some relief from that. Compression is the correct method to relieve trigger points. There are several timing options when utilizing compression for TPs that seem to work. Minimum of 7-15 sec per TP repeating 3x each spot is one way to address them that works effectively. “RAYMAC” found that 60 sec 1x worked to relieve his. Trigger points are not the same as scar tissue. They are usually found in muscles, tendons, ligaments… as a secondary occurrence after injury or due to biomechanical dysfunction or overuse or …..

Myofascial Pain and Dysfunction, the Trigger Point Manual, vol.s 1 and 2 by Janet Travell and David Simons are the definitive texts on Trigger Points and various treatment plans for them. Expensive books, more in depth information than a non-practitioner would generally want to have.

I'm a sports massage therapist in Santa Monica, CA who works with all kinds of folks, including athletes, with an emphasis in my practice on recovery, optimum performance, injury prevention and when that hasn't happened for whatever reasons, clinical applications to hasten soft tissue healing. I'd like to clarify a few concepts to perhaps enhance your effectiveness in attempting to rid yourself of the adhesions in your hams. “RAYMAC” mentioned that he had some ART treatments for the problem in his hamstrings. We don't really know from his post what the diagnosed problem in his hamstring was, however. In your case, you specified 2nd degree hamstring tears with subsequent scar tissue development. I assume from this description that you had a medical diagnosis. Always a good idea in sports injuries, especially after an impact injury or loud pop. (Only partly kidding)

I'm also assuming that your medical insurance doesn't cover your prescribed therapy. Too bad. If it did, you could contact Michael Leahy's center in Colorado to see if he's certified any Rpts or DCs in your area that use ART effectively for lower body problems, thereby getting good deep tissue work with a practitioner that insurance would pay for. With that approach you might be able to sustain a weekly or twice a week frequency with the deep tissue work and augment that by utilizing skillful rehab exercises to eradicate the schmutz remaining in your hamstring. There are other forms of deep tissue work that would be effective to help with the removal of the adhesions as well, but ART (Active Release Technique) certainly can be a skillful approach.

If you don't work it out effectively old adhered tissue within a muscle can weaken it, due to cross-linked strands, unable to fully relax or contract under load. They feel to the touch like sausages in your steaks, if you don't mind my food metaphors. In hams they can be down deep near the bone, in bellies or at tendon origins or insertions. They can be thick in bellies like sausages, or more like gristle stranded like fettuccini noodles through the muscle where the tears healed but adhesions remain, thus reducing your well sculpted tri tip into an old stringy chuck steak.

Here are a couple of ideas I'll throw at you. If you have a friend or mate you could enlist to help you, ask that person to use a frozen Dixie cup full of water with the lip peeled away 1/2" to trace along the path of the adhesion, stopping at each new Dixie cup width for a moment while you contract the hamstring. Obviously you are laying prone for this protocol, with a towel under the leg to catch the drips. Start with a straight leg and bend it up in a controlled, strong, but not too fast contraction while your friend holds the ice cup firmly into the adhesion, not giving way as you contract. Hurts a bit but you are in control of how much by the intensity and duration of your contraction. Make a few passes through the ham, covering the entire adhesion with your Active Release Ice treatment. That could be followed by some lengthwise stripping strokes with same ice cup or deep transverse friction strokes across the site of the lesion with ice cup and along its length as above. Follow the whole thing with 15 min on an ice pack and repeat every other day.

If you want to be really slick you could do this protocol after a rehab training session for the hams, 2-3x/week, depending on how well they recover from your last session. One way to improvise a training regime, if you have not already been prescribed one specifically by your physical therapist would be to use the eccentric training paradigm written up on Testosterone.Net for Achilles tendinosis and apply it to your hams. Choose exercises that cause you NO pain. After injury it is important that you train without pain. This does not mean that it hurts less as it warms up but at first is quite painful. That is how adhered tendons behave, so no pain all the time is a must.

Pick weights that you can do pain free, probably on equipment, for this stage of your training. EG seated or prone leg curls, contract with both, lower with injured so the increased load occurs only on eccentric. Or use the glute ham machine if it is second stage rehab or you are very strong there foundationally. This method was studied and found effective at removing adhered tissue in tendinosis when the adhesions were in the Achilles tendon, as you'll read in the article on Carleton Sports Medicine Clinic’s page, but I've seen a basketball player work very old schmutz out of his gastroc bellies using these eccentric emphasis training regimes quite effectively with a minimum of body work just to jump start the process, so to speak. Old bound up adhesions are more stubborn to eradicate in my experience than fresh stuff. I saw him once and we did deep work on them followed with ice, then he trained the calves eccentrically followed with ice and a month later when he returned for another session they were greatly improved. At that point the work I did was on tissue already softened and much less schmutz remained to be worked out. We were both happy with the result. It hasn't come back either, been about a year. Anecdotal, I know, but for what it's worth, provides an example of how you might do much of it yourself with a minimal of hands on work to finish clearing it out.

Always get plenty of water & protein, vitamins, anti-oxidants when you are healing injuries. MSM, EPAs EFAs, glucosamine/chondroitin can help recovery, regeneration of connective tissue. Avoid using it in ways that hurt while you are using these methods to clear out the adhesions as it is being temporarily weakened by the deep tissue work with a specific healing goal in mind. This can take anywhere from 3 to 12 treatments to get the schmutz out. Depends on how much schmutz there is, how fast you heal, diabetes can slow down recovery, if you re-injure it in the meantime, overuse, ??? Very few of my clients require 12 sessions to get the schmutz out, very few get it out in less than 3.

Good luck with this little project,
Di
Dianna Linden, M.T., M.S.S.
di@diannalinden.com