Stage  1  2  sessions    

• ACUTE  INFLAMMATORY  NECROTIC  PHASE    • Day  0-­‐3  • Immobilisa7on,  ice  and  rest  helps  control  ini7al  bleeding  and  inflammatory  response,  protects  from  further  mechanical  insult  

• I  session  is  required  for  acute  care.  A  second  followup  session  if  imaging  is    required  or  DVT    risk  • Followup  call  to  pa7ent  next  day  or  review  app.  Statement  of  advice  emailed  to  pa7ent  next  day  if  necessary.  • Management  -­‐  Complete  rest,  non  weigtbearing  if  possible,      boot?,    Strapping,  ice,  compression,  immobilise  muscle  in  painfree  lengthened  posi7on  if  possible.  Adust  painfree  lengthened  posi7on  day  2.  

Stage  2  2-­‐3  sessions  

• LATE  PART  OF  INFLAMMATORY  PHASE  BEGINNING  OF  PROLIFERATIVE  PHASE  • Day  4  • Early  mobiisa7on    promotes  more  capilliary  ingrowth  as  well  as  bePer  muscle  fibre  orienta7on  •   2  -­‐  3  supervised  sessions  are  required  to    teach  exercises,  ensure  that  volume  is  appropriate  and  technique  is  correct.  Some  support  tape  may  be  required.  

• Management  -­‐  Teach  pain  free  stretch,  exercises  to  maintain  fitness,  incuding  upper  body  and  core  strength  program,  massage  to    uninvolved  part  of  muscle,  strapping  ,  unassisted    ambula7on  if  painfree,  stretching  to  uninjured  musles  

Stage  3  2-­‐3  sessions  

• REGENERATIVE/REPAIR/PROLIFERATIVE  PHASE  • Approximately  day  7-­‐10  • No  pain  with  moderate  stretch  and  normal  amula7on  • Early  mobilisa7on  promotes  more  capilliary  ingrowth  as  well  as  bePer  muscle  fibre  orienta7on  • Visits  2-­‐3  are  required  for  exercise  prescrip7on  to  ensure  volume  is  appropriate  and  to  ensure  technique  is  correct,  massage  to  affected  muscle,    

• Basic  concentric  and  eccentric  strengthening  for  involved  muscle      including  use  of  pilates  bed,  general  strengthening  and  more  advanced  cardiovascular  condi7oning,  stretching  to  uninjured  muscles.  

Stage  4  3  sessions  

• CONTINUATION  OF  THE  REGENERATIVE  PHASE  AND  START  OF  THE  REMODELLING  PHASE  • Approximately  day  14  -­‐  21  • Progression  of  weight  training  to  func7onal  and  ac7vity  specific  ac7viites  including  co-­‐ordina7on  drills  and  plyometrics  

• 3  visits  are  required  for  exercise  prescrip7on  to  ensure  volume  is  appropriate  and  to  ensure  technique  is  correct,  massage  to  affected  muscle  

Stage  5  1  session  

• FITNESS  TEST  • Approximately  day  21  -­‐  35  • 1  visit  is  required  for  fitness  test  -­‐  check  range,  concentric/eccentric  strength,  func7onal  strength,  sports  specific  ac7vity  

LOWER  LIMB  MUSCLE  TEAR  PROTOCOL