Rest prevents worsening of the injury. Place the injured knee to rest the first few days after the trauma, this can prevent the formation of a large gap within the muscle, reduce the size of the hematoma, and the size of the connective tissue scar. A short period of immobilization accelerates the formation of granulation tissue at the site of injury during the initial phase. Gradually mobilization should be started to optimize the healing by restoring the strength of the injured muscle, preventing muscle atrophy, the loss of strength, and extensibility.
Ice therapy lowers the intra-muscular temperature and decreases blood flow.
Compression wrap or bandage can help to decrease both blood flow and excess interstitial fluid accumulation. It aims to prevent hematoma formation and interstitial edema, thus decreases tissue ischemia.
The elevation of an affected leg above the level of the heart results in a decrease in hydrostatic pressure, and also reduces the accumulation of interstitial fluid, so there is less swelling at the place of injury.
Ultrasound helps to enhance the process of healing. It produces the thermal effect, which is of benefit to chronic muscle strains, it also reduces inflammation and promotes healing, which can help with an acute injury.
Transcutaneous electrical stimulation (TENS):
Transcutaneous electrical stimulation (TENS) can be used to decrease pain and swelling. It can help pump out inflammation, reduce pain, and desensitize nerve fibers. It also can strengthen muscle and re-educate.
Shockwave therapy is used to produce an improvement in healing and regeneration by a single acoustic wave impulse which stimulates healing of soft tissue, mainly by inhibiting the function of afferent pain receptors and increasing angiogenesis. Therefore, it increases blood flow by inducing a healing process mediated by the generated inflammatory process
Mobilization is done to restore normal pain-free movement of the leg. The areas above and below the injury site are mobilized initially. It should be carried out gently and initially do not mobilize over the site of injury. But as the pain decreases, mobilization over adjacent sites to the injury can be started gently.
Active range of motion exercises:
Active range of motion is done once the injured leg is recovered well. This phase includes simple range of motion exercises like knee flexion extension, ankle movement, and toe movements. But before starting with AROM exercises passive movements are recommended.
Stretching exercises should be done carefully to the point of discomfort, but without pain. This includes techniques such as passive, active-passive, dynamic, and proprioceptive neuromuscular facilitation stretching. e.g. Static quad stretch, hip flexor stretch, etc.
Strengthening exercises are done to gradually increase the load that is put through a muscle. Initially, isometric or static exercises are advised, then progress to low-level pain-free exercises and then to advanced exercises with the resistance band and finishing with sports-specific running and sprint drills. Strengthening exercises can also be done in an aquatic pool by using the resistance of water.
Isotonic exercises are begun with the lightest free weight, 3 sets of 10 repetitions up to 3 times a day. Terminal knee extensions at 20 degrees, increase as comfort and knee flexion allows. Once terminal knee extensions are done properly without extensor lag, free weights are added to the SLRs and terminal knee extensions, weight is increased slowly.
These exercises include higher velocity eccentric exercises that include plyometric and sports specific activities such as squat jumps, split jumps, bounding and depth jumps, single leg bounding, backward skips, lateral hops, lateral bounding, plyometric box jumps, eccentric forward pulls, eccentric backward steps, eccentric lunge drops, single and double leg deadlifts, etc.
Isokinetic exercises are very high-intensity exercises such as swimming, running, treadmill walking Isokinetic strength testing should be performed under both concentric and eccentric action conditions.