Elements Phsio hex logo

Hands on therapy versus strength work?

Always remember your principles of injury, inflammation and recovery
Hands on therapy versus strength work?

A common question I get asked for all injuries. Always remember your principles of injury, inflammation and recovery.

In a simple ankle sprain scenario damage occurs, its repairs via an inflammatory process that develops a scar / replaces the injured tissue. The time period for this to take place is dependant on the extent of damage in terms of which structures are involved and how much of the structure is damaged.

For example, muscle heals quicker than tendons, tendons heal quicker than nerves.

Diagnosis is key to recovery. Hands on work helps manage pain, swelling, muscle spasm and joint stiffness. It facilitates ‘normalising the injury site’ and all hands on techniques, needling, massage, mobilisation, manipulation etc all utilise the same principles.

Strength work is aimed at returning muscles, tendons, ligaments and joints, as well as balance mechanism, to normal function so you can use the joint to its full potential again.

Both Hands on therapy and Strength work prescription are vital parts of injury recovery, which is why in Elite Sport they are utilised as a combined approach to fast track recovery.


  • Grade II Calf tear whilst skiing
  • Grade II = 30% of fibres of the medial gastroc head involved
  • Rotational tear at musculotendinous junction
  • As tear site was at the border of the muscle and the tendon it increases the healing time
  • Mike is a keen runner 5-10km distances
  • Return to run time approximately 6 weeks

Initial management

  • Testing to determine extent of tear
  • Heel raise in shoe to allow tear site to heal supported and in a shortened position
  • Compression to minimise the bleed at the site of tear
  • Walking limit, no walking for more than 10 minutes at a time for the first week
  • Hands on flush to injury site to flush out inflammation 
  • No stretching, isometrics exercise to normalise walking

2 weeks 

  • After 2 week subsequent sessions to retest and check our diagnose is correct, ensure the tear site is supported with tape to allow pain-free walking, mobilise the scar tissue, and start to increase the strength work.

Mike had to complete 2-3 daily exercise sets as well as cycling and walking sets to ensure he was getting the calf strong enough to return to running at 6 weeks.

From 5 weeks he started a walk run program again allowing adaptation of the tear site.

Good rehabilitation means when you return to running you complete distances with no failure in the injury site and no further tear but you have to work hard.

Sign up to our newsletter