Muscle Injuries Muscle Tear Muscle Strain

A muscle tear or muscle fiber tear (muscle injury) refers to the tearing of individual or all fibers of a muscle.

The muscle injury is one of the typical sports injuries and accounts for 10-35% of all sports accidents.

Muscle injury can be caused by:

  • Through a direct trauma , whereby external force is applied to the muscle (e.g. a press blow in soccer ); the damage is greater when the muscle is tense.
  • By an indirect trauma; no external force is involved here, the muscle simply isn’t able to stretch sufficiently in a hasty stretch (e.g. in soccer, a missed shot (missing the ball) can injure one of the hamstrings: hamstrings, semimembranosus, and semitendinosus), or there is a sudden contraction of a relaxed muscle.

This muscle injury is more common in some sports: soccer, American football, sprinting, high jumping, baseball, and bodybuilding.
Mostly the muscles of the legs are affected, especially the calf muscles and the muscles that attach to the knee : the ischiocrural muscles (at the back of the thigh) and the thigh quadriceps.

The quadriceps of the thigh consists of four muscle heads, of which the straight muscle of the thigh ( rectus femoris muscle ) is the most prone to injury, while the other three (external broad muscle ( vastus lateralis muscle ), medial broad muscle ( vastus medialis muscle ) and middle wide muscle ( Musculus vastus intermedius )) usually do not suffer any injuries.
In football players, the adductors of the thigh (inside) can suffer a muscle tear.
In the upper limb muscles, the biceps, pectorals and deltoids are the most affected and can tear at shoulder level.
You are unlikely to see a patient in the doctor’s office with torn muscles in the following muscles:

  • abs
  • back muscles
  • Lumbar muscles (lower back)
  • trapezius muscle (between the shoulders)
  • forearm muscles
  • The hand muscle
  • Buttock muscle

A muscle tear is rare in children and the elderly.
A rupture of the muscle fibers also involves a considerable leakage of blood, which in the milder cases remains circumscribed intramuscularly; in the case of more severe injuries, on the other hand, a bruise ( hematoma ) forms due to the good blood circulation in the muscles .
The lesion usually occurs at the ends of the muscle, rarely in the center of the muscle belly.


Causes of a muscle fiber tear

There are many causes of a muscle injury.
External factors include, above all, low outside temperatures and unsuitable ground conditions.

Internal factors include:

  • muscular imbalances,
  • insufficient warm-up period,
  • insufficient level of training,
  • lack of elasticity,
  • previous damage to the muscle,
  • Muscle fatigue from overtraining followed by short recovery periods.

Other causes are a lack of mineral salts, poor technique in sports and poor coordination.

Muscle rupture symptoms

The American Medical Association (Craig, 1973) classifies muscle injuries into three degrees of severity:
First-degree injury: strain of the musculo-tendon unit, in which individual muscle and tendon fibers tear;
Second-degree injury: part of the muscle fibers are torn, but the discontinuity of the muscle-tendon unit is not complete;
Third-degree injury: complete tear of the muscle-tendon unit.

With injuries of the first degree, the pain is minimal, with active movement and muscle stretching it increases; Range of motion and muscle strength are not subject to any particular restrictions.
The pain occurs after exercise.

In second-degree injuries, the pain is more severe because a higher percentage of muscle fibers are torn.
The pain occurs immediately when training begins, but athletes are able to complete the training or match/competition without major discomfort after warming up; but this is exactly where the problem lies, because the ongoing physical activity can worsen the clinical picture.
When the muscle is cold, the symptoms appear as the muscle contracts and stretches.

In third-degree injuries, the muscle is completely or mostly torn.
The pain is very severe, it makes it impossible to continue competition, play or training, and it can also be felt when pressing on the affected area.
Extensive bruising appears over the area of ​​the tear.
When palpating, a dent can be felt at the injured area. In rare cases, the patient has a fever
as a result of a major injury .

Diagnosis of a muscle fiber tear

It is important to see a specialist who is able to make the correct diagnosis and assess the severity of the injury, because the extent of the damage determines which therapy to use.
As an imaging method for diagnosing muscle injuries, a tendon-muscle ultrasound is performed, on which the exact location and size of the injury can be localized.

In rare cases, magnetic resonance imaging is performed.
It becomes a problem with deep injuries in highly developed muscles, such as those found in athletes (e.g., a soccer player’s thigh quadriceps).
In these cases, the clinical examination is based on an analysis of the medical history, when and how the injury occurred (during or after exercise), the nature of the discomfort (localized or diffuse), and sensations on palpation.

If the athlete reports diffuse pain that occurred after training, it could just be a muscle tension ; if, on the other hand, he was unable to finish training or competition because of the pain and a dent can be felt on palpation, a muscle tear is suspected.

What to do? Proper treatment of muscle stretching

The treatment of muscle injuries depends on the type and extent of the damage.
A doctor’s prescription is required to start physiotherapeutic therapy measures that help to accelerate the healing process, prevent or reduce scarring and prevent relapses.

Kinesio taping : Effect: relieves tension. Shape: a “Y” stripe. Length: below the heel to the hollow of the knee. Apply the tape without tension; start slightly below the heel, stretch the calf and cover the outer area of ​​the calf muscle bellies.

In the case of a muscle injury, the LUCK rule should be applied for the first 24-48 hours (rest, ice, compression, elevation); The aim is to limit injury and inflammation.
The initial treatment includes the following: immobilization, cooling 3 to 4 times a day (exposure time approx. 20 minutes), bandage and elevation of the injured part of the body.

Pharmacological treatment
Doctors usually recommend muscle-relaxing drugs (muscle relaxants) and painkillers (analgesics); the latter are preferable to anti-inflammatories (NSAIDs) because inflammation resulting from injury is an endogenous repair mechanism that would be disrupted by these drugs.
If the patient has a major tear in the calf muscle (such as the gastrocnemius, or internal head of the calf muscle) and needs to use crutches, the doctor will prescribe heparin (an anticoagulant) until weight bearing can be restored in the injured leg.
In this way, deep vein thrombosis can be prevented.

Natural remedies, rehabilitation gymnastics and physiotherapy
The athlete should take a break from sport for a while; the sports break will last from one week to two months, depending on the extent of the injury.
As the injury recovers, the muscle forms a fibrous scar structure, which is scar tissue that is less stretchy than the muscle fibers.
A few days after the trauma, transverse friction massage ( Cyriax ) and careful mobilization help to maintain the elasticity of the muscle and align the fibers of the scar tissue.

It is important not to massage the area of ​​the injury until the scarring is complete or there is a risk of it getting worse. A massage may only be done in front of and behind the injured area.

The principle of eccentric contraction is that injury usually occurs through this mechanism, so the muscle must be trained to withstand this anaerobic working condition.

Video of an eccentric hamstring flexor exercise; the muscles are tensed during the extension movement to slow the fall.

If the muscle is immobilized, the fibers can point in all directions when the scar forms; On the other hand, if the muscle remains in motion, the fibers of the newly formed connective tissue align themselves with the lines of force and will later be more elastic.
In the case of a complete muscle tear, a surgeon must be consulted as surgery may be necessary.

CO2 laser,  ultrasound  and  Tecar therapy are used as apparatus-based, physiotherapeutic treatment measures; once the injury is closed, stretching exercises and eccentric muscle building exercises must also be performed to increase muscle elasticity and prevent relapse.

Treat with heat or cold?
Within the first 24 hours after the injury, the injured area can be cooled with an ice pack.
A hot water bottle should then be applied to promote absorption of the bruise and formation of muscle-replacing fibrous tissue.

prognosis and aftercare

So that training and competitions are not started prematurely, a subsonic examination should be carried out after the end of the therapy; if the injury has not yet completely healed, physiotherapy must be continued, otherwise the situation could deteriorate again.

The principle of eccentric contraction is that injury usually occurs through this mechanism, so the muscle must be trained to withstand this anaerobic working condition.
The ultrasound will show the amount of bruising that has formed as a result of the injury, but the muscle tear may be less extensive and difficult to see because the lesion is obscured by the blood that has leaked out.
The healing time for a muscle tear is about 1 mm per day, but the results of the ultrasound examination must be analyzed carefully.
The therapies provide a 1mm reduction in bruising per session, but they do not provide accurate information about the lesion.

Is it possible that pain remains even though the last follow-up ultrasound shows that the muscle tear has closed?

Yes, it depends on the size of the injury, but with lesions larger than 2 cm it is quite normal to experience discomfort.
Football players usually find their way back to their normal training and playing activities; First you start with a differentiated training and gradually you return to normal activity.

Pain and discomfort usually go away within one to two months.

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