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Muscle injury

A muscle injury is the rupture of one or all of the muscle fibers, it can be partial or complete.

It is a very common injury in sports, its incidence varies between 10% and 35% of the total number of injuries in the sport. 
The lesions can be caused by:

• By direct trauma if the muscle is affected by a force that comes from outside (for example a football accident), the damage is greater if the muscle is contracted. 
• If it is caused by an indirect trauma , there is no external force, the muscle simply can not stretch too much during a very fast elongation (for example, a vacuum kick that can injure a flexor muscle of the leg: biceps femoris, semitendinosus and semimebranosus ) or a strong contraction of a relaxed muscle.

Assessment of muscle injury

The most affected athletes are those who practice: soccer, football, short distance running, jumping, baseball, bodybuilding.

The muscles that are injured most often are in the lower limbs, especially the twins and those that attach to the knee : the hamstrings (posterior thigh muscle) and the femoral quadriceps. 
The quadriceps muscle is composed of 4 parts, the one that breaks most often is the rectum of the thigh, while the other 3 (vastus lateralis, vastus medialis and vastus medias) usually do not injure themselves.

Players may have a tear in the adductor thigh muscles (on the inside). 
In the arm, the muscles most affected are the biceps brachii, the chest, and the deltoid that can tear at the shoulder level.

A patient with a muscle injury is unlikely to appear in the clinic: 
• Abdominal 
• Dorsal 
• Lumbar (lower back) 
• Trapezius (muscle that lies between the shoulders) 
• Forearm 
• In the hand 
• In the gluteus

Muscle distension (or stretching) is rare in children and the elderly. 
A laceration of the muscle fibers causes an important blood shed, in less serious cases remain confined within the muscle, but in the most important cases a hematoma forms because the muscle is very vascularized. 
The lesion usually forms at the ends of the muscle, rarely seen in the center of the muscle belly.


Muscle quadriceps and anterior thigh © Andreas Meyer / Fotolia.com

Causes of Muscle Injury

The reasons that lead to an injury can be many. 
The external factors are mainly the low temperature and the non ideal field of play.

The internal factors are:

• Muscle imbalances 
• Inadequate heating 
• Low training level 
• Lack of elasticity 
• Previous muscle injuries 
• Fatigue caused by excessive exercise, followed by a very brief recovery

Among the small causes we found the lack of mineral salts, poor execution of athletic movement and poor coordination.


Symptoms of muscle injury

The American Medical Association (Craig, 1973) divides muscle injuries into three different levels in this way:

  • First-Degree Injury :  Stretch muscle that causes the breakdown of  some muscle fibers .
  • Second degree injury : wear of a part of muscle fibers, but without complete interruption of muscle.
  • Third degree injury : complete rupture of the muscle.

In first-degree injuries, pain is minimal, aggravated by exercise and stretching of the muscle, movement and strength remain almost normal. 
The pain appears after the end of the workout.

In second-degree lesions, pain is more intense because damage affects a larger number of fibers compared to minor lesions. 
The pain occurs immediately, as soon as the training begins, but the athletes after warming can finish the training or the competition without great discomfort, this is very risky because continuing the activity, the clinical picture can worsen. 
When the muscle is cold, the symptoms appear with contraction and stretching. 
We can notice a lot of stiffness in the affected part of the body.

A third degree injury is the rupture of the muscle or most of it. 
The pain is very intense and prevents the continuation of the competition or the training, also feels tightening on the affected area. 
In the injured area a large hematoma appears. 
During palpation, a depression is felt at the level of the lesion. 
Rarely does the patient have a fever after a serious injury.


Diagnosis of muscle injury

It is essential to seek the medical specialist who knows how to make the correct diagnosis and assess the severity of the case because the treatment varies according to the type and size of the injury. 
For the instrumental diagnosis of muscle injuries, ultrasound  of the muscle is usually performed to locate the area of ​​the lesion and its size. MRI
is rarely performed .

The problem is that deep lesions can be found in very developed muscles such as those of athletes (for example in the quadriceps of a football player).

Shoulder Ultrasonography

In these cases, the clinical examination should be based on the patient’s clinical history, at the time when the pain arose (during or after training), the type of nuisance (localized or diffuse) and what feels during palpation.

If an athlete says that the pain occurred after training and spread, it is likely to be only a contracture , while if you could not finish the race or training because of the symptoms and feel a depression during palpation, we can think at one injury .


What to do? The treatment

The treatment of muscle injuries is customized according to the type and size of the injury. 
A prescription is required to begin treatment for physical therapy that speeds healing, reduces scarring, and helps prevent recurrence.

Kinesio taping : Action: Relaxation. Shape: a strip to ‘Y’. Length: under the heel to the popliteal cavity. Apply the tape without tension, starting just under the heel and putting on stretching the calf. With the tape wrap the outside of the twins’ muscular wombs.

In the case of an anatomical lesion, the treatment in the first 24/48 hours consists of the REST protocol (rest, ice, compression, elevation) or is a treatment that prevents the worsening of lesions and inflammation. 
This protocol involves : Rest, ice 3/4 times a day for 20 minutes, bandage and elevation of the limb. 
Generally, doctors recommend muscle relaxants and analgesics, the latter is preferable to anti-inflammatory drugs (NSAIDs) because  post-injury inflammation is a physiological mechanism of repair of the human body, so it should not be harmed with these drugs.

The athlete will have to stay away from the field for a variable time depending on the size of the injury, from one week to two months. 
In case of distension , the muscle repairs the lesion to form a fibrous scar tissue, that is, a less elastic tissue of the muscular one. 
After the first day of the trauma, deep transverse massage (or cyriax) and cautious mobilization is needed to maintain muscle elasticity and help align the fibers of the scar tissue. 
It is important not to massage the area of ​​the lesion until it does not form the scar because it can worsen the clinical condition, it is possible to massage only in the upstream and downstream area.

The principle of eccentric contraction is that the injury usually occurs with this mechanism, so it is necessary to accustom the muscle to resist those conditions characterized by anaerobic work.

If the muscle is immobilized, the scar is formed by fibers that can go in any direction, but if the muscle continues to move, the fibers of the connective tissue that form have an arrangement according to the lines of force and are more elastic. 
In cases of complete rupture of the muscle, it is necessary to consult a surgeon, because surgery may be necessary (very rare ).

Capacitive and Resistive Power Transfer for Muscle Contusion

It is indicated the instrumental physiotherapy with Laser , Ultrasound and  Capacitive and Resistive Energy Transfer , only the lesion is healed, an activity is required to make the muscle more elastic and to avoid relapses, so it is important the eccentric stretching and strengthening.


Is it better the heat or the cold?

In the 24 hours after the injury we can only put a block of ice to cool the area a bit. 
After one day, it is advisable to keep the hot water bag to facilitate the absorption of the hematoma and the formation of fibrous tissue that replaces the muscle.


Prognosis and recovery time

It is necessary to avoid races and training very early, it is recommended to perform an ultrasound  at the end of the treatment cycle, if the injury is not healed does not need to stop the physiotherapy, because it runs the risk of increasing the severity of the problem.

The principle of eccentric contraction is that the injury usually occurs with this mechanism, so it is necessary to accustom the muscle to resist those conditions characterized by anaerobic work. 
The ultrasound  shows the size of hematoma formed because of the injury, but the slot size may be smaller and is not seen because the blood hiding injury.

The recovery time for a torn muscle is about 1 mm per day, but it is necessary to read the ultrasound report well. 
The treatment reduces blood shedding by 1 mm each day, but we can not have accurate data on the lesions.


Is it possible that the pain remains even if the last ultrasound showed that the lesion is healed?

Yes, it depends on the size of the injury, but with lesions of about 2 cm or more, it is normal to have discomfort. 
Usually players resume their training competing as before, start with a differentiated training and gradually return to normal activity. 
The pain or discomfort usually goes away within a month or two.

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