Muscle Strain PDF

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Muscle Strain Common in contact sports such as football and rugby union. Hamstrings are the most frequent injured muscle group (females more than males for being quad dominant) CAUSES  Failure to cope with demands placed upon the muscle Commonly affected:  Hamstrings  Quadriceps  Gastrocnemius What do these have in common?  Biarthrodial (crosses 2 joints)

**Explain and expand on these points** CLASSIFICATION  Grading system  British athletics muscle injury classification

GRADES OF MUSCLE STRAIN Oxford Scale to test.  Grade 1 (Minor)  Small number of muscle fibres  Localised pain (during or after activity)  No loss of strength  Grade 2 (Moderate)  Significant number of muscle fibres  Pain  Swelling  Strength decrease  ROM limited  Grade 3 (Severe)  Complete tear of the muscle  Most frequent at musculotendinous junction (MTJ)  Sudden onset pain  Decreased ROM at 24hrs  Muscle weakness  Pain on walking BRITISH ATHLETICS MUSCLE INJURY CLASSIFICATION  Minor, moderate and severe – lack diagnostic accuracy + provide limited prognostic information  Diagnostic base for clinical decision-making + aid prognosis

 Injuries are graded on extent (grades 0–4)  Grades 1 – 4 further sub-categorised based on location / MRI investigation  Waiting time for access  Expense  Primarily developed for hamstring muscle strain The British Athletics Medical team have therefore developed a muscle injury grading system that has a clear diagnostic framework and uses the available prognostic evidence to assist in classification. It has been primarily developed as a hamstring injury classification, influenced by the literature in this field, but with potential to be extrapolated for use in other muscle injuries.  Grade 0A  Focal muscle soreness  After exercise - may also occur during exercise  No or little strength inhibition on manual testing  Palpate focal area of ↑ muscle tone  MRI - negative muscle injury  Microscopic muscle damage  Grade 0B  Generalised muscle soreness  Common after unaccustomed exercise (DOMS)  MRI normal  Grade 1 Small injuries (tears)  Grade 2 Moderate injuries (tears)  Grade 3 Extensive tears  Grade 4 Complete tears

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Grade 4 injuries are complete tears to either the muscle (Grade 4a or 4b) Compete tear to the tendon (Grade 4c) – no movement Sudden pain onset – nerves gone also – complete rupture Significant + immediate limitation to activity Often palpable gap May be less pain on contraction than grade 3 injury – nerve endings come away with the tendon

A) Myofascial injury – in the belly

B) Within muscle (usually at MTJ) C) Extends in to the tendon

STAGES OF HEALING Phases can overlap **Hematoma = a solid swelling of clotted blood within the tissues  Bleeding  0-6 hours  Inflammatory  Marked hematoma post injury  Myofibrils contract  Proliferation (repair)  Regeneration of myofibres (muscle fibres)  Production of connective scar tissue  Type 3 (no order) to type 1 (parallel)  Collagen – framework of tissue  Expose the tissue to regular movements (stretching, optimal loading, massage, exercise prescription)  Remodelling  Maturation of regenerated myofibres  Reorganisation of scar tissue (by exposing to load to strengthen the tissue) Example.

Grade 2 bicep femoris strain (footballer)  Subjective Assessment  When did it happen (stage of healing theyre in)  How did it happen (training/playing)  Did you carry on? Condition of the game? (weather/indoor,outdoor)  Position?  Part of the game? – fatigue, conditioning,  Pain? VAS. ROM in joint. Flexibility in muscle. Strength in muscle.  Medical history – injuries? ACUTE MANAGEMENT  Ice + Compression  Immobilization – depending on injury severity  Mobilisation + motion  Avoid aggressive stretching (avoid for the first 72 hours) – disrupting inflammatory phase  Gentle massage (avoid for the first 72 hours) – “ .. “ REHAB PROGRAMME  What will determine what goes in to the programme?  What will the exercises focus on? - Order of the exercises matters  What will determine the exercise prescription?  What are the goals of the rehabilitation programme?  Are there any other factors to consider? e.g. information from the Physiotherapist?  FMS Return to Sport  No clinical consensus when an athlete can return safely  No single test or clinical observation as gold standard What can we use to assess readiness to return to sport?  ROM  Flexibility  Strength  Performance of functional activities  Pain (VisualAnalogScale)  FMS

 Time, distance, load RECURRENT MUSCLE STRAIN  ↓ tensile strength (point of which tendon cannot cope) of scar tissue at previous injury site  ↓ strength of muscle in other areas due to disuse and/or pain inhibition  ↓ flexibility of the muscle-tendon unit secondary to inhibition and/or scar formation  ? Adaptive changes in biomechanics + patterns of sporting movements after injury Muscle strains will resolve in approx. 3 weeks with appropriate rehabilitation...