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Muscle injuries (sports)

We have collected here different types of muscle injuries – from cramp to complete muscle rupture – that can occur in the practice of a sport activity, whether you are a beginner, confirmed, competitor or high-level practitioner. These injuries especially concerning the lower limb (muscles of the thigh and calf) as well as the adductors, can compromise the sporting activity of leisure or the objectives of competition of an athlete.

The management of muscle injuries has three important objectives:

  • a quick cure and a return to the usual sporting activity;
  • lack of transition to chronic injury;
  • a reduction in the risk of recidivism when the sports activity resumes.

Each year, approximately 9% of all Quebecers 6 years to 74 years practicing sports or leisure suffer an injury requiring consultation with a medical professional. (This statistic includes all types of accidental injuries, including fractures.)

Types of muscle injuries

There are several types of muscle injuries, depending on the circumstances and the context of the accident, as well as the interrogation and clinical examination data.

  • Cramp: it is not strictly speaking a muscle injury but rather a temporary dysfunction. The cramp is indeed an extremely painful contraction, involuntary and transient, similar to a grinding affecting one or more muscles. It can occur at rest, during sleep or with exercise. The origin of cramps occurring in a sporting context is complex. They would be the result of insufficient supply of oxygen or blood electrolytes, or an accumulation of toxins related to the effort. They may be secondary to muscle exhaustion or to dehydration.
  • Contusion: this is the consequence of direct trauma to a muscle in contraction phase most often or at rest. It is manifested by localized pain at the point of impact, swelling and sometimes bruising (hematoma or puckering of blood under the skin following rupture of vessels, colloquially known as blue). These manifestations are all the more important and profound as the initial trauma is intense.
  • Elongation: This is the first stage of muscle injury. It corresponds to an excessive elongation of the muscle. Elongation occurs during excessive muscle strain or as a result of excessive contraction. Some muscle fibers are stretched to break. it is therefore a very limited tear, even “microscopic”. Elongation is manifested by pain of effort that causes neither lameness nor hematoma. The injured person feels acute pain, such as a sting, during a start for example or on a muscle badly heated or tired. The effort is still possible, although a little painful. The muscles of the quadriceps (anterior muscle of the thigh) and the back of the thigh (the hamstrings) are most likely to undergo an elongation. The practice of sport is still possible but painful.
  • Slamming: the breakdown also corresponds to an elongation mechanism in which many fibers have been broken and bleed. The pain is sharp, similar to a stab in the muscle. A feeling of slamming is sometimes felt, hence the term breakdown. There is also talk of stage 2 tearing. At the breakdown stage, sporting activity is no longer possible. Walking is also difficult.
  • Tear: The muscle tear is like a broken muscle, like a bone fracture. The pain is such that it sometimes causes discomfort and a fall. The tears mainly concern the hamstrings, adductors and calves (“tennis leg”). The support on the member is very difficult and the continuation of the sporting activity became impossible. The bleeding is important and a hematoma does not take long to appear.

In reality, all intermediates are possible between simple elongation, small breakdown and tearing and the exact classification of the muscle lesion can be difficult to assess by clinical examination alone. Hence the interest of ultrasound and MRI (Magnetic Resonance Imaging) which are exams of choice when it comes to making an accurate diagnosis or measurement of the lesion, especially for the diagnosis of tear.

 

The muscle

The main characteristic of a muscle is its ability to contract by producing movement.

Its classical representation shows us a muscular tissue swollen in the middle, which continues at the ends by 2 tendons . It is formed of several fibers, thin, long (some are the length of the muscle), arranged parallel, grouped in bundles and separated by connective tissue. This fibrous reinforcement allows the shortening of the muscle, synonymous with movement.

But contrary to popular belief, muscles are not only dedicated to movement or gestural activity. Indeed, many muscles solicited at rest; this is called the muscle tone allowing for example the standing up.

 Causes of muscle damage

As we have seen, the vast majority of muscle injuries involve the lower limbs (thigh and leg) and are often consecutive to the practice of a sport , mainly contact sports (football, hockey, boxing, rugby, etc.), acrobatic sports (snowboarding, skateboarding, etc.) and those that require fast starts (tennis, basketball, sprint, etc.). Muscle injuries can be observed:

  • At the beginning of the exercise: overtraining (excessive training) or insufficient training, insufficient warming or poor quality, bad sportsmanship, …
  • At the end of the exercise: fatigue, lack of suppleness of the muscle.
  • During the exercise : poor sportsmanship, abrupt, violent and uncoordinated movements , especially if there is an imbalance between the strength of the agonist muscles (which make the movement) and that of the opposing muscles (which make the opposite movement ) – for example, biceps and triceps, quadriceps and hamstrings.
  • In direct trauma with a hard object (crampon, knee of another athlete, pole, etc.).
  • Due to an intense or prolonged effort.
  • Due to an anterior healed muscle injury.
  • In case of overweight.
  • When using unsuitable training equipment (shoes especially …).
  • Because of a training surface too hard (bitumen, concrete …).
  • In the absence of sufficient hydration, before, during or after exercise.
  • When the power supply is unsuitable.
  • In the absence of stretching after the effort and more generally, insufficient muscle stretching in relation to the muscular stresses.
  • During an effort in a cold environment.

 Symptoms of muscle injuries

Muscle cramp

  • Stiffness of a muscle accompanied by intense pain ;
  • Loss of mobility of the joints related to the muscle.

Contusion

  • Pain at the point of impact and a dark spot under the skin, depending on the evolution of the injury: brown, red, blue, green or yellow.

Elongation or breakdown

  • Functional impotence, acute, sharp and brutal pain in a muscle. The pain manifests itself in muscle contraction, stretching and palpation. This injury requires stopping the effort, but still allows movement. The more serious the injury, the more intense the pain and the more functional impotence is important.

Tear

  • Appearance of rapid swelling. If the muscle injury is just under the skin, sometimes a small bruise (quadriceps).
  • The pain is often compared to a stab. The bruise is sometimes bulky. At this point, the member is no longer functional.

 People at risk

  • All the people who practice a sport: professional or amateur athletes, simple amateurs of leisure sports.

n general, the risk of muscle injury increases:

  • in case of insufficient warm – up before the meeting itself;
  • in case of poor lifestyle (lack of sleep, deficient diet, etc.), which causes fatigue and muscle weakness;
  • with age, because  : elasticity and strength of muscles and tendons decrease with time;
  • when using anabolic agents (substances that lead to an increase in the muscular system), which promote the development of the muscular fiber, but weaken the tendons, which do not adapt (imbalance);
  • when psychological problems ;
  • in case of postural problem ;
  • lack of hydration;
  • in the absence of physiotherapy care after injury or incomplete or misbehaving rehabilitation ;
  • unsuitable or poorly practiced weight training or stretching exercises;
  • The poor quality of the sports facilities or inadequate sports equipment.

Prevention of muscle cramps

  • Avoid dehydration by drinking before, during and after exercise in small amounts. The hydration helps maintain blood circulation in the muscle fibers;
  • Alternate the consumption of water and the consumption of sports drinks with the advantage of containing salts and minerals. Indeed, cramps can be caused by a lack of sodium and potassium in the muscle.
    Council. Respect the recommendations of the manufacturer. Beware of drinks containing too much sugar and requiring sufficient dilution in the water. These drinks should be limited to intense activities lasting more than one hour;
  • Pay attention to the appearance of the first signs of fatigue. It is necessary to know to stop before the appearance of the cramps or the muscular injury
  • Does your efforts and avoid too intense or prolonged efforts during the first sessions. Progress gradually in a sport. Muscle fatigue that occurs when the muscle is not used to providing the required force can cause cramps.

Prevention of bruises

  • Wear the recommended prevention equipment: helmet, shin guard, knee pad, ankle brace, etc.

Prevention of stretching

  • Adopt a healthy lifestyle: balanced diet , maintaining a healthy weight (obesity can lead to stress or strain on the muscles), sufficient sleep in quality and quantity;
  • Take advice from a competent coach , whether it is to introduce you to a new sport or perfect the technique;
  • Avoid suddenly increasing the intensity of physical effort, whether it is your professional activity or your sport. By gradually increasing the effort , the body is allowed time to adjust and strengthen the muscles while softening the tendons;
  • Respect a rest period to recover sufficiently after training and competitions. Listen to your body and avoid exercising if you still feel tired by previous efforts;
  • Adapt your sports activity to your fitness and your age;
  • Plan good equipment. Do not hesitate to consult a sports podiatrist in case of pain in the feet: soles adapted to your morphology can correct many morphological abnormalities and possible defects support;
  • Before the physical activity: prepare your body for the effort (cardiovascular, respiratory, muscular, tendinous …) with a gradual heating of your muscles and your tendons (about 10 minutes). A light jog or brisk walk is suitable. The intensity of the preparation depends on the intensity of the activity which will then be carried out. Consult a coach specialized in practiced sport;
  • After physical activity: do a stretching session, in other words progressive and controlled stretching , alternating tension maintained for about 20 seconds, then relaxation and taking care to slowly stretch all the muscles used during the exercise. Physical activity. Stretching is a very interesting exercise in injury prevention, provided you do it in a moderate way.
Important. Physiotherapy and the number of sessions prescribed must be respected to reduce the risk of recurrence and fibrosis, a difficultly reversible complication that can occur as a result of bruising, breakdown or tearing. It is characterized by the formation of a scar inside the muscle that will stiffen it, making the muscle contractions painful.

Cramp treatment

To stop a cramp, you first have to stretch the muscle while fighting against the contraction. For example, in the case of calf cramp, bend the foot and toes upwards and fight against muscle contraction by stretching the leg. Once the cramp stops, a gentle massage on the calf relieves residual pain. Ice can also be applied to the muscle to reduce the rate of muscle contraction and prevent the inflammatory response.

Treatment of breakdown, tearing and bruising

Given the average time of healing of the muscle fiber of the order of 12 days, the sports rest is essential regardless of the type of muscle injury. A sporting stop that will be even longer than the muscular injury is important.

  • Simple Elongation. The immediate application of ice and a rest of 10 days are sufficient.
  • Simple breakdown. Like elongation, the immediate application of ice is recommended when it is a breakdown. On average, count 3 weeks of strict sports stop.
  • Tear.This is the most serious muscle accident. All the intermediates are possible between injuries of a few centimeters long until the total rupture of the muscle. The treatment depends on the size of the lesion and the ultrasound data, which will make it possible to accurately assess the size of the hematoma (an emergency ultrasound is of little value because the hematoma is not yet completely constituted). Treatment includes immediate icing, compression bandage, limb elevation, analgesics. The stopping of the sport can require between 2 and 6 full months according to the importance of the lesion. The recovery of the sport must be careful. Sequelae can be formed, such as calcification of the hematoma, especially in the quadriceps (operable if discomfort is important), or scar muscle. These sequelae occur most often when the recovery was too early or if inappropriate massages were performed during the acute period.
In practice

The management of a muscle injury involves three different phases, the acute phase (in the hours and days following the accident), the rehabilitation phase (in the weeks that follow) and finally the resumption of the sports activity. . The following tips are about elongation and breakdown

Acute phase

During the first 3 days (72 hours) after trauma, the treatment of elongation is aimed at stopping hemorrhage in the muscle. It is based on 4 main elements whose acronym is GREC:

  • G lace: intended to relieve pain and reduce inflammation by contracting blood vessels. Apply ice for 10 to 12 minutes every 1 to 2 hours for the first 2 or 3 days while keeping the limb elevated. Subsequently, reduce reduce the frequency to 3 or 4 times a day. Continue applying ice as long as pain symptoms persist;
  • R epos: rest is important in order to prevent further injury. It is necessary to stop the sports activity that caused the trauma, without however completely immobilizing the affected member;
  • É levation: if the wound regards the leg or ankle, the leg must be maintained in an elevated position. The elevation of the limb helps fight against edema by promoting venous return;
  • C ompression: intended to limit the swelling and accumulation of blood around the injured area. The use of an elastic bandage fulfills this role.
Warning. The application of heat (especially hot baths), stretching and massage are strictly prohibited. Indeed, the heat dilates the blood vessels, thus amplifies bleeding and inflammation. Muscle stretching may aggravate muscle damage. As for massage (or even palpation!), It can intensify the pain, aggravate the lesions and cause haemorrhage.

 

Tips for applying ice

The ice must be applied to conform to the contours of the injured area. It should be placed in a bandaged bag without loosening so as not to stop blood flow but enough to allow compression to stop bleeding. Ice cubes contained in a plastic bag can be applied directly to the skin or placed in a thin, wet towel. There are also ice-cold gel packs (Ice pak) sold in pharmacies that may be practical.

However, when using these products, do not place them directly on the skin because there is a risk of frostbite. In the absence of freezing refrigerant, a practical solution is to use frozen vegetables in plastic packaging.
There is no need to apply cold compresses or “magic bags”because they are not cold enough and / or heat up too quickly.

Drugs. In case of severe pain, take paracetamol or acetaminophen analgesic medications. They do not replace the compression and application of ice.

When the inflammatory reaction is important, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be consumed over a short period of time: 2 or 3 days only. You should always monitor their possible side effects on the stomach, which can be major (heartburn, gastrointestinal bleeding, ulcers, etc.) and learn also their contraindications.

Physical exercise. Do not hesitate to practice physical exercises to keep you in shape, since they do not solicit the injured member.

 Rehabilitation phase

Physiotherapy treatments. The goal of management is to allow healing of the lesion and return to a painless, supple and strong muscle. Prescribed by a doctor, specific rehabilitation exercises performed by the physiotherapist or physiotherapist can solicit the injured muscle and begin to stretch and strengthen gently. The delay of this care depends on the evolution of the lesion (swelling, pain, bleeding …) and its importance. Of gentle massage can be practiced away from the painful area in order to remove muscle spasms.But in no case should massage the painful area, otherwise aggravate the lesions. It is the same in case of muscle rupture. Depending on the severity of the injury, exercises will gradually be integrated. Pain is a good guide for adjusting the intensity of activities. Subsequently, rehabilitation and regular gradual training are undertaken.

Resumption of normal activities

Physical activity can be restarted only when all pain is gone and muscle strength and mobility of the injured limb have returned to normal. In the long term, it may be beneficial to continue physiotherapy exercises to prevent such events from recurring.

Note. The creams and ointments heated for relieving muscle pain have little use in the treatment of muscle injuries, so acute that rehabilitation. The momentary sensation of comfort remains very superficial because their action is limited to the skin. On the other hand, they can be used in anticipation of an effort practiced in cold environment, but not dispensing of the heating.

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