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What is breakdown?

The breakdown is a muscular lesion consecutive to the rupture of a more or less important number of muscle fibers (cells capable of contraction contained in the muscles). It is secondary to an effort of intensity greater than what the muscle can support and is usually accompanied by local bleeding (which forms a hematoma).

The term “breakdown” is debatable; it is part of an empirical clinical classification in which one finds the curvature, the contracture, the elongation, the breakdown and the tear or rupture. From now on, professionals use another classification, that of Rodineau and Durey (1990) 1 . This allows the distinction between four stages of a muscular lesion of intrinsic origin, that is to say occurring spontaneously and not following a stroke or a cut. The breakdown mainly corresponds to stage III and is similar to muscle tearing.

What are the symptoms of breakdown?

breakdown is manifested by various symptoms over time:

1) First comes a brutal, violent, “stabbing” pain, which is accompanied by a snap and which forces the cessation of the effort in progress.

2) The muscle in question becomes paralyzed and becomes difficult to mobilize for the victim. Stretching (passive) and isometric contraction are then impossible and very painful . The pain becomes permanent, and any movement soliciting the muscle in question induces a pain close to the initial one. The pain is also sharp and extended to palpation.

3) One or more hematomas appear in the following hours or days, sometimes accompanied by bruising and discolouration around the injured muscle (depending on the extent, position and depth of the injury).

4) The muscle stays stiff for several weeks.

What are the people at risk of breakdown?

Muscle breakdown is a frequent occurrence for the great sportsman, especially for sprinters, dancers, circus artists and footballers, but also in many sports during a low-speed stretching of the hamstrings. or during their eccentric contractions. The breakdown is however not limited to athletes: it can occur during daily tasks.

The wound easily affects the hamstrings, quadriceps, adductors or the medial gastrocnemius. It can, however, affect all muscles, even those that seem well protected such as sphincters, perineum or those that drive and control the eyeball.

What are the risk factors for breakdown?

There are factors that increase the risk of a breakdown occurring  :

  • A non-existent or inadequate heating
  • An unusual or excessive effort
  • A state of fatigue
  • A lack of flexibility (decrease of the articular amplitudes)
  • A history of muscle tear (2.7 times more risk)
  • Underlying joint lesions (2 to 3 times more risk)

20% of the injuries would occur during the matches against 31% during sports training.

How to treat breakdown?

objectives of the treatment are threefold: to obtain quality cicatrization, to avoid chronicity and to reduce the risk of recurrence.

Immediate treatment

The clinical examination must make it possible to identify the degree of severity of the lesion. Once the doctor has identified the breakdown or tear, he will start treatment with a phase called “PRICE” (this is a mnemonic):

1) P rotection. The injured muscle should not be massaged, including with an anti-inflammatory gel, but protect it with padding to mitigate the impact it may have with other objects.

2) R epos. Rest is essential: it accelerates the healing of the muscle.

3) I ce. Moderate ice application can help reduce pain and swelling by lowering blood flow to the injured area. The duration and methods of application do not benefit from a recognized protocol but it is advisable not to apply the ice to the skin and not more than 20 minutes per hour. On the contrary, the application of heat is strongly discouraged.

It is also recommended to make a C ompression the injured muscle with an elastic bandage and make an E levation the member in question (to limit the accumulation of blood in the affected area).

Note : According to a study, sports circles do not always respect this protocol: in 40% of cases, the ice is not applied and in 80% of cases, there is no compression.

 

During the first ten days

The first-line examination is ultrasound. It will make it possible to ensure the diagnosis, to search for any immediate complications and to assess whether the hematoma should be punctured (depending on the size, pain and location) as it may hinder healing.

During this inflammatory phase , analgesics are often used to reduce pain. However, it is imperative to avoid the prescription of NSAID drugs (non-steroidal anti-inflammatory drugs) such as aspirin or ibuprofen because, as anticoagulants, they increase edema by blood effusion. Once the bleeding stops, they can again be used to reduce inflammation.

After the first ten days

The healing phase follows the inflammatory phase. Soft sessions of physiotherapy are generally recommended in which passive stretching (for better muscle fiber orientation), electrostimulation, muscle strengthening and light massage can be performed. Depending on the severity of the lesion, this phase may last longer or shorter. It precedes the recovery phase (or re-education) during which various stretches, deep massages and bodybuilding exercises are performed. At the end of this (about 45 days, depending on the severity of the injury), the person can resume a sports activity if it no longer feels pain. Generally, the return to sport is too early: a study has shown that among people who suffered a hamstring injury, 12% experienced a recurrence in the first week.

Most muscle lesions heal without sequelae, but some may evolve unfavorably (fibrous scars in particular). Various medications to calm the pain can be administered by the doctor throughout the treatment.

What are the complementary approaches to treat the breakdown?

Note  : massages must be banned during the first days following the injury.

Various natural products may have an interest in the management of muscle pain.

Comfrey . Clinical studies suggest applying comfrey 1 to 3 times daily for two weeks to reduce muscle pain and bruising.
Dosage: Apply, 2 to 4 times a day, an ointment or lotion containing comfrey (root or leaves).
Caution  : Commission E recommends that the topical use of comfrey be limited to a maximum of 6 weeks per year, to avoid possible accumulation of  pyrrolizidines  (a toxic substance for the liver) in the body.

Bromelain . Bromelain is a group of enzymes found in pineapple. Several studies in Europe suggest that taking bromelain supplements (alone or in combination with other enzymes) helps to reduce inflammation  and pain caused by surgeries, hematomas and  bruises .
Dosage : Take 125 mg to 500 mg, 3 times a day.

Arnica . The effectiveness of arnica in the face of muscle pain remains controversial. Topical and oral formulations were studied. A clinical study on a 7% arnica cream showed that its application three times a day did not reduce muscle pain compared with a placebo. Other studies have shown that it slightly reduces lumbago pain and body aches. The current state of research does not, however, confirm their effectiveness in this regard.

The  Commission E  and ESCOP  nevertheless approve the use of arnica  externally  to treat among others the  bruises  and  muscle aches .

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