International SportMed Journal - Volume 5, Issue 3, 2004
Volume 5, Issue 3, 2004
Author Jean-Louis CroisierSource: International SportMed Journal 5, pp 169 –176 (2004)More Less
Investigating factors associated with muscle strains highlight the multifactorial origin of the injury and the difficulty of identifying isolated or combined factors that caused the injury. Among the numerous causes reported in the literature, only a few have been scientifically associated with injury occurrence, while others have been empirically suggested. Contradictions in articles dealing with muscle strength and imbalance are frequent, and are probably the result of differences in methodology and criteria for patient inclusion. Imbalance in muscle strength commonly refers to abnormal bilateral asymmetry (between homologous groups) and a disruption of the agonist-antagonist ratio. Some authors who focus on a history of hamstring or adductor strains have demonstrated the frequent abnormality of muscle strength and balance by means of isokinetic assessment. Mixed ratios, combining the eccentric performance of "decelerating" muscles (such as the hamstrings) and the concentric performance of "mobiliser" muscles (such as the quadriceps) are suggested and seem relevant. An increased emphasis on eccentric strengthening exercises, particularly for the hamstrings, and ratio correction on the basis of statistically selected cut-offs, significantly reduces the recurrence rate of the injury and lingering complaints upon return-to-sport. Similarly, isokinetic interventions, as a preseason screening tool in sports where there is a high rate of muscle strain injuries, could detect imbalances early and thus promote a preventive strategy.
Author Malachy P. McHughSource: International SportMed Journal 5, pp 177 –187 (2004)More Less
Muscle strains are common in high speed sports and account for 10-40% of injuries in sports such as soccer, Australian Rules football and American football. The first step in prevention of muscle strains is to identify the incidence of injury for specific muscle strains. The next step is to identify risk factors for that particular muscle strain. Then an intervention or interventions can be developed to address a specific risk factor or combination of risk factors. Lastly, the incidence of injury can be reassessed following implementation of the intervention. In practice this process is rarely completed in sports medicine. Many studies do not accurately measure injury incidence and therefore cannot properly identify risk factors. Other studies document injury incidence and risk factors for all injuries but do not address the incidence and risk factors particular to muscle strains. There are few studies that have implemented prevention strategies resulting in a reduction in muscle strains. Based on the available literature it appears that a history of previous muscle strain, muscle weakness and age are risk factors for muscle strains. For many sports the period of preseason training provides a window of opportunity for sports medicine clinicians to implement injury prevention strategies. Based on limited research, it appears that muscle strengthening programmes, with an emphasis on eccentric loading, targeted at specific muscle groups susceptible to injury in a particular sport, and applied to players suspected to have increased risk of injury, can effectively reduce the incidence of muscle strains.
A clinical approach to the diagnosis and management of acute muscle injuries in sport : review articleSource: International SportMed Journal 5, pp 188 –199 (2004)More Less
The purpose of this review was to provide the clinician with an approach to the diagnosis and management of acute muscle injuries in sport. An acute muscle injury can be defined as any injury resulting from a sudden excessive intrinsic or extrinsic force application to muscle tissue that results in a disruption of the muscle fibres and surrounding tissue. Acute muscle injuries represent a spectrum of pathology, with the most common injury being the partial muscle tear or strain injury. General risk factors for acute muscle strain injuries are previous recent muscle injury and past muscle injury, decreased muscle strength (mainly eccentric muscle strength), muscle imbalance (decreased eccentric (antagonist) to concentric (agonist) muscle strength), decreased musculotendinous flexibility, increased age, and increased training load. The diagnosis of an acute muscle injury is made clinically (history and physical examination) with the use of soft tissue diagnostic ultrasound being the special investigation of choice. Management in the acute inflammatory phase (1-72 hours post-injury) is by ice, compression, elevation and immobilisation. Therapeutic ultrasound and hyperthermia (after 48 hours) are also useful to increase healing. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in the first 24-48 hours may delay healing but after 48 hours, and for up to 7 days post-injury, NSAIDs are useful to aid clinical recovery. The use of corticosteroids and hyperbaric oxygen should be avoided but anabolic steroids have been shown to increase healing in experimentally induced injuries in animal studies.
Source: International SportMed Journal 5, pp 200 –208 (2004)More Less
Strenuous physical exercise can induce damage and injury to muscle tissue that is manifested as soreness, a decreased range of motion, swelling, pain, and impaired functional capacity. Compression is a therapeutic technique widely used in the treatment of muscle and other soft tissue injuries, though evidence in support of this remedial therapy has until recently being largely anecdotal. Recent scientific research has indicated that external compression can be an effective treatment that minimises swelling, improves the alignment and mobility of scar tissue, and improves proprioception in an injured joint consequent to eccentric damage models and DOMS. The principles behind compressive treatment methods are based on known principles affecting the lymphatic system, reducing oedema, skeletal muscle contractions, local pressure gradients, and the influence of gravity. The rationale for applying compression to injured tissue are, (i) its theoretical ability to reduce oedema via the creation of an external pressure gradient, (ii) by reducing the space available for swelling to accumulate, haemorrhage and haematoma formation can be decreased, and (iii) providing mechanical support that can facilitate the capacity to produce force which is critical for rehabilitation. Compression involves a "dynamic immobilisation" strategy that allows for greater neural input and the capacity for limited movement during the recovery process. This treatment protocol represents an easily administered therapy that can be used effectively without great financial cost.
The role of non-steroidal anti-inflammatory drugs (NSAIDs) after acute exercise-induced muscle injuries : review articleSource: International SportMed Journal 5, pp 209 –227 (2004)More Less
Objective : To examine the role of non-steroidal anti-inflammatory drugs (NSAIDs) in treating exercise-induced muscle injuries.
Data sources : Electronic databases MEDLINE, PreMEDLINE, and SPORTDiscus were searched for articles published between 1966 and 2004 using the keywords "NSAID AND exercise AND skeletal muscle" in combination. The bibliographies of the retrieved articles were examined to identify other relevant papers, which also were included in the review.
Study selection : The 26 articles reviewed in this paper described studies that used the injury models most relevant to exercise-induced muscle injuries, incorporated NSAIDs as the main therapy, included multiple modes of outcome measurement, and contained appropriate controls and follow-up.
Data extraction : Data were analysed with a focus on the method of muscle injury, NSAID dosing regimen, outcome measurement, control, and conclusion of study. The strengths and weaknesses of the studies were also examined.
Data synthesis : The data on the role of NSAIDs in muscle injuries are conflicting. Some studies suggested that NSAIDs may improve muscle function acutely after injury, but delay muscle regeneration later. Other studies did not show any negative effect of NSAIDs on muscle healing. Most agreed that NSAIDs are most efficacious if given shortly after muscle injury, and that prolonged NSAID administration provides little benefit to muscle recovery.
Conclusions : NSAIDs should be given shortly after exercise-induced muscle injury to provide analgesia and reduce early inflammatory damages. There is no benefit to prolonged NSAID therapy. Future studies should focus on combining NSAIDs with other modalities, including growth factors and ex vivo gene therapy, to enhance muscle regeneration and prevent tissue fibrosis.
The effects of hyperbaric oxygen on recovery of eccentric muscle injuries in athletes : review articleSource: International SportMed Journal 5, pp 228 –237 (2004)More Less
Hyperbaric oxygen therapy (HBOT) involves intermittent inspiration of 100% oxygen at elevated ambient pressures, not exceeding 3.0 ATA. HBOT is approved for the treatment of many illnesses, and has been demonstrated to influence a wide range of physiological functions. Based on the assumption that HBOT may enhance the healing rate of connective tissue damage and reduce oedema formation induced by physical training, especially high-resistance training, several studies have investigated the effect of HBOT on recovery from eccentric muscle injury. The consensus among the controlled studies conducted to examine the efficiency of HBOT in the recovery from eccentric muscle injuries, is that there is no apparent effect. It is concluded that the practice of enhancing the rate of recovery by scheduling athletes for regular HBOT sessions is not warranted.
Source: International SportMed Journal 5, pp 238 –243 (2004)More Less
A chronic muscle injury can be defined as a chronic muscle injury that is characterised by disruption of muscle fibres, which results in muscle dysfunction. These injuries are frequently not recognised, and can cause considerable morbidity to the injured athlete, particularly if they are not managed appropriately. Chronic muscle strain injuries can be subdivided into two main subtypes : Type I - presenting with symptoms that are of gradual onset, with no history of an acute precipitating event, and Type II - presenting with a history of a previous acute muscle injury, which has not recovered fully and is still symptomatic. The diagnosis of these injuries is made using clinical criteria, and occasionally MRI or ultrasound can be used to confirm the diagnosis. Treatment is by aggressive rehabilitation focussing on restoring muscle strength, flexibility and neuromuscular control.