A muscle injury is a common complaint and often occurs in athletes. In this newsletter we would like to introduce you to the anatomy, the different muscle injuries, causes, symptoms and treatment of muscle injuries.
Anatomy:
Muscles are connected to the bones with tendons. They run over one or more joints. By contracting (tightening) movement takes place, in which one bone is pulled towards another.
Muscles consist of different muscle bundles, which in turn consist of different fibers. There are three types of muscle fibers, type 1, type 2A and type 2B.
Type 1, are also called red muscle fibers, because they are well supplied with blood and therefore rich in oxygen. Since the fibers mainly use oxygen for their tension, they are able to perform light activities for a longer period of time without getting tired.
Type 2B fibers are also called with muscle fibers. They are called white because they are not well supplied with blood. The tension and relaxation of the muscle can be done without oxygen and they are able to perform explosive and heavy activities. However, these muscle fibers get tired quickly and produce a lot of lactate, which causes acidification.
The last type, type 2A, is called the intermediate muscle fiber, and is basically a mix between the other two types. Type 2A fibers can supply strengst and stamina. The strength however is less than with the white muscle fibers and stamina is lower than with the red muscle fibers.
In almost every muscle in the human body, these three types of muscle fibers can be found. The ratio is hereditary, but also depends on the load placed on it. The calf muscles are a good example. With an untrained person the muscle consists of 50% type 1 and 50% type 2B fibers. Top athletes however, for instance marathon runners, have 90% of red muscle fibers and professional sprinters, have 80% white muscle fibers.
Injuries:
The most common muscle injuries are muscle tears, strains, bruises and problems due to overloading the muscle. Below we will discuss these injuries.
With a muscle tear, the muscle tears partially or completely. Usually this happens with an explosive effort (for instance a sprint), or when the muscle is stretched too far. The muscle tear is either grade 1,2 or 3. Grade 1 means the muscle is damaged less than 5%, grade 2 means the muscle is damaged between 5 and 50% and grade 3 is a complete tear.
The first two grades are most common in explosive sports, like soccer and hockey. For instance, one of the leg muscles will tear. Fortunally grade 3 isn’t very common.
When the tissue of the muscle is stretched too far during an activity, the muscle is strained. Usually there is no damage to the muscle and recovery is often shorter than with a tear.
Another common muscle injury is for a muscle to bruise. Usually this happens when there is forceful contact with an external object. For instance when some one’s knee hits your upper leg. The muscle can be damaged and we speak of a bruise.
Lastly, with a movement too heavy or too many movements, the muscle can become overloaded. The muscle is not able to recover properly, because of too much waste that is produced and there is not enough time to get rid of it.
Symptoms:
For each injury the symptoms are described next. For some injuries the symptoms are the same and others differ. Therefore knowing the syptoms during examination, makes it easier to determine the injury.
- Muscle tear:
- Acute shooting/stabbing pain, sometimes feels like some one is kicking you
- Pain/unable to use muscle
- Sometimes bruising
- Decreased flexibility /stiffness of the muscle
- Sometimes you can feel a dent in the muscle
- Touching the spot is painful
- The pain is usually very local
- Muscle strain
- The pain can occur immediately or later after the activity or cooling down
- Cramping feeling
- Stiffness in the muscle
- The pain is spread throughout a wider area
- Generally no bruising or swelling
- Muscle bruise
- Contact with object or person
- Local bruising and/or swelling
- Pain at point of contact
- Hardening of tissue at point of contact
- Pain when using the muscle
- Decreased flexibility /stiffness of the muscle
- Overload
- Pain in muscle, usually not local
- Feels like the muscle is heavy
- Feels like the muscle is too tight
- Increased muscle tension
- Cramping of the muscle
Causes:
There are many different causes for muscle tears and strains, below a couple of important contributors are mentioned:
- Not enough flexibility of the muscle
- The length of the muscle fiber bundles
- The implantation angle of the muscle fibers
- A restriction in movement of the joints or muscles that are affecting the muscle
- Not enough power and/or stamina of the muscle
- A prior muscle tear (in the same muscle)
- Overload
- Muscle fatigue
- Poor warm-up
When a muscle is overloaded, there are overlapping issues:
- Sudden heavy strain on the muscle
- Not enough rest between putting strain on the muscle
- Incorrect build-up of training
- Sustaining muscle strain longer then the muscle is capable of handling
Most of the issues mentioned above can be influenced! With your physiotherapist you can have a look at what could cause a potential injury in your case. This can be treated, or even better, injuries can be prevented altogether.
Bruising of the muscle can not be prevented, but with treatment you can play sports again as soon as possible.
Treatment:
Treatment of muscle injuries consists mostly of an active recovery. Starting with a relative resting period, with the emphasis on relative. It is important to keep using the muscle within the load it is capable of handling, meaning light activities that don’t hurt while performing them. If you stop using the muscle altogether, the rehabilitation will take longer. Therefore it is recommended to start treatment for a muscle tear as soon as possible. Starting one week later will delay the recovery by three weeks!
In the first phase of the rehabilitation process, the muscle will be trained without overloading it. This is done with relative light exercises. During the process the exercises will become heavier and eventually the exercises will become sport specific. Further the physiotherapist will work with the contributing factors; this could be to solve certain movement restrictions. But the physiotherapist mainly guides you through the process and makes sure the exercises have a good build-up, so that you can reach the next phase of the recovery process.
When the muscle has a big (sub-)total tear an operation might be necessary. After the operation physiotherapy is recommended. Not only for a good rehabilitation but also to decrease the chances of a new tear.
Preventing an injury:
Muscle injuries can prevent you from playing sports for a couple of weeks, or even months. As mentioned before, the chances of muscle injuries can be significantly decreased with specific exercises. A physiotherapist that is specifically trained on that area can make an exercise schedule for you. The exercises will improve the areas, that are prone to injuries. During an intake your personal contributors can be determined.
Essential in prevention is a good rehabilitation of the muscle injury. More than halve of the recurring injuries take place in the first month when starting to play sports again. Usually the rehabilitation was not good enough or too short. You need to be pain-free and the strength and flexibility of the muscle needs to be more or less equal both left and right. Also there shouldn’t be any fear to put load on the muscle again.
