Muscle Injury

Basic Science clinical implications

 Laceration
Contusion
Contracted Muscle
Relaxed Muscle
Strain
Muscle specific
Location specific

Types of injury
 Compare with bone: regenerative process
Repair process: scar formation

Repair Process
 Destruction
Rupture & necrosis myofibres,
clot,
inflammatory reaction
Repair
Phagocytose necrotic tissue,
Regeneration of myofibres,
scar tissue, blood vessels
Remodelling
Maturation of myofibres,
Contraction/reorganisation scar tissue

Healing phases
 Critical to staging
appropriate AJSM Jarvinen et al
management 2005 Muscle injuries
- biology and
treatment 33 5

Time Course
 Destruction phase
Halted by fire doors

Day 2
 Satellite cells
activated

Day 3
 Myofibroblasts fused
Connective tissue
denser

Day 5
 Muscle cells growing
into scar

Day 7
 Scar condenses
Regenerating
myofibres close the
gap

Day 14
 Virtual fusion of
myofibres

Day 21
 M&SS&E Grefte et al
Model for
regeneration around
fibrotic lesions in
recurrent strain
injuries 2010 pp 813-
9

Scar tissue
 Importance of
mobilisation

Myofibrillar growth
Vascularisation
 Denervation will
compromise muscular
regeneration
completely

Reinnervation
 Excessive and / or
early movement result
in marked increase in
scar tissue

Mobilise?
 By Day 10 the Scar is Active movement
no longer the weakest should be started
part prior to this
Firm bandaging Move, but dont
stretch

Early management
 Importance of early
immobilisation in
No RCTs prevention of excessive scar
tissue formation
Individual Jrvinen M, Lehto MUK.
components have The effect of early
validity mobilization and
immobilization on the
Rest healing process following
muscle injuries. Sports Med.
1993;15:78-89.

R.I.C.E.
 Ice Deal DN, Tipton J,
Rosencrance E, Curl WW,
Smaller haematoma Smith TL. Ice reduces edema:
between ruptured a study of microvascular
permeability in rats. J Bone
stumps
Joint Surg Am. 2002;84:1573-
Less inflammatory 1578.
reaction Hurme T, Rantanen J, Kalimo
Slightly accelerated H. Effects of early cryotherapy
in experimental skeletal muscle
early regeneration injury. Scand J Med Sci Sports.
1993;3:46-51.

R.I.C.E.
 Compression Thorsson O, Hemdal B, Lilja
B, Westlin N. The effect of
Reduction of
external pressure on
intramuscular blood flow intramuscular blood flow at
to area rest and after running. Med Sci
Debateable effect in Sports Exerc. 1987;19:469-473.
isolation Thorsson O, Lilja B, Ahlgren
Good effect in L, Hemdal B, Westlin N. The
effect of local cold application
combination with ice on intramuscular blood flow at
50% reduction in IM rest and after running. Med Sci
blood flow Sports Exerc. 1985;17:710-713.

R.I.C.E.
 Elevation
Reduction in
hydrostatic pressure,
Blood pressure
dependent

R.I.C.E.
 No load, no
stretching
Explain why to the
Day 0-3
patient
RICE
No NSAIDs

Summary
 Gentle load
unresisted
movement, no
Day 3-5 stretching
Can start heat
? modalities

Summary
 Gentle Stretching
Day 5 - 10 Gentle Muscle
activation (no pain)

Summary
 Carefully increase
amount of
resistance, and
Day 10 - 14 harder stretching
no pain but
pulling sensation
OK

Summary
 Increase amount of
resistance training
Day 14-21
By Day 21 heavier
resistance training

Summary