9 - MUSCLE STRAIN OF LL Flashcards
Adductor related groin pain:
- description
- monitoring of recovery during rehab
ADDUCTOR RELATED GROIN PAIN
- Mostly commonly in adductor longus
- Adductor strains at myotendinous junction are usually acute
- Adductor injuries near musculotendinous insertion can have acute (adductor strain, rupture or complete avulsion) or gradual (insidious long-standing adductor related groin pain such as adductor enthesopathy or pubic apophysitis onset
- 90% resolve in less than 3 weeks
Monitoring of recovery during rehab
- Copenhagen 5 sec squeeze should be <5/10 during exercise & up to 48h afterwards
- Consider delaying onset of muscle strengthening until pain < 5/10 on squeeze test (preferably 0-2/10)
Exercise for adductor related groin pain
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Progression of Copenhagen Adductor exercises (CAE) + effects
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Effect of CAE
- Positive effects seen after doing rehab
- Significant reduction in pain while doing rehab
- Significant improvement in eccentric contraction of adductors
Clinical milestones for adductors RTS
- Full performance often not achieved until 3-6 months after RTS
- Muscle strengthening should continue at least 3 days per week
until pre-injury performance achieved
+ table
Return to sport after adductor injury
- Grade 0-2, adductor rupture: time for recovery approx. 3weeks, exercises treatment, 90% of people could return to sport after 3 weeks
- Grade 3, adductor rupture: 12 weeks to recovery, exercise treatment
- Long standing adductor related groin pain: 18-20 weeks to recovery, exercise treatment
- Long-standing adductor & pubic related groin pain: 20 weeks to recover, exercise treatment
- Long standing adductor & pubic relation groin pain: no treatment
Hamstring injury (HSI):
- description
- Assessment
HAMSTRING INJURY (HSI)
- Can be result of accumulated repetitive microscopic damage OR sudden onset (OR sudden on gradual)
- Usually related to combination of:
o High forces on muscle tendon unit (active or passive)
o M-T lengthening beyond capacity
o High velocity movements
Assessment following HSI
- Palpation: site of maximal pain on palpation should be measured (distance from ischial tuberosity AND
length of defect in muscle)
- ROM: hip flexion & knee extension ROM should be assessed (may be limited by pain), active knee
extension test to assess symptoms
o DF ROM on knee ta wall associated with HSI
- Isometric strength with report of NPRS & dynamometry if available
Isometric hamstring testing description
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Progressive return to sport after HSI
Progressive return to running
- Stage one after athletes can walk with minimal pain (<4/10)
- Stage 2 when moderate speed running tolerated
- Stage 3 only when high speed (> 80% of max velocity) can be
performed pain free
HSI rehab:
- criteria to return to play
- early stage exercises
HSI rehabilitation – criteria for return to play
Decision for return to play (RTP) normally based on criteria related to:
- Clinical assessment
- Performance tests
- Isokinetic dynamometry
- Askling H test
- Studies using combination of clinical, performance & isokinetic testing showed lower rates of reinjury & faster RTP
- Askling H test seems good option to assure low reinjury rates
- RTP model for hamstring injuries in football for RTP definition & RTP criteria after hamstring injury.
Consensus statement from hamstring injury prevention strategies (HIPS)
HSI rehabilitation – exercises (early stage)
- Askling et al. protocol of lengthening mainly during eccentric contractions revealed effective in faster
RTP & lower reinjury rate
- Mean of 28 days to RTP (assessed by Askling H test)
- In 37 injured layers, 0 reinjuries after 1 year
Table
Quadriceps muscle injuries:
- description
QUADRICEPS MUSCLE INJURIES
- 3rd most common muscle tear in football
- 5% of all football injuries, 19% of all muscle related injuries
- Occur in kicking, fast sprints / jumps, forceful eccentric contractions
- Risk of recurrence = 17%
- Contusions also significant, usually affecting vastus muscles, severity depending on loss of knee flexion
passive ROM: > 50% of knee flexion, 50-30% or <30%
- Mild: 2-5 days recovery
- Severe: 20-25 days
Difference between contusion vs grade I sprain
Table
British athletics muscle injury classification
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CONSERVATIVE MANAGEMENT:
- goals
- phases
Goals of conservative management
- Regain pain-free ROM as soon as possible
- Improve muscle strength (can be marked loss) with respect to stage of healing
- Start with low resistance / high rep concentric progress to higher resistance / low reps eccentrics
- Maintain general fitness
Phases of conservative management
1. Acute management (PEACE & LOVE)
2. Pain free active & passive stretching with eccentric & isometric contractions, early initiation
3. Gym-based treatments
4. Finally, RTS (field-based training)
Conservative vs surgical management of quads injuries
Conservative vs surgical management of quads injuries
RTS takes 3-5 months post-surgery (depending on injury)
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