Muscle Injuries in Sports Flashcards
Muscle injuries in sports medicine
Most common, misunderstood + inadequately treated conditions
Muscle injuries account for what percentage of all injuries in sport
10-30%
Muscle injuries often occur during
Sport or training
Over 90% caused more often by indirect trauma (overloading) OR by direct trauma (impact)
What strains were most common injury occurence
PTM
What is most common muscle injury in track and field
Hamstrings- 20.4%
Followed by quads, then gastrocnemius calf injuries- depends on sport though
Which hamstring makes up 75% of the hamstring injuries
Biceps femoris
How much more likely are men to sustain a hamstring strain than women
64%
Men had significantly higher rates of hamstring strains than women during both games and practices
Hamstring injuries preseason
No differences between men and women
BUT men significantly more likely to sustain strain during in-season
Epidemiologically, muscles have been…
Increasing over the last 12 years despite assessing RFs and applying prevention controls
Depending on leg position and relationship to the ground, the hamstring can serve as a
Hip extensor
Knee flexor
External rotator of hip and knee
Short head of the biceps femoris innervation
Common peroneal nerve
Long head of the biceps femoris innervation
Tibial portion of the sciatic nerve
Hypothesis of discordant contraction in biceps femoris
Due to dual innervation
Can lead to injury
Two different types of acute hamstring strains
Most common injury type occurring during high-speed running
Other occurs during movements leading to extensive lengthening- e.g. high kicking, sliding tackle and sagittal split
High-speed running hamstring injury
Mainly located on long head of biceps femoris
Typically involves the proximal muscle-tendon junction
Extended lengthening hamstring injury
Stretching-type
Located close to the ischial tuberosity
Typically involves tendon tissue of the semimembranosus
High-speed running hamstring injury vs stretching type
Running one cause a more marked acute functional impairment
BUT requires a shorter rehab compared to stretching
Rule of thumb- the closer to the ischial tuberosity, the longer the rehab
Injury location hamstring
Determined both by maximal pain upon palpation by MRI during the first 2 weeks after injury occurrence
High speed running hamstring injury rehab
Common for athlete to experience a considerable improvement 4-6 days after the injury has happened, especially with respect to pain, strength and flexibility
BUT healing only at initial stage here and risk of re-injury evident, since injured tissue less able to absorb energy
Stretching type hamstring injury rehab
Important to inform the athlete that the rehabilitation period is likely to be prolonged, even though the initial symptoms are relatively mild in terms of pain and functional impairment
The athlete can undergo demanding rehabilitation training early on, as long as pain-provoking exercises are avoided. Passive stretching and heavy load exercises appear to provoke the stretching-type of injuries by increasing pain
Hamstring injuries definition
Acute Non-Contact Posterior Thigh Muscle injuries, with all the athletes reporting an incidence during training or competition, either structural or functional, presented with the Musculoskeletal triad, leading to a time loss more than a day
Muscle injury grading 2014
Classification based on extent (grades 0-4) site (a, b or c) of injury
Site of injury is determined as myofascial (a), muscular/musculotendinous (b), or intratendinous (c)
Extent of injury is determined by MRI features of the muscle injury
The first MR study that described findings with poor prognosis of muscle injury evaluated 14 patients and found that
muscle rupture and retraction, haemorrhage, ganglion-like fluid collections, and greater than 50% cross-sectional involvement were associated with convalescent periods of more than 6 weeks
MRI imaging often reserved for
The more severe injuries where a rupture is suspected
What decides if surgery needed
Determining the extent (partial vs complete) and location of rupture, as well as the extent of tendon retraction in the case of complete rupture
Imaging Grade 0
Normal US
Imaging Grade 1
Subtle US findings
Ill-defined hyperechoic or hypoechoic intramuscular areas or a swollen aponeurosis
Imaging Grade 2
Partial muscle tears
Haematoma formation
Imaging Grade 3
Complete muscle tears
Haematoma formation
MRI and hamstrings
70% of hamstring injuries seen in professional football
showed no signs of fibre disruption on MRI
Muscle injury Grade 1 tissue damage
Few muscle fibres involved
Muscle injury Grade 1 symptoms
Not apparent until conclusion of activity
Very little swelling and pain only with activity
Muscle injury Grade 2 tissue damage
Moderate number of fibres involved with intact fascia
Muscle injury Grade 2 symptoms
Immediately painful and moderately sore to palpation
Muscle injury Grade 3 tissue damage
Many fibres involved with incomplete fascial injury
Muscle injury Grade 3 symptoms
Immediately painful and sore to palpation
Patient may limp to avoid pain
Severe pain with flexion vs, resistance and/or full extension
Muscle injury Grade 4 tissue damage
Complete dissociation of fibres and fascia
Complete rupture
Muscle injury Grade 4 symptoms
Immediate severe pain
Ecchymosis below area
Palpable defect
Clinical Anatomical classification- 1st grade
Mild
Partial number of injured fibres
Clinical Anatomical classification- 2nd grade
Moderate
Incomplete number of injured fibres
Clinical Anatomical classification- 3rd grade
Severe
Complete number on injured fibres
Classifications based on
Within 6h detailed history & thorough clinical examination 48 hours post injury re evaluation Active range of motion Ultrasonographically findings Recorded time to full rehabilitation
Clinical evaluation at 48 hours
Palpation of the posterior aspect of the thigh with the athlete prone to elicit tenderness if present
Provocation of pain on isometric contraction of the posterior thigh muscles
Provocation of pain on passive hip flexion with the athlete supine
Triad for inclusion in study
Tenderness to palpation
Pain with resisted movement (knee flexion, extension of hip)
Pain with passive stretching flexion of the hip with the knee extended
Total ham ruptures in elite athletes
Not common
Posterior thigh muscle injuries- 1st and 2nd degree
Functional injuries
Posterior thigh muscle injuries- 3rd and 4th defree
Structural injuries
Most of Ham injuries are
Functional
Operative intervention
Severe injuries, e.g. complete rupture, either at insertion or origin, typically result from extreme and forceful hip flexion with knee fully extended (e.g. water skiing)
Often may require operation with extensive rehab
Hamstring strain injury common signs and symptoms
Sudden onset
Minimal to severe pain
Difficulty walking or running
Local haematoma likely with more severe injuries
Substantial local tenderness possible
Defect at site of injury
Substantial decrease in strength
Substantial decrease in flexibility
Negative slump test
Palpation of gluteal trigger points doesn’t influence hamstring symptoms
Occasionally abnormal lumbar/sacroiliac exam
Abnormal local ultrasound, except for very mild strains
Posterior thigh referred pain from another source (not hamstrings)
Sudden or gradual onset Minimal to moderate pain May describe tightness or cramping Able to walk or run with minimal change in symptoms during activity No haematoma Minimal to no tenderness on palpation Minimal to none decrease in strength Minimal to none decrease in flexibility Frequently +ve slump test Palpation of gluteal trigger points may reproduce hamstring symptoms Frequently abnormal lumbar/sacroiliac exam Always normal ultrasound
Hamstring reinjury definition
Injury at same site as index injury
Early= within 2 months
Late= 3 to 12 months
Reinjury- athletes with acute grade II hamstring injuries
Experience higher risk of re-injury than athletes with grade I, III, IV straings
Re-injury recurrence rate
12-31%
High risk of reinjury
Early return to sport
Poor rehab programme
high rate reinjury factors
Persistent weakness in injured muscle
Reduced extensibility of musculotendon unit due to residual scar tissue
Adaptive changes in the biomechanics and motor patterns of sporting movements following original injury
RFs that contributed to original injury (e.g. strength + control lumbopelvic muscles + quad tightness)
Previous injury
Age
