Everywhere we turn we are told to exercise; but as beneficial as is exercise, keeping fit is not without its perils. Whether you exercise for fun or play competitive sports such as football, golf, cricket, hockey or track and field, you may experience many types of injury, muscle injuries being among the most common. In fact, you don’t even have to play sport to get a muscle injury. By the time you have read this article you will realise that not all muscle injuries are equal, and recovery will depend on the severity of the injury, your overall health and the steps you take towards your recovery.
An injury can be described as physical harm or damage to someone’s body caused by an accident or attack. So what exactly is a muscle injury? Muscle injuries can either be acute, injured through trauma, or chronic, overuse or failure of an acute injury to repair sufficiently. Below is an overview of the most common types of muscle injury and the best management to ensure recovery and return to function.
Muscle strains should not be confused with sprains. A sprain describes overstretching of ligaments (fibres that attach to bones to aid stability) whereas strains occur when excessive mechanical stress is applied to muscles and tendons, e.g. overstretching or performing excessive repeated movements, causing damage or tears to the muscle fibres. The most common causes of a sprain are improper use of a muscle, fatigue or overuse. Although this type of injury can happen spontaneously, it is not uncommon for sprains to result from minor injuries to the muscle that build up over time, rendering the muscle weak and vulnerable. Sprains therefore can be seen in sports that involve running and jumping and are usually categorised depending on the severity of the injury. The most obvious signs are pain and swelling but in cases where the muscle has torn you may also notice bruising.
• Grade 1 sprains are mild and usually only affect a few muscle fibres, less than 5%, and therefore no loss of power. The pain is not usually felt immediately and in fact pain may not be felt until the next day. These mild sprains can often be treated at home using the P.O.L.I.C.E protocol: Protection, Optimum Loading (movement as pain allows), Ice, Compression, Elevation. Recovery will usually take 2-3 weeks.
• Grade 2 sprains are a little more serious and there may be tears to up to half of the muscle fibres, resulting in swelling, weakness, and some loss of range and pain (especially when contracting the muscle). These take a little longer to heal and full recovery can take up to three months.
• Grade 3 sprains are the most serious of the three and describe a complete tear of the muscle. It can usually be identified by the amount of bruising, swelling and change in the shape of the muscle. There will also be difficulty moving the injured area and excruciating pain. These injuries often require surgical intervention to repair the torn muscle.
Contusions, also known as bruises, occur from an impact to a muscle. The impact causes the capillaries under the skin to break, resulting in blood leaking out into the surrounding tissues. Most of us have at one time or another experienced a contusion. Usually these injuries recover spontaneously within a few weeks but in severe cases, where bleeding and swelling continue, it can cause complications such as a clot, shock or compartment syndrome. Although most contusions just disappear on their own, without any obvious lasting effects, in some cases, where there is extensive bruising, there may be underlying scar tissue which can cause decreased flexibility and power. In these cases a series of stretching and strengthening exercises may be recommended by your physiotherapist or doctor.
Cramp is a common phenomenon seen in sport but also in some other health conditions and, at times, it can even occur for no apparent reason. The most common areas of cramp are the foot, calf and thighs. There are several causes of cramp but the most obvious are dehydration, lack of electrolytes (potassium, sodium and magnesium) and muscle fatigue. In many cases cramp resolves in a matter of minutes but for some the pain and stiffness can last for up to a week.
Despite the cause of injury, the repair process is the same. After the initial injury, the destruction phase, the inflammatory stage will begin where destroyed and damaged tissue is removed from the area by special cells, in the plasma part of blood. Next come the repair and remodelling stages. The length of each of these stages will depend on the severity of the injury but involves repair of the damaged tissue by laying down a random network of fibres, better known as scar tissue. Initially these fibres are weak and any mechanical force to the area can cause the fibres to tear.
This is why it is extremely important to rest after an injury, although rest does not mean sitting down and doing nothing. During the rest period it is important to perform gentle mobilisation exercises to improve blood flow to the area and better formation of scar tissue.
After this initial period of the healing process the fibres are now strong; in fact they may have more strength than surrounding tissue so failure to fully rehabilitate the injury may result in injuries to the area around the newly formed scar. In order to ensure that all fibres operate under optimum conditions it is important to undergo a programme of rehabilitation which focuses on stretching, strengthening and proprioception exercises. Physiotherapists can guide your recovery and return you to activity (and sport), helping you to achieve your maximum potential with less risk of re-injury.
