pathology: sprain

yogabook / pathologie / sprain

sprain / muscle sprain / distension

Definition of

Unphysiological stretching (more than 25% of the resting position) of a muscle without fiber tears leads to irritation of the non-contractile (measuring and regulating) muscle spindles, which disrupts tone regulation and leads to edema and local inflammation in the muscle. Most commonly affected are the adductor, quadriceps, biceps femoris and gastrocnemius muscles (CMSI, Calf muscle strain injuries). As a rule, there is no underlying trauma. The first sensation of a disturbance occurs in an eccentric movement and is intensified with each similar eccentric movement. If you continue the movement that triggered it, you risk a more severe strain with a much longer recovery time (up to 8 weeks) or a torn muscle fibre, if not a torn muscle. Since pulled muscles are one of the main reasons for missed training or competition time in professional sports, a great deal of research is being done in this area for prevention and therapy. Some therapy options that are usually not available to recreational athletes can be found in the treatment of torn muscle fibres.

Muscle strains can be categorised into three types:

  • with mild symptoms, only minimal struktural damage to the muscle, no or only minor restrictions and a rehabilitation period of 10-14 days
  • with moderate pain, noticeable restrictions, possibly swelling and haematoma, and a rehabilitation period of 6-8 weeks.
  • with severe restrictions, muscle cramps, swelling and significant bruising, as well as a rehabilitation period of no less than 8-12 weeks.

If a grade 1 strain develops and the activity is maintained, it quickly becomes a grade 2 or 3.
Typical triggers are explosive force exertions. Strains are more likely to develop in biarticular or polyarticular muscles than in monoarticular ones. Strains often occur close to the tendon or in the tendon near the insertion.

ICD M62

Cause

  1. Unphysiological strain that does not correspond to the level of training or the situation in terms of strength or stretching requirements

Predisposing

– Behavior

  1. Insufficient training or stretching condition
  2. Insufficient warm-up
  3. Sports with rapidly changing demands on the muscles, sprinting, soccer, handball, tennis, badminton, squash, etc.
  4. Overload
  5. Muscle fatigue
  6. Poor general condition
  7. Insufficient fluid or electrolyte intake
  8. Taking anabolic steroids

– Musculoskeletal system

  1. Deformities of the foot
  2. muscular imbalances, e.g. between agonists and antagonists
  3. Insufficient training or strength of the affected muscle
  4. Insufficient flexibility of the affected muscle

– Other factors

  1. Low ambient temperatures
  2. existing cold

Diagnosis

  1. Sono to rule out fiber tears and hemorrhages
  2. Pressure soreness
  3. Hardening
  4. MRI: increased T2w signal, feathered along the fibres; The hyperintense fat strands may be missing in T2w.

Symptoms

  1. sudden pain on movement, increasing with each similar movement
  2. Cramp-like pain on exertion
  3. Painful stretching, pulling to stinging, but stretching improves
  4. Pressure soreness
  5. In contrast to a torn muscle fiber (where the pain is sudden): gradual development of the pain
  6. Tone in the area of the strain often increased
  7. Tense, hardened feeling in the muscle
  8. No loss of function
  9. possibly slight swelling

Complications

  1. torn muscle fibres, torn muscle
  2. tendon rupture
  3. especially during the early years: avulsion fracture
  4. Recurrence due to defective healing: scar tissue makes the muscle more susceptible due to a lack of function and altered flexibility

Therapy

  1. Immediate termination of the load
  2. PECH:
  3. After 1-2 weeks of rest, the muscles should be fully operational again
  4. Kriterien für die Wiederaufnahme des Sports sind:
    • complete freedom from pain
    • full prior flexibility
    • full prior muscle strength
      Any return to sport before the criteria have been met carries a high risk of recurrence. Statistically, it takes 4-6 weeks for a strain to be returned to sport at low risk in mild cases, and 4-6 months in more severe cases.
  5. NO anti-inflammatory drugs, NO massages or heat applications in the first 48 hours, NO alcohol in the first 48 hours