Muscle Injury Treatment 2023

28/01/2023 Inflammatory phase • REACTIVE VASOCONSTRICTION ( 30 mins ) Redness, swelling,pain and lost of function Bradykinin, Histamine and thromboxanos Neutrophils arrive at the site ( 1 hr): cleaning • REACTIVE VASODILATATION – Increasing vessels permeabiliy – Fagocythosis and myotubules apeea...

28/01/2023 Inflammatory phase • REACTIVE VASOCONSTRICTION ( 30 mins ) Redness, swelling,pain and lost of function Bradykinin, Histamine and thromboxanos Neutrophils arrive at the site ( 1 hr): cleaning • REACTIVE VASODILATATION – Increasing vessels permeabiliy – Fagocythosis and myotubules apeears – START point of normal proliferation healthy tissue – INFLAMMATORY PHASE IS BIOLOGICAL/NECESARY 3 3 Normal Response • Formation of Minimal Scar • Increase in Tensile Strength and a Decrease in the Number of Fibroblasts Signals the Beginning of the Maturation-Remodeling Phase • PAIN DECREASING SWELLING CONTROLLED 4 2 28/01/2023 Abnormal Response • Persistent Inflammatory Response Causes Extended= aedeme • Normal pattern disturbed by external agents Pain and swelling present > 6 days 5 Minimize the Early Effects of abnormal response • Controlling aedema • Modulating Pain • Facilitating Healing 6 3 28/01/2023 Proliferation Phase • Realignment of Collagen Fibers Along Lines of Tensile Force to bring scar flexibility • ANGIOGENESIS. • COLLAGEN SYNTHESIS Collagen Type III. • From 7 to 21 days. • Objective: to promote neovascularisation and cell proliferation. 7 Remodelation Phase • Formation of normal scar tissue (flexible) • Biomechanicals properties are adquired. • Objective : strenthg and functionality 8 8 4 28/01/2023 Phases and Duration in MSK Tissues Snyder-Mackler. Developmen Treatment Pathways, 2012. 9 9 Mueller-Wohlfahrt H-W, et al. Br J Sports Med 2013 10 10 5 28/01/2023 Type 1. Overexertion Injuries . Treatment FISIOTERAPIA: – – – – – – Masoterapia. Crioterapia/Termoterapia. Radiofrecuencia. Hidratación. Estiramiento Suave y Progresivo. Ejercicio suave de baja intensidad al cabo de unos días. FISIOTERAPIA PROFILÁCTICA: – Estiramientos regulares. – Control del nivel de entrenamiento y periodos de reposo. – Vigilancia de la hidratación: sudoración excesiva. – Termoterapia previa. 11 11 Type 2. Neuromuscular Disorders. MUSCLE CRAMP Involuntarily and forcibly contracted muscle that does not relax, with painfull sensation Muscle cramps often occur when : .- a muscle is overused or injured .- you have not had enough fluids (dehydration) .- you have low levels of minerals such as potassium or calcium Affects whole muscle 12 12 6 28/01/2023 MUSCLE CRAMP : Treatment Stretching with slow techniques Hydratation PREVENTION : Avoid dehydration. Drink plenty of liquids every day.. During the activity, replenish fluids at regular intervals, and continue drinking water or other fluids after you're finished. Stretch your muscles. Stretch before and after you use any muscle for an extended period 13 13 Type 2.Muscular Disorders: CONTRACTURE Tightening or shortening of muscles, with joint stiffness and local pain , increased with local pression Affects local area of muscle, palpable and sensitive – – – – – – Muscle overuse. Inadequate recovery. Chronic fatigue. Direct trauma. Joint asymmetries and/or agonist-antagonists. Activation of Myofascial Trigger Points (MTrPs) 14 14 7 28/01/2023 MUSCLE CONTRACTURE : Treatment Physical Therapy : ▪ ▪ ▪ ▪ Deep Termotherapy TENS 1-20Hz Local stretching Myofascial Trigger Point. PREVENTION : Avoid postural imbalances 15 15 Mueller-Wohlfahrt H-W, et al. Br J Sports Med 2013 16 16 8 28/01/2023 Structural Muscle Injuries : Type 3 /4 17 17 MUSCLE STRAIN TYPE 3 TYPE 3A TYPE 4 Myofibrillar rupture Greater number of injured fibers (less than 5% of fibers) SMU* ( more than 10%) SMU * Muscle rips into two separate pieces or shears away from its tendon Local tenderness Painfull whole muscle with and without contraction Mild swelling , not ecchymosis Swelling and ecchymosis in 24 hrs before Complete loss of muscle function, as well as considerable pain, swelling, tenderness Normal strength: contracción perserved Loss of strength: Impossible to contract Loss of stenght Normal Rom o limited <10% Limited ROM 10 – 50% Pop in the muscle at the time of injury Minimal LOCALISED pain if palpation or moving PHYSICAL THERAPY TREATMENT SURGICAL TREATMENT 18 18 9 28/01/2023 Skeletal muscle ultrasound (SMU) Muscle ultrasound is a convenient technique to visualize normal and pathological muscle tissue as it is non-invasive and real-time. 19 19 Tratamiento en las lesiones / trastornos musculares. Tipo 3 y Tipo 4. Roturas musculares. • Etiología: – Sobre-estiramiento superior al 25%. – Falta de preparación muscular: atrofia, músculo poco flexible, ejercicio sin correcta hidratación y calentamiento previo. – Condiciones externas: terreno, equipación, condiciones ambientales. – Edad. • Sintomatología: – Dolor brusco e intenso, sensación de punzada: “pedrada”. – Impotencia funcional. – Incremento del dolor en las horas siguientes. 20 20 10 28/01/2023 Tratamiento en las lesiones / trastornos musculares. Tipo 3 y Tipo 4. Roturas musculares. FISIOTERAPIA “IN SITU”: PRIMERAS 48h – RICE/PRICE/POLICE. – Reducción del Estrés. – No dolor (no movilización) OBJETIVOS FISIOTERAPIA POSTERIOR: – Disminuir Edema. – Promover la actividad neuromuscular. – Incremento de fuerza y elasticidad. – Prevención de recidivas. – Readaptación deportiva. Kerr KM, Daily L, Booth L .1999 21 21 Tratamiento en las lesiones / trastornos musculares. Tipo 3 y Tipo 4. Roturas musculares. FISIOTERAPIA POSTERIOR: 3er a 7º día – Termoterapia suave superficial. – Estiramientos y movilización en arco no doloroso. – Electroterapia: TENS y EMS mínima contracción. – Drenaje linfático. – Masoterapia distante al foco lesional. – Vendaje funcional. PREVENCIÓN DE LA CALCIFICACIÓN HETEROTÓPICA FISIOTERAPIA POSTERIOR: 2ª y 3ª semanas – Progresión en la movilización y estiramientos. – Comienzo de ejercicio activo, progresivo. – Reiniciar carga: comenzar con CNTR al 25% RM contralateral. – Masoterapia. – EMS: IF, TENS, KOTS. – Propiocepción. – Trabajo aeróbico y funcional. 22 22 11 28/01/2023 INFLAMATORY PHASE I MAXIMAL PROTECTION 0-4 day Muscle Strain Rest + compression Limit painfull motion Control pain Isometrics PROLIFERATIVE PHASE II MODERATE PROTECTION MATURATIVE PHASE II MINIMAL PROTECTION > 15 day >7 day Mechanical stimulus : US, stretching Isotonics Increase strenght Eccentrics : plyomtretics 23 23 Mueller-Wohlfahrt H-W, et al. Br J Sports Med 2013 24 24 12 28/01/2023 MUSCLE CONTUSION Direct blow or repeated blows in muscle. The condition is common in contact and collision sports, such as football, hockey, boxing, wrestling, and full-contact martial arts. • Symptoms : Tenderness Swelling Difficulty moving injured limb Anatomical integrity preserved: not tissue injuried Short evolution : 72 hrs 25 25 MUSCLE CONTUSION • Rest. Protect the injured area from further harm by stopping play. You may also use a protective device (i.e., crutches, sling). • Ice. Apply ice wrapped in a clean cloth. (Remove ice after 20 minutes.) • Compression. Lightly wrap the injured area in a soft bandage /Kinesiotape 26 26 13 28/01/2023 MYOSITIS OSSIFICANS Extra-skeletal ossification that occurs in muscles & other soft tissues, after injury • Symptoms : Restricted range of movement Pain in the muscle when you use it A hard lump in the muscle An X-ray can show bone growth 27 27 28 28 14 28/01/2023 MYOSITIS OSSIFICANS • PREVENTION • Not applying cold therapy and compression continously after injury. • Avoid intensive masage after the injury. • Pulsed Ultra sound • Maintain available range of motion. • Iontophoresis with 2 % acetic acid solution. • Extra corporeal shock wave therapy 29 29 15