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Muscle Injuries in Sport            

Introduction:

Muscle injuries are commonplace in football and are frequently sustained in both training and playing.   These can occur either through direct contact or non-contact mechanisms. 

Examples of non-contact injuries are strains of the hamstring, thigh or calf muscles while direct contact injuries often include severe muscular bruising as a result of being kicked; usually to the quadriceps group of the thigh.

A simple muscle strain is defined as the tearing of a few fibres; and the classic example of this is the feeling a sharp pull or tear while running, sprinting or changing direction. 

92% of injuries in football are reported to affect the four major muscle groups of the lower limb according to Ekstrand et al, (2011); and from that it can be seen that injuries to the hamstrings (37%), adductors (23%), quadriceps (19%) and calf muscles (13%) are the normal. 

Ueblacker et al (2015) gave the figure for overall thigh muscle injuries as 25% of all injuries sustained.   Calf strains were reported to comprise 3.6% of all injuries recorded in a 5 year study of football players by Armfield et al, (2006). 

The management of soft tissue issues is therefore a high priority when dealing with footballers and football injuries.

Injury grading
 
Injuries to muscles and ligaments are graded according to their severity based on the American Medical Association Standard Nomenclature of Athletic Injuries (1966).  Although other grading scales are currently being considered, these are less universally adopted and injuries still tend to be graded under the old system as either one, two or three. 


Broadly speaking, a Grade 1 muscle strain is simply the tearing of a few muscle fibres and these usually heal relatively quickly. 


Grade 1 injuries are generally more of an irritation than an actual injury problem as such, and rarely take longer than 10 to 14 days to heal. 

Grade 2 injuries involve more than a few muscle fibres and take on average anything between two and six to eight weeks.  Depending on the extent of the injury, however, this can be considerably longer. 

Grade 3 muscle injuries constitute a complete rupture of the muscle and can sometimes require surgical repair.  Often a severe Grade 2 calf tear involving a significant percentage of muscle fibres can be confused with a Grade 3 tear; since the symptoms are often the same. 

The injury grading system for musculo-ligamentous injuries is really only a guide and as you can imagine, injuries fitting into the Grade 2 category will vary. 


This can be from a very mild Grade 2 injury which is a little more than a sub-acute Grade 1 injury, to severe Grade 2 strains with the damage done to a greater percentage of the muscle fibres than not.


So at this end of the scale these higher level Grade 2 injuries are in essence bordering on being Grade 3 complete ruptures.

It follows then, that the recovery period for injuries categorised as Grade 2 will be variable; and this explains why in so many cases different players with the same (theoretical) injury grading will vary so much in their response to treatment in terms of training days lost and absence from the team. 

In healing terms, the body doesn’t replace injured tissues on a like for like basis; therefore damaged muscle fibres are repaired using a form of scarring.   This makes the likelihood of further injury a strong possibility if the healing process is disturbed too soon. 

Injury Treatment and Management

Although the research on recurrent injuries applies to all injuries, this is particularly true in the case of muscle damage.  The healing process needs to be complete in order for the injured tissue to be strong enough to withstand the demands placed on the body. 

After the acute stage where ice and rest are the priorities, treatment generally consists of heat applications, gentle massage and stretching, plus specific exercises to strengthen the muscle. 

The importance of early cold applications are essential to any soft-tissue muscle injury, since ice reduces pain through having a sedative effect on nerve endings and also reduces swelling. 


When a muscle tears it bleeds around the affected area; and the early application of ice helps to limit this in the early, important, stages of injury treatment. 

By restricting the damage to the muscle through the colder temperatures, the increased flow of blood to the injured area can be limited through early applications of ice-packs which will help to minimise swelling. 

It’s important at this stage not to increase the blood flow to the affected area by applying any form of heat, or by introducing any form of massage treatment until the acute phase has passed; usually after about 4  - 7 days but this is often variable. 

Football places a high demand on the muscle tissues due to the requirements of the game, therefore after the early stages of injury treatment the emphasis changes to one of active exercise with a focus on strengthening and stretching. 

Finally, we get to the functional stages where footballing activities are introduced.  It’s at this stage where we need to be careful and only encourage a return to play once the player is capable of performing all the functional aspects of the game without pain and

at the same levels as before the injury occurred. 

Hagglund et al (2006) indicated that the biggest risk of recurrent or repeated injury comes from having sustained a previous injury to the same structure.

So if you try to come back to play too soon then you are simply increasing your chances of sustaining a similar injury in the future (Orchard et al, 2005).

 
References:

Armfield DR, Kim DH, Towers JD, Bradley JP, Robertson DD (2006).  Sports-related muscle injury in the lower extremity.  Clinics in Sports Medicine.  Vol. 25; 803 – 842


Eckstrand J, Hagglund M, Walden M (2011).  Injury incidence and injury patterns in professional football -  the UEFA injury study.  British Journal of Sports Medicine.  Vol 45 (7); 553 – 558.

Hagglund M, Walden M, Ekstrand J (2006).  Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons.  British Journal of Sports Medicine.  Vol. 40, 767 – 772.

Orchard J, Best TM, Verrall GM (2005).  Return to play following muscle strains. Clinical Journal of Sports Medicine   Vol. 15, 436 – 44.


Ueblacker P, Mueller-Wohlfahrt, Ekstrand J (2015).  Epidemiological and clinical outcome comparison of indirect (strain) versus direct (contusion) anterior and posterior thigh muscle injuries in elite male football players: UEFA Elite League study of 2287 thigh injuries (2001 – 2013).  British Journal of Sports Medicine.  Bjsports - 2014-094285 Published Online First: 9 March 2015..
 

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