The most common muscular injuries in athletics are strains, torn muscle fibers, and ruptured muscles, triggered by the sudden overstretching of a tensed muscle, for example when sprinting or stopping.
While often difficult to distinguish between a strain and a tear, a muscle tear can usually be identified by a palpable dent in the belly of the muscle.
Im Akutfall ist die PECH-Regel anzuwenden und in weiterer Folge konservative Therapie bestehend z.B. aus Salbenverbänden, Medikamenten, Schonung, Physiotherapie und Eigenbluttherapie (ACP).
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further treatment in sport are muscle strains, tears in the muscle fibre and muscle tears to different extents. If a muscle is subject to a sudden stretch over its physiological mass, we talk about a muscle strain, whereby the anatomical structure of the muscle generally remains intact. It is often difficult, however, to differentiate between a muscle strain and a muscle tear. As microscopic tears to the muscle fibres also often occur in a muscle strain, if the stretch exceeds the available strength of the muscle, a muscle fibre tear or even a muscle tear can occur. Depending on the extent, muscle fibres are therefore torn or muscle is generally torn completely in two.
Whilst the differentiation between muscle strain and muscle tear is often clinically difficult, a complete muscle tear is often detectable by a palpable indentation in the muscle belly - with the exception of a very low-lying muscle, which cannot be palpated.
The typical injury patterns are sudden slowing down, sprinting, but also combinations of slowing down and accelerating (for example turning and hitting movements in baseball) which lead to hyperextension of the tensed musculature.
Typical symptoms of muscle strain are immediate, severe to stabbing pain, swelling, haematoma, restriction of movement to immobility, and, in the case of a muscle tear, a palpable interruption in continuity.
In the case of muscle fibre tears and muscle tears, the pain often increases further overnight as a haematoma (= sanguineous effusion) forms, which presses on the surrounding structures.
The demarcation of the muscle stiffness (= myogelosis) is important. Myogelosis is also very painful and can really spoil a marathon or running training. It is, however, very easily treated. Areas of muscle stiffness occur as a result of overexertion or incorrect weight bearing and are often easily palpable in the musculature as definite knots. With the appropriate physiotherapy (the painful knots are massaged whilst in pain), however, this problem can often be brought under control very quickly. Muscle relaxing baths and acupuncture are also helpful. If not treated, the increased muscle tension in the region of the hardening can also lead to muscle fibre tears under renewed stress.
A range of fundamental factors encourage the muscle to be more susceptible to tearing:
- As a result of relative underperfusion, a lack of warming up leads to the different muscle and joint receptors receiving inadequate information, which means that the optimal interaction of the musculature is impeded. Even though articles in newspapers have unfortunately suggested recently that stretching before and after sport would be inconsequential, this is incorrect. A single study has been used here as proof, and all other studies that have described the positive effects of stretching have not been taken into consideration. The reality is that you should lightly warm up before running. Then come the stretching exercises, which significantly reduce the risk of injury and overexertion damage. You should also stretch consistently after running to reduce muscle shortening. It is certainly true that stretching exercises can be carried out afterwards by a sprinter, but for the long-distance runner, warming up and stretching before and after the run is essential.
- Inadequate training or muscle fatigue as a result of recovery phases that are too few and too short or too many training sessions, or even general overtiredness, lead to overexertion of the musculature, which means that muscle strains occur more easily.
- Previous muscle tears with scar formation lead to an increased susceptibility to injury as a result of the lower elasticity of the scar tissue.
- Athletes who have a tendency to muscle hardening are particularly susceptible to muscle injuries.
If a muscle strain becomes a muscle tear, the PICE rules are to be applied at once - and every minute counts for these:
- P is for pause. This means: Do not grit your teeth and bear it, stop the sport immediately. The injured or painful body part should be rested.
- I is for ice. Treat the affected area immediately with ice, cold running water or a cold compress (e.g. Coldpack from the pharmacy). Cold reduces bleeding and swelling, however never place cold packs directly onto the skin. Cover the affected site with a towel. Caution: Do not use cold on open wounds!
- C is for compression. Application of a firm dressing with an elastic bandage is the next step, preferably with a cold compress around it. Large haematomas are prevented in this manner (heavier bleeding can lead to further muscle fibre damage and pronounced defects without compression). Ensure that you do not apply the bandage too tightly. Bandage, do not tie up!
- E is for elevation. Doing this reduces the blood supply. Fluid that escapes from the blood vessels and into the surrounding tissue is removed more easily. This means that the swelling and the pain linked to it is reduced.
weitere Therapie of muscle fibre tears is as follows:
1st to 3rd day: Tape dressings, anti-inflammatory ointment dressings and medications, muscle relaxants, electrotherapy, mobilisation with crutches.
From the 4th day: Ultrasound therapy, interference current, physiotherapy. Further mobilisation on crutches with weight bearing up to the pain threshold. Note: No passive stretching or massage in the case of strain for three weeks, muscle fibre tear for six weeks and muscle tear for eight to twelve weeks.
And then the main characteristic of the treatment comes into play: Whilst training must be recommenced as soon as possible for muscle strains (always significantly below the pain threshold), rest for weeks is required for muscle fibre tears... Sport should only be recommenced if you are generally completely pain free (i.e. even during physiotherapy).
Eine Möglichkeit die Heilung drastisch zu beschleunigen ist die lokale Gabe von Wachstumsfaktoren, zB mittels Eigenbluttherapie (ACP). ACP (autologes konditioniertes Plasma) ist ein Eigenblutprodukt. Dazu wird der/dem PatientIn Blut aus einer Armvene abgenommen und auf eine spezielle Weise zentrifugiert. Dadurch werden Thrombozyten (Blutplättchen) aktiviert, die wiederum proliferative Substanzen freisetzen (wie Platelet Derived Growth Factor ,PDGF) und morphogene Proteine (Transforming Growth factor, TGF), welche für Muskel-, Sehnen-, Knorpel- und Knochenheilung wichtig sind.
Neue wissenschaftliche Studien zeigen, dass durch die Anwendung von Eigenblut (ACP) die Heilung von Muskelverletzungen, aber auch auch von Sehnen- und Knorpelproblemen signifikant beschleunigt und verbessert werden kann.
If progress is optimal, athletes can recommence training after two to three weeks, which means that the healing time is therefore halved. Moreover, the
application of these growth factors also reduces the development
of inadequate scar tissue.
Weitere Informationen zur Eigenbluttherapie (ACP) finden Sie hier: Eigenbluttherapie (ACP).
In the case of significant muscle tears, however, an operation may be necessary, with clearing of the haematoma and suturing of the torn musculature. Unfortunately, sutures in the torn musculature (in contrast to tendon ruptures) often hold very poorly, therefore an operation is often disregarded.
Complications following muscle tears:
In rare cases, painful calcifications can form (= myositis ossificans) - this complication usually occurs when the patient begins to train again too early in the regeneration process. Additional problems include pronounced scarring, which significantly reduces the elasticity of the affected muscle, and possible painful cyst formations.
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Muscle ache is significantly less harmful than the muscle injuries listed above. We understand this to be pain that occurs following sporting exertion, particularly in the case of high levels of strain or untrained muscle groups. This is often noticeable within the first few hours after sport.
Previously, we assumed an overacidification of the muscle caused by lactate (= hydroxypropionic acid salt and occurring in the case of anaerobic exertion). However this hypothesis has been dismissed since then for three reasons:
- Muscle ache occurs primarily in untrained athletes who overexert themselves. Lactate is created during any anaerobic exertion, in both novices and professionals.
- According to the lactate hypothesis, muscle ache would have to occur especially after sporting activities in which particularly high lactate values are measured (sprinters, swimmers). Practice shows, however, that the muscle ache occurs more frequently after strength training, during which very little lactate is formed.
- Lactate has a half-life value of around 20 minutes, yet muscle ache often occurs hours later, long after which the lactate level has normalised.
The currently established theory is that muscle ache is caused by the formation of microscopically small muscle fibre tears, in which tissue fluid is stored. This causes painful muscle swelling, however the process takes some time, which also explains the delayed onset of muscle ache hours after exertion.
In principle, severe muscle ache should be avoided - i.e. all sudden and excessive exertions for which the current level of training is inadequate. Thorough warming up is also important to ensure good perfusion of the musculature prior to maximum exertion.
If you are already suffering from muscle ache, the following helps:
- alternating cold/warm compresses in the first 24 hours. This facilitates the provision of muscles with oxygen and nutrients as well as the flushing out of harmful substances, such as proteins from damaged muscle cells.
- Warm compresses, warm baths, preferably with alleviating bath additives (e.g. relaxing baths). A sauna and steam bath are also very helpful.
- Anti-inflammatory ointments and essential oils may also bring relief.
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