Chapter 12: Muscle Strains

Understanding muscle strains Muscle strain, also called a pulled muscle, occurs when muscle fibers are overstretched Increased tensile stress is the primary cause of muscle strains Strains can occur in any muscle but are mostly likely in muscles that cross two joints Muscles commonly strained muscles: hamstrings, quadriceps, gastrocnemius, muscles of the rotator cuff, pectoralis major, biceps brachialis, muscles of the neck

Figure 12-1 Muscle strain. Fibers in the muscle, tendon, or musculotendinous junction or at the attachment site tear due to overstretching.

Common signs and symptoms Signs and symptoms differ depending on grade (severity of injury) and stage (duration of symptoms) Acute stage: symptoms typically last 3 – 4 days following injury Subacute stage: symptoms typically remain from 3 days to 3 weeks following acute stage Chronic stage: symptoms continue beyond subacute stage

Figure 12-2 Degrees of strain. Few fibers are torn in first-degree strain (left). Several fibers are torn in second-degree strain (middle). All fibers are torn in third-degree strain (right). The muscles and tendons may shorten and bunch up near the attachment site. Adapted from Clay and Pounds, 2008.

Possible causes and contributing factors Cause of strain is overstretching with too much tensile stress Strain can also occur in an unhealthy muscle that can’t lengthen in the average normal range Previous injury increases risk of strain Athletes are particularly prone to strains Age

Figure 12-3 Injury – re-injury cycle. Scar tissue alters the shape and function of the affected fibers, leaving the muscle at risk for re-injury. From Werner R. A Massage Therapist’s Guide to Pathology, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2009.

Conditions commonly confused with or contributing to muscle strains Sprain Tendinitis Spasm/cramp Myofascial pain syndrome DOMS Avulsion fracture Bursitis Hernia

Massage therapy research Hopper et al. (2005). Evaluation of the effect of two massage techniques on hamstring muscle length in competitive female hockey players. Farr et al. (2002). The effects of therapeutic massage on delayed muscle soreness and muscle function following downhill walking.

Working with the client Client assessment Health history Postural assessment ROM assessment: active, passive, resisted Special tests: none Palpation assessment

Figure 12-4 Bruise following muscle strain. The darkest area of bruising suggest the precise location of torn fibers.

Condition-specific massage Treatment goals and techniques are the same for first- degree strains in all stages and second- and third-degree strains in the subacute and chronic stages Treatment should be relaxing Remember that you are working on tissue that is compromised

Figure 12-5 Muscle strains overview diagram. Follow the general principles from left to right or top to bottom when treating muscle strains.

Client self-care Avoid re-injury Perform self-care throughout the day Take regular breaks from stationary postures or repetitive actions Gentle self-massage Stretching and strengthening exercises

Suggestions for further treatment There should be some improvement with each session. If not, consider the following: There is too much time between treatments The client is not adjusting ADLs or not doing self-care The condition is advanced or involves complications The client has an undiagnosed underlying condition

Chapter 13: Ligament Sprains

Understanding ligament sprains Sprain is an overstretch injury to a ligament Ligaments are tough but flexible fibrous bands; they stabilize joints, restrict excessive movement, and prevent joints from moving in a direction that would cause injury Injury to a ligament often initiates an inflammatory response

Common signs and symptoms Sprains can occur in any joint but occur most often in the ankles, knees, wrists, and fingers Overstretching may result in injury ranging from minor tears to complete rupture Signs and symptoms differ depending on the grade (severity of injury) and stage (duration of symptoms) Sprains produce local pain, stiffness, pain on passive stretch, and impaired ROM Bruises and inflammation may be present

Figure 13-3 Ligaments that cross joints are most commonly injured. It is essential to know the fiber direction of each of the ligaments that cross and injured joint in order to properly assess and treat the sprain. Adapted from Clay and Pounds, 2008.

Figure 13-4 Acute ankle sprain. Common signs of an acute ankle sprain include inflammation and bruising.

Stages of ligament sprains Acute: symptoms typically last 2 – 3 days following injury Subacute: symptoms typically remain from 2 – 4 weeks following acute stage Chronic: symptoms continue beyond the subacute stage

Possible causes and contributing factors Most common cause is a swift, high-impact movement that stretches the ligament beyond its capacity May also occur during ADLs if client has systemic disorders, deconditioning, or repetitive actions have weakened the ligament and destabilized the joint Beginning a new activity following a period of inactivity Failure to warm-up before vigorous activity Poor technique; immobility; insufficient rehabilitation Weight gain, especially from pregnancy

Conditions commonly confused with or contributing to ligament sprains Muscle strain Tendinopathy Avulsion fracture Bursitis

Contraindications and special considerations Hemarthrosis Bruises Muscle testing Protective muscle splinting Re-injury Treatment duration and pressure Friction

Massage therapy research Several studies report significant improvement in sprains treated with combination therapies Gemmell et al. (2005). A theoretical model for treatment of soft tissue injuries: treatment of an ankle sprain in a college tennis player.

Working with the client Client assessment Health history Postural assessment ROM assessment: active, passive, resisted Special tests: ligamentous stress test Palpation assessment

Condition-specific massage Treatment goals and techniques are the same for grade 1 sprains in all stages and grade 2 and 3 sprains in subacute and chronic stages An acute grade 3 sprain requires medical attention Wait 24 – 48 hours after a grade 1 or 2 sprain before beginning treatment Treatment must be relaxing

Figure 13-7 Ligament sprains overview diagram. Follow the general principles from left to right or top to bottom when treating ligament sprains.

Client self-care Avoid re-injury Perform self-care throughout the day Take regular breaks from stationary postures or repetitive actions Gentle self-massage Stretching and strengthening exercises

Suggestions for further treatment There should be some improvement with each session. If not, consider the following: There is too much time between treatments The client is not adjusting ADLs or not doing self-care The condition is advanced or involves complications The client has an undiagnosed underlying condition