Effective Management of Muscle Injuries: A Physiotherapy Perspective

Muscle injuries are a common occurrence, affecting athletes, fitness enthusiasts, and even individuals engaging in everyday activities. Because of this, sports physiotherapy has been gaining favour and popularity in managing muscle injuries. Understanding how to effectively manage these injuries is also crucial for optimal recovery and the prevention of further damage. To further understand how muscle injuries occur we can delve into the anatomy of a muscle and how injuries occur. 

A muscle is made up of a bundle of muscle fibres that is surrounded by an outer sheath that allows it to move smoothly over the surrounding tissues. These muscle fibres will shorten and lengthen when we move our body which means there is a combination of muscle contraction and relaxation that is coordinated through our nervous system. This is what allows us to run, kick, throw and even something as simple as walking and breathing. 

When we suffer from an injury, it is usually known as a pulled muscle or muscle strain which means there is a partial or complete tear of a muscle. The tear can occur in any one of these such as: within the muscle itself, at the junction between the muscle and tendon (most common type), and in the tendon where it attaches to the bone.

These injuries commonly happen during excessive loading of the muscle. For example: injuries tend to happen when the muscle is contracting while it is elongating. There are some other factors that can predispose an individual to injury such as older age, previous muscle injury, less flexibility, lack of strength in the muscle and fatigue.

If you are unsure that you might be currently suffering from a muscle strain, look out for these signs and symptoms:

• Sudden pain that worsens while contracting the muscle
• Swelling and bruising
• Loss of strength and range of motion
• Sensation of pain likened to being stabbed

After the inflammatory phase, the muscle begins to heal by regenerating muscle fibres from the cells around the area of injury. However, a significant amount of scar tissue also forms where the muscle was injured and over time it is thought that the muscle tissue never fully regenerates and makes the strained muscle more prone to injury.

Sports physiotherapy plays a pivotal role in the treatment and rehabilitation of injured muscles. This article outlines key steps and strategies from a physiotherapy perspective to ensure effective muscle injury management.

1. Initial Assessment and Diagnosis

The first step in managing a muscle injury is an accurate assessment and diagnosis. This involves: 

Clinical Examination: A thorough examination to determine the extent and nature of the injury. This may include assessing the range of motion, strength, and specific points of tenderness. 

Imaging Techniques: In some cases, imaging techniques such as MRI or ultrasound may be required to confirm the diagnosis and rule out other potential issues. An x-ray may be helpful to rule out fracture or dislocation as the cause of pain. Occasionally, the tendon can pull off a piece of bone at where it attaches, which can be seen on x rays.

2. Immediate Management (First 48 Hours) 

The initial 48 hours post-injury are critical. The primary goals during this phase are to reduce inflammation, minimise pain, and prevent further injury. Key strategies include:

PEACE (Protection, Elevation, Avoid Anti-Inflammatories, Compression, Education):

The PEACE protocol is used in the initial stages of injury management, typically within the first few days after injury. The goal is to reduce bleeding, swelling, and pain, while also promoting optimal tissue healing.

• Protection: Avoid activities that aggravate the injury and deload the affected area to minimise bleeding and swelling.
• Elevation: Elevate the injured limb above the level of the heart to promote fluid flow out of the injured tissue.
• Avoid Anti-Inflammatories: Avoid using anti-inflammatory medication, as it can negatively affect long-term tissue healing and impair the healing process.
• Compression: Use compression bandages or wraps to reduce swelling and promote fluid flow.
• Education: Educate the patient on the importance of proper injury management and the importance of early and effective treatment.

LOVE (Load, Optimism, Vascularisation, Exercise):

The LOVE protocol is used in the subsequent stages of injury management, typically after the initial PEACE protocol has been completed. The goal is to promote optimal tissue healing, strength, and function.

• Load: Gradually increase loading of the affected area to promote strength and function.
• Optimism: Maintain a positive attitude and focus on the recovery process.
• Vascularisation: Promote blood flow to the affected area to promote healing and tissue repair.
• Exercise: Incorporate exercises and activities that promote strength, flexibility, and proprioception.

Pain Management: Over-the-counter pain medications such as NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) can be used to manage pain and reduce inflammation. However, they should be used under the guidance of a healthcare professional.

3. Rehabilitation Phase 

Once the initial inflammation has subsided, the focus shifts to rehabilitation. This phase is tailored to the individual’s specific injury and recovery goals and typically includes:

Controlled Mobility and Gentle Stretching: Gradual reintroduction of movement helps prevent stiffness and maintains flexibility. Gentle stretching exercises should be initiated early but within a pain-free range.

Strengthening Exercises: As healing progresses, strengthening exercises are introduced to restore muscle strength. These exercises should be progressive, starting with low resistance and gradually increasing as tolerated.

Neuromuscular Re-Education: This involves exercises that help retrain the muscles to respond correctly to signals from the nervous system. It is essential for restoring normal movement patterns and preventing re-injury.

4. Advanced Rehabilitation and Functional Training

Advanced rehabilitation focuses on restoring full function and preparing the individual to return to their previous level of activity. This phase includes:

Sport-Specific or Activity-Specific Training: Exercises and drills that mimic the movements and demands of the individual’s sport or activity help ensure they are ready to return safely.

Agility and Plyometric Training: These exercises improve coordination, balance, and explosive power, which are crucial for athletic performance and injury prevention. 

Manual Therapy: Techniques such as massage, myofascial release, and joint mobilizations can help reduce muscle tension, improve flexibility, and enhance recovery.

5. Prevention of Future Injuries 

Preventing future muscle injuries is a key component of physiotherapy. Strategies include: 

Education and Awareness: Educating individuals about proper techniques, warm-up routines, and the importance of regular conditioning exercises.

Customised Exercise Programs: Developing personalised exercise programs that address any muscle imbalances, weaknesses, or flexibility issues identified during the rehabilitation process.

 Regular Monitoring and Adjustment: Continuously monitoring progress and adjusting the rehabilitation program as needed to ensure optimal recovery and performance.