What is an overstretch injury to a musculotendinous unit (muscle fiber injury)?
Strain
What is a grade 1 strain?
Minor stretch, few torn fibers
What is a grade 2 strain?
Several to majority of fibers torn
What is a grade 3 strain?
Complete rupture or avulsion fracture
What fracture is piece of bone attached to tendon/ligaments get pulled away from the main part of the bone?
Avulsion fracture
What are the etiology?
- Sudden overstretch of muscle
- Extreme contraction
- Trauma
- Chronic overuse
- Inadequate warmup for activites, limited flexibility, muscle fatigue
Where are the most common strains?
- Hamstrings
- Quadriceps
- Gastrocnemius
- Adductors
- Rotator Cuff
- Pec Minor
- Biceps Brachii
- Erectors
What are the signs & symptoms of a grade 1 strain?
- Can continue activity with mild discomfort
- Discomfort or mild pain
- Minimal or no loss of strength or function
- Local tenderness
What are the signs & symptoms of grade 2 strain?
- Difficulty continuing activity due to pain or weakness
- Possible snapping sound or sensation
- Palpable gap at the injury site
- Some loss of strength & function
- Protective spasm
- Bruising or hematoma may be present in more severe cases
- Protective spasm may limite ROM
What are the signs & symptoms of a grade 3 strain?
- Unable to continue activity due to significatn pain and weakness
- Snapping sensation or sound
- Bruising
- Severe pain aggravated by movement
- Possible swelling
- Palpable gap
- Often visible deformity, as the muscles shortens & bunches up
- Hematoma at the lesion site
- Protective spasm that decreases ROM
- Bandages, slings or crutches may be used
What are the signs & symptoms during acute?
- Inflammation
- Loss of function d/t swelling, protective spasm & pain
- Bruising red, black & blue
- Mm, blood vessel, nerve damage possible in grade 2 & 3
What are the signs & symptoms in early subacute?
- Inflammation decreased
- Swelling decreases, protective spasm are still present
- Bruising is black & blue
- Crutches & sling
- ROM is limited
- Adhesions are starting to form
- TPs, local & compensatory
- Reduced proprioception
What are the signs & symptoms in late subacute?
- Inflammation further decreased
- Edema decreased & gel like like
- Protective spasm has been replaced by ADH & FR
- Bruising is yellow, green & brown
- Crutches / sling
- ROM increased
- Adhesions are maturing
- TPs, local & compensatory
- Reduced proprioception
What are the signs & symptoms in chronic?
- Inflammation is gone
- Tissues may be cool d/t adhesions
- Fascial restrictions
- Edema is barely noticeable / gone
- Bruising gone
- Point tenderness is local to injury site
- ROM is limited in direction of injury - strength reduced
- Adhesions are matured & local to site
- TPs are local
- Reduced proprioception at joint
What are contraindications & precautions?
- No testing other than pain free AROM in acute grade 2 or 3
- Do not completely remove protective spasm (acute)
- No distal circulatory techniques (acute / early subacute)
- If a grade 3 strain is casted, no heat applications immediately proximal to the cast
- No frictions with inflammatories
- Avoid joint movement that produced pain or will overstretch the injured site
Assessment findings in acute
- Antalgic gait if injury is in web joint
- Antalgic posture
- Px facial expression
- AROM is limited due to pain
- PROM (grade 1 only) : pain and muscle spasm in the range that stretches the affected muscle
- RROM (grade 1 only) : minor or no loss of strength in the range that test the affected muscle
Assessment findings in subacute / post acute
- AROM is limited due to pan
- PROM limited, painful, tissue stretch end feel in the range that stretches the affected muscle
- RROM contracture must be gradually increased
- MM strength shows weakness
- MM length shows shortness
Assessment findings in chronic
- AROM may be limited
- PROM mildly painful, tissue stretch end feel in the range that stretches the affected muscle
- RROM & mm strength test show possible decrease in strengthW
What are the goals of this treatment?
- Control inflammation (acute)
- Reduce edema & pain (acute)
- Prevent excess adhesion formation (early subacute)
- Maintain strength, function & mobility
- Encourage local circulation d/t mm are highly vascular
- Decrease muscle imbalances
- injured muscles needs strengthening - Restore mobility
- Norm mm tone
- Gradually restore muscular length & strength
- Reduce TPs & adhesions
What are massage techniques to do?
- Kneading reduce HT, adh
- Stripping reduce HT, adh
- Frictions reduce adh & scar tissue
- O+I / GTO release reduce HT
- AROM
What are homecare exercises?
- RICE / PRICES in acute
- Breathing exercises for pain reduction
- ROM exercises
- Pain free in acute - Stretching
- Strengthening
- Self massage / foam rolling
