The importance of physical activity and sports to maintain and promote health, well-being, and work capacity cannot be overstated. "A healthy mind in a healthy body" is a commonly used motto in exercise, and not without a reason.

However, it should be remembered that physical activity and sports also involve a risk of injury. Sports injuries comprise the largest item under the accident category in Finland. The number of physical injuries is high, but fortunately, serious injuries are relatively rare, though.

Muscle Injury Classification

Nearly half of the physical and sports injuries are muscular injuries of varying degrees. Most of the muscular injuries that occur during exercise are either contusions (bruise) or strain-type injuries. Muscle contusion injuries are quite common in contact sports, but they also occur in sports that involve running, for example, as a "wooden leg" in the event of a fall. However, the most common form of musculoskeletal injury is tear/rupture.

The classification of muscle injuries is based on the amount of muscle tissue, i.e. muscle fibers, affected, the damage to the muscle membrane surrounding the muscle, and the symptoms caused by the injury. Normally, muscle injuries are classified into three categories of severity.

In first-degree muscle injuries, only a few muscle fibers are torn. Symptoms usually include muscle pain and muscle spasm / cramp (Charley horse). Muscle strength is often preserved or only temporarily impaired. In second-degree injuries, some of the muscle fibers are torn, but some of the fibers remain intact. In this type of injury, the main symptoms are pain and weakening of muscle strength as well as impaired function. In third-degree injuries, the muscle is completely torn and undergoes a loss of function.

Muscle is a highly vascularized tissue, so in case of an injury, its blood vessels also get damaged. For this reason, a blood clot always forms in the affected area, which at the beginning appears as swelling and later as bruising.

The Cornerstones of Muscle Injury Treatment

The goal of muscle injury treatment is to create the conditions for the improvement of the damaged muscle, so that healing is as quick as possible and the functional outcome of the muscle is as good as possible. Treatment aims at preventing late symptoms and complications.

First aid for muscle tissue injury should follow the I.C.E. rule —the cornerstones of treatment are Ice, Compression, and Elevation. The purpose of the treatment is to prevent bleeding, to decrease hematoma formation and swelling, and speed up healing. Scar tissue formation is also reduced when the amount of blood discharge is limited. In the early stages of recovery, I.C.E. is combined with rest of the injured muscle group. It is important to start the I.C.E. treatment as soon as possible at the injured site. You can use a cold pack or an ice bag to apply cold. Place an injured limp in an elevated position and compress it using a tape and an ice bag.

The function of the damaged muscle should be checked and tested a few days after the injury. If there is progress in muscle function and it is certain that there is no excessive bleeding or extensive muscle rupture, careful rehabilitation can be started. For example, rehabilitation of first-degree injuries will begin early, just a few days after the injury. This prevents the development of muscle atrophy. During the initial stage, the torn muscle is supported by taping it during exercise. It is important that training does not cause pain. Then muscle training can be gradually increased. It should be noted that healthy muscle groups must also be maintained in good conditions. Rehabilitation is carried out moderately with caution. The most important thing is to prevent the recurrence of muscle injury. It is only towards the end of rehabilitation that the athlete is presented with a variety of sports specific exercises and can return to competitive sports.

Surgical treatment of musculoskeletal disorders should be carefully considered, as the I.C.E. treatment and proper rehabilitation will produce a good outcome in most cases. Muscle injury very rarely requires surgery. If a large hematoma inside the muscle is detected or the function of the injured muscle is clearly impaired, surgery should be considered. Surgical treatment should be more susceptible if the patient is young or active, because they have often a greater functional deficit. If surgery is needed, it should be carried out as early as possible.

What to Do in Case of Muscle Injury?

• First aid treatment: apply I.C.E.
  • Cold pack + bandage on the injured muscle
  • Elevate position and rest
• For mild injuries, start rehabilitation with light muscle exercises, gradually increasing exercises for strength and movement.
• In most severe muscle injuries, after providing first aid, contact a doctor with experience in the treatment of muscle injuries, as delayed surgical treatment may impair the final functional outcome of the muscle.

Lasse Lempainen
Orthopaedic Surgeon