Year: 2022

Muscle strains, torn muscles, pulled muscles, DOMS?!?!

Part 1.

We’ve all heard of the common old “I’ve strained/pulled/torn a muscle” or even the basic “Ohhh the muscles are a tad sore after that workout!”. But what has actually happened when you get a strained/torn/pulled muscle? And why do we experience DOMS (delayed onset muscle soreness) after a good workout? Knowing what happens during a muscle strain is the first step in understanding how to best manage your muscle soreness or injury, and will get you set up for the best outcomes both short- and long-term.

Basic muscle anatomy

To understand muscle strains and DOMS we must first appreciate that muscles are complex and adaptable things. Picture muscles as a bunch of tubes (called sarcomeres) bundled together like many straws, which attach from bone to bone via tendons (see Image 1). Muscles (red part) have a stretchy, elastic-like property (think strong elastic band) and do all the hard work. Tendons (white part) on the other hand don’t do as much work, but act more to transfer force that the muscle produces, and connect muscles to bone. Tendons are strong, flexible, and play an important role as well.

Image 1. Cross section of a muscle

How does a muscle work?

Muscles are living, breathing (sort of) things which work by pulling (concentric contraction) and releasing (eccentric contraction). Picture a bicep curl. Your bicep works concentrically to lift the weight up and bend at the elbow, and works eccentrically when slowly lowering the weight back to a straight arm position (see Image 2). In technical terms muscles work via the ‘sliding filament theory’ involving actin and myosin units which form the sarcomeres. Both concentric and eccentric muscle contraction requires varying degrees of effort, and this is where muscle injuries and soreness starts to come into play.

Image 2. Concentric and eccentric contraction of the biceps muscle.

Why do muscle strains occur???

Muscle strain injuries ultimately result from tissue/muscle failure. In other words, the muscle is exposed to a load or force higher than they can handle, and the activity demand exceeds the muscle capacity.

Exposure to load/force can come from a variety of sources. This includes lifting heavy objects, to repetitive movements (for example running), to high velocity moments (for example changing direction during footy). Exposure to load/force can lead to small micro-tears within the muscle, and if the force is great enough or prolonged enough then larger sized tears can obviously occur. Remember, since muscles are living/breathing things so they can be slowly trained to adapt to load. This is where DOMS comes in!

What are DOMS?

DOMS refers to that generalised muscle ache we get after a good exercise session, or after attempting a new exercise your body isn’t quite used to yet. I’m sure many of you can remember a time where you have gone back to the gym or a sport after holidays, and the next few days feeling pretty darn sore for the next few days. Then gradually over a few sessions your body gets used to said exercise and that soreness slowly goes away. That is ADAPTATION in a nutshell.

To explain this in slightly more technical terms, during an exercise session you are exposed to high or repeated external forces causing small micro-tears to your muscles, but in a manner that is controlled, not overly painful, and within your muscle tissues capacity (think lifting weights, or doing gentle cardio). Following the cool down period after your exercise session, the body begins the healing process and its associated inflammatory reaction to heal these micro-tears and rebuild your muscle tissue stronger than before (ADAPTATION).It is believed that these micro-tears and the inflammatory response (and several other theories) are what causes DOMS. The peak of DOMS typically sets in 1-2 days after the session is completed, and the soreness begins to ease after this.

It should be worth noting that you do NOT need to experience DOMS in order for adaptation or hypertrophy (building muscle size) to occur. However, the more you exert and challenge a muscle differently the more likely DOMS will occur.

What does a muscle strain/DOMS feel like?

With muscle strains individuals may describe a painful strong pulling sensation, which can appear sharp in nature and progress to more of a strong achy feeling over time. In more significant cases a strong pop may be felt. During early stages there may be limited movement around the injured area, and you may notice some bruising and swelling develop over time. Pain is most likely worsened when attempting to use the affected muscle.

Likewise, DOMS can often result in limited movement but to a lesser degree, and symptoms typically ease with gentle movement. Strains are often felt at the time of exercise, particularly the more severe ones, whereas DOMS is felt over the next few days.

Why do some muscle injuries heal quicker than others?

Healing rates of muscle injuries are largely dependent on the location. The injury can occur in three distinct locations; the periphery of the muscle (myofascial), in the bulk of the muscle (musculotendinous), or in the tendon (intratendinous). The most commonly injured location is the musculotendinous part. Naturally, the extent of the injury will also influence how long it takes to heal. Muscle strains can be graded using different scales, although the simplest and most commonly used grading system ranks strains as shown below.

Other comorbidities such as diabetes or smoking can notably slow down healing rates as well.

Part 1 SUMMARY:

• Sore muscles after a big workout or different workout is normal!

• DOMS typically occurs the next few days following a workout, whereas a strain is typically felt at the time of exercise.

• Muscle strains typically occur when the demands of a muscle exceed its capacity.

• Muscles are adaptable to load, training them up slowly and steadily is your best bet.

• Healing times vary between degrees of strain, and personal factors as well. Make your own journey!

An early and thorough assessment following a muscle strain is essential whether you are wanting to simply get back on your feet or return to high level sports. Book in to see your physiotherapist for a thorough assessment and tips on how to best handle your individual rehab journey.

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WILSON TANG, PHYSIOTHERAPIST

Hemiplegic Migraines are a rare type of migraine disorder which involve single sided weakness and aura/sensory symptoms. This can be due to genetics or can occur spontaneously in certain individuals.

Symptoms can range in intensity and can last for a few days and in severe cases a few months. The motor symptoms will tend to last longer than the headache symptoms and these will often present quite similar to a stroke. In the majority of cases patients will tend to make a full recovery.

Triggers can be things such as stress, lack of sleep, emotional distress and physical exertion. Women are three times more likely to be affected and average age of onset of symptoms is between 12 and 17 years of age.

Diagnostic criteria for Hemiplegic migraines is as follows:

At least 2 attacks fulfilling the criteria 2 and 3

Aura consisting of both of the following:

• Fully reversible motor weakness
• Fully reversible visual, sensory and/or speech/language symptoms

At least 2 of the following 4 characteristics:

• At least one aura symptom spreading gradually over at least 5 minutes, and/or at least 2 symptoms occurring in succession
• Each non-motor symptom lasts 5 to 60 minutes, and motor symptoms last less than 3 days
• At least one aura symptom is unilateral
• Aura is accompanied or followed by a headache within 30 minutes.

Given how similar presentations are to a stroke or TIA, CT’s, MRI’s and spinal punctures may be needed to rule out any other pathologies.

The attacks are managed with preventative medications which are taken ongoing for the life of the individual. Though as patients get above the age of 50 the occurrence of motor symptoms tends to reduce and they are more likely to be affected only with migraine and aura symptoms.

Motor symptoms can be treated similar to that of acute stroke rehab and provided all scans are clear of any tissue damage there should be full symptoms resolution in an accelerated time frame.

STROKE

A stroke occurs due to disrupted blood supply to the brain. There are two types of strokes that commonly occur ischaemic (blockage of a blood vessel) or haemorrhagic (bleed from a blood vessel). Both will lead to damage to the nerves and cells within the brain. This damage then leads to the functional deficits that are seen in stroke survivors. Physiotherapy has an important role to play to improve these deficits and help the individual get back to living as independently as possible.

Clinical guidelines suggest that where practical patients should commence mobility exercise within 48 hours, therefore in the early stages physiotherapy intervention becomes crucial. A physiotherapist will conduct a thorough assessment of the patient’s level of motor and sensory function and use this assessment to guide rehabilitation requirements. Once rehabilitation is started it is also recommended to complete as much as practically achievable. The more that patients can undertake the better the overall recovery will be.

As part of this rehabilitation process it is recommended that specific goals are set. These goals should be made collaboratively and should involve the client, their family and other treating practitioners apart the health care team. This will help individually tailor rehab programs and keep everyone on the same page with treatment.

For more information check out out full breakdown of stroke and best evidenced care at https://physioplus.com.au/stroke-recovery/ or book an appointment with one of our fantastic clinicians today.

With the redevelopment of the Whitten Oval soon to move into full swing, our suite of over 12 years for Physio Plus Footscray is soon to be flattened.

As such, this has given us the opportunity to move to a new custom fitted out facility just down the road at 1/1 Whitehall Street, Footscray.

We’re looking forward to the new facility being open to you all and being able to welcome you into an open, inviting and clinically impressive space.