Author: Michael Ranger

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.

In the ever changing Covid Safe environment, please find below links to the state specific information on provision of health services:

Queensland

Victoria

New South Wales

South Australia

Western Australia

Northern Territory

Tasmania

ACT

Travel and borders

A calf raise or heel raise is a common exercise prescribed by physiotherapists as part of the rehabilitation in a range of lower limb conditions. At times this can be performed poorly and as such will not have the desired result. Research conducted by Rio et al 2016 focusing on the calf raise as part of Achilles tendinopathy rehab suggests that the simple use of a metronome can lead to a reduction in tendon pain as well as an increase in our control over the muscle (referred to as motor control).

Exercises are normally used as part of rehabilitation to create physiological changes to the muscle with the goal of improving strength. When combined with an external cue (such as a metronome) this begins to target motor control as well. To complete any task successfully you need both the strength and motor control aspect of the movement. This is particularly important in tendinopathy rehab as the pain associated with tendinopathy has been shown to lead to abnormal tendon loading and changes in neural drive (messages from your brain to the muscle both of which affect our motor control. These changes are part of our body’s protective response.

The use of a metronome to pace the concentric (rising up onto your heels) and the eccentric (lower down to the floor) phase has been shown to restore a normal pattern of tendon loading in those individuals with Achilles tendinopathy. This will also lead to an increase in time under tension during your repetitions and thus improvements in the physiological changes within the muscle. As a starting point, set your metronome at 60 beats per minute and aim for a two-beat rise, a two-beat pause at the top and a two beat lower for each repetition. Though this has been predominantly researched in calf raises, there is a further investigation into its applicability for other exercises.

Rio E, Kidgell D, Moseley GL, et al Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review

British Journal of Sports Medicine 2016;50:209-215.

What is CRPS?

Complex regional pain syndrome (CRPS) is a term characterised by chronic
persistent pain. CRPS can affect any part of the body, but mainly occurs in the arm
or leg following injury and often involves certain changes to the area including
extremely sensitive skin, reduced function in the hand or foot, redness, warmth,
swelling, and changes to the way nails and hair grow. The onset is mostly
associated with a trauma, surgery or immobilisation however there is no link
between the severity of injury and subsequent CRPS.

What causes CRPS?

It is not clear what causes CRPS however once triggered changes occur in the way
the nerves function. Nerves that carry motor information (nerves that drive
movement), sensory information (nerves that drive feeling and touch) and those
that play a role in other functions including blood flow, which affects temperature
and colour changes within the skin can be affected. This can often lead to weakness
and stiffness.

Who gets CRPS?

CRPS affects approximately 5 out of every 100,000 people with a female to male
ratio of 3.5:1. The lower limbs are generally more affected than upper limbs with
the leg affected in 60% of cases and the arm in 40%.

CRPS symptoms

The diagnosis of CRPS is not based on a single test with a black and white result
however there are a range of symptoms that may lead to the diagnosis of CRPS.
● Constant pain, higher than the normally perceived pain
● Extremely sensitive skin eg painful to gentle touch or numbness
● Temperature changes eg sweating or extremely cold
● Skin colour changes eg blotchy, pale, red, blue
● Reduced or painful range of motion
● Changes in hair and nails
● Swelling

Treatment for CRPS

There is no simple treatment for CRPS and treatment will often involve a number of
different modalities with the aim to restore movement and function of the affected
limb and reduce pain. Some common treatment approaches include:
● Physiotherapy – often involves patient education surrounding pain, manual
therapy techniques to improve range of motion and most importantly
exercises to improve the strength and functioning of the affected limb.
● Pain relieving medications.
● Psychological support – to help cope with stress, sleep disturbances and
chronic pain.

Top 4 tips to reduce injury risk when returning to exercise post-lockdown

Have you recently returned to sport or the gym since coming out of lockdown and found you could barely move the next day? Don’t worry – me too! This general soreness is completely normal and is a sign your body is responding to a new exercise stimulus and needs to adapt.

Different to this general soreness however is an actual injury (more on this in an upcoming post). With the excitement of Victoria opening up and returning to a “Covid-normal”, we have seen a number of injuries in people returning to sport and the gym.

Here are my Top 4 tips to reduce your injury risk during this time!

1) Ease your way back in!

You could be forgiven in all the excitement to start exactly where you left off, and you may get away with it, but unfortunately going from “zero to hero” and the “all or nothing” approach may also bring you unstuck.

A gradual build back towards your pre-lockdown activity levels will greatly reduce your injury risk and can be broken down into four key areas:

– Intensity: how hard are you working? How much are you puffing and sweating?
– Duration: how long are you exercising for?
– Frequency: how many times per week?
– Type: is the activity or skill new or different?

If you can avoid a big spike in these areas you’ll greatly reduce your risk of injury. There are simple and effective ways of monitoring your exercise workload, which I’ll cover in an upcoming post.

2) Warm-up!

Getting your body moving before exercise is a quick and easy way to reduce your injury risk. Aim for a more active warm-up rather than static stretches (i.e. sitting down touching your toes). Think squats, leg swings, windmills etc. It doesn’t have to take long and whatever you can do to get your body moving and feeling warm will help prepare the body for what’s to come!

3) Recover! Recover! Recover!

The importance of recovery cannot be understated during this time.

This can come in many forms, but by far the most important one is sleep! Of course we all sleep, but how well do we sleep? Do you go to bed quite late or wake up really tired? During sleep is where a lot of our body’s natural recovery and healing occurs, and so good sleep hygiene will help your body to recover in time for the next exercise session. A day in between exercise sessions is in a lot of cases a good idea to help reduce your injury risk.

There are many other recovery strategies that you could utilise and they include:

– Stretching
– Foam rolling/spiky ball use
– Hot/cold showers
– Beach recovery (if you’re game to brave Victoria’s chilly water!)

– Good nutrition

4) Listen to your body!

Last but not least is listen to your body! Sometimes for no apparent reason we feel really great and better than expected during an exercise session, and sometimes we feel really lousy and worse than expected. This is normal. So listen to your body, and if you’re feeling fantastic push yourself a little harder, and if you’re feeling a bit off then look after yourself and consider doing a little less.

So there you have it…

My top 4 tips to reducing your risk of injury post-lockdown. I hope you’ve found them useful and help you make a successful return to whichever form of exercise you enjoy! If you’ve succumbed to a post-lockdown injury or have a niggle and feel like you might be on the verge of one, go and visit your physiotherapist today and they can help you get back on track and fit and firing!