Wednesday 17 April 2013
Quadriceps contusions – Just a bruise?
This article is going to talk
about Quadriceps contusions. This is an extremely common injury with a high
occurrence in contact sports such as rugby or American football, but is also
common in sports where the ball travels at high speeds causing a contusion.
Contusions are often referred to as ‘just a bruise’, however no treatment or
incorrect treatment can severely delay a return to sport.
How it occurs?
Direct blows to the anterior thigh from
another player or a ball are usually the main mechanisms of injury. Trauma to
the muscle will cause localised bleeding due to primary damage to myofibrils,
fascia and blood vessels. The contusion may be either intramuscular; which is
where the bleed is confined to the muscle compartment; or intermuscular where
the fascia surrounding the muscle is broken and blood escapes into other
compartments of the thigh.
What are the
symptoms?
Quadriceps contusions are classified
as Mild, Moderate and Severe. A mild contusion is usually tender to touch, sore
after cooling down or the next morning and may restrict full range of knee
movement by 5-20%. A severe contusion will have obvious bruising, the rapid onset of swelling and bleeding may
not be able to be controlled. There will be difficulty weight bearing on that
leg, a loss of quadriceps strength and a sever loss of movement of around 50%.
A moderate contusion will sit between the two grades.
Treatment
The treatment can be divided into four stages:
Stage 1- Control the Haemorrhage.
The most important period in the treatment of a thigh contusion is in the first 24hours following injury. This is done through Rest, Ice, Compression and elevation (RICE). Soft tissue therapy should not be used at this stage but some gentle stretching should be started. Depending on severity this stage of treatment can last between 48hrs-3days.
Stage 2- restoration of pain free range of motion.
After 24-48 hours, it is important to see an injury specialist such as Sports Therapist or Physiotherapist who can correctly diagnose the injured muscles and begin a rehabilitation program. Usually some gentle soft tissue work will be initiated, stretches increase, and static muscle contractions started. Usually gentle exercises such as pool walking or static bike will be indicated by the therapist.
Stage 3 – Functional rehabilitation.
Stretches are maintained through this stage and concentric and eccentric exercises introduced. There is gradual increase of repetitions, speed and resistance of these exercises.
Stage 4 – Gradual return to sport.
All rehab becomes sport specific i.e. kicking, jumping and multi-directional activities. A full training session should be completed pain free before a return to sport. Some soft tissue therapy may be necessary to relieve any quadriceps myofascial tension.
All rehab becomes sport specific i.e. kicking, jumping and multi-directional activities. A full training session should be completed pain free before a return to sport. Some soft tissue therapy may be necessary to relieve any quadriceps myofascial tension.
What are the risks
following a thigh contusion?
After a moderate to severe contusion some complications may occur. Intramuscular hematoma may result in high pressure within the muscle compartment; this can lead to a diagnosis of compartment syndrome. This is usually manageable with conservative treatment and surgery is not usually implicated.
Occasionally after a contusion the hematoma can calcify,
this means small bits of bone can develop within the quad muscles. This is
known as myositis ossificans. The more severe the contusion the more likely the
development of myositis ossificans, the risk of this is also increased with
inappropriate treatment of the injury. Once this problem has developed there is
little that can be done to increase the absorption rate of the bits of bone
from the muscle, this can lead to increased pain with activity, in the morning
and can often cause night pain.After a moderate to severe contusion some complications may occur. Intramuscular hematoma may result in high pressure within the muscle compartment; this can lead to a diagnosis of compartment syndrome. This is usually manageable with conservative treatment and surgery is not usually implicated.
Visit our clinic website at www.revolutionsportsinjuries.co.uk
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Thursday 5 July 2012
The forces march is a demanding five-day
event where athletes complete at least a marathon distance a day! This is an
event that Revolution Sports Injuries Clinic supports every year and provides
graduate sports therapists to offer injury diagnosis and treatment as well as
sports massage. This year the event was made even more difficult by the heat wave
that Britain experienced at the end of May. Never the less the event was yet
again, a great success!
What
is the Veterans Charity?
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| The Sports Therapy team for the forces march 2012 |
The Veterans Charity
focuses on providing direct support in the form of
what we call 'modest provisions', anything from a wheelchair, mattress or
bath-lift to everyday items like TVs, microwaves, clothing and food
and even bicycles.
We have helped many Veterans to get
the things that we often take for granted but, when provided quickly, can
make a real difference to how they live. For many former service personnel, it
can be difficult to make ends meet and to cope with the pressures of life. The
Veterans Charity has helped to make life better for those who have served our
country and now need our help. We have also provided advice to Veterans who
simply don’t know which way to turn next and need some guidance.
We at Revolution Sports Injuries
Clinic are looking forward to The Forces March 2013!
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| A well deserved beer and an ice bath for some of the runners after completing the whole five day event! |
For information about Revolution Sports Injuries Clinic go to:
If you are interested in entering the Forces March 2013 go to:
Thursday 14 June 2012
The past month has very busy at our clinic as well as summer events that we are involved with. Not only are our staff now trained to use Dry Needling in our clinic, which involved some intensive training with a great training provider called Club Physio but we have been out in the field working with athletes at events such as The Forces March which is 5 marathon distances over 5 days. We also have a ex patient and athlete who's charity is supported by Revolution Sports Injuries Clinic currently cycling across the USA for a charity called Sea2Sea. More on these great events and athletes in my later blogs. This month's article is going to look at the major
muscles of the core, the principals of how the core works and the forces that
are exerted on the structures around it.
The Muscles:
The local stabilizing muscles:
- Transverse abdominis (TVA)
- Multifidis
- Diaphragm
- Muscles of the pelvic floor
We will be focusing on the TVA and Multifidus muscles as they are
specifically related to posture and the imbalances can be easily be detected.
This is the deepest abdominal muscle. Its origins are the iliac crest, inguinal
ligament, lumbar fascia and cartilages of the inferior 6 ribs. It inserts on to
the xiphoid process, linea alba and pubis.
This muscle is the bodies natural weight belt and is responsible for
drawing in the abdominal wall. This muscle is key to the stabilization of the
core. Richardson et al. (1999) found people without back pain TVA fired
30milliseconds prior to shoulder movement and 110 milliseconds prior to leg
movement. This shows that the TVA has a feed-forward role and activates prior
to limb movement stopping the spine from being exposed to vulnerable forces.
Multifidus
This is the largest and most medial of all the lumbar muscles. It
fibers are centered on each of the spinous processes, from here fibers radiate
inferiorly to the transverse processes of the vertebra 2,3,4 or 5 levels below.
Multifidus is key in the production of extension forces, which are
essential in the stabilization of the lumbar spine during flexion as well as combating
shear forces that maybe applied.
Richards et al. (1999) identified that the TVA and Multifidus muscles
are vital stabilizers to the lumbar spine and dysfunction can lead to injury.
This is due to the fact that both attach with the thoracolumbar fascia to
create a cradle to protect the back from injury.
The Global stabilizing muscles:
- Rectus abdominis
- Internal and external oblique’s
- Quadratus Lumborum
These muscles are responsible for the movement of the core.
If you can imagine, when the core works in harmony your local
stabilizing muscles fire prior to limb movement and stabilize the spine then
the global stabilizers fire to provide movement of the whole torso.
It is due to this system that athletes and coaches talk about the
importance of the core. All movements whether it be kicking, running, throwing,
tackling, skiing or skating utilizes the core to develop power as well as to
provide balance.
I hope this has provided you with an overview of the core muscles and
their purposes. Next month I will discuss the injuries and pain associated with
imbalances and muscles firing correctly. In the meantime if you have any
questions please feel free to drop me an email or catch up with me when you see
me around the gym.
Have a great month,
Thursday 8 March 2012
I am going to do a series of articles covering the pelvis and sacroiliac joint (SIJ), this will be followed by an article on the causes of injury. The final article will look at the effect that core strength and correct muscular balance has on the stability of the pelvis and the lower back. This first article will look at the pelvis as well as the sacroiliac joint.Anatomy
The pelvis is made up of two Ilium bones posteriorly and the pubic bones anteriorly, as well as a triangular bone called the sacrum. The sacrum sits at the base of the lumbar spine with the Ilium bones inserting at each side. The pubic bones are joined anteriorly at a cartilaginous joint called the Pubic Symphysis.Sacroiliac joint functions
The SIJ is designed to transfer large loads and its shape has adapted to this task. The sacrum is essentially the ‘keystone’ between the wings of the pelvis (Gibbons, 2011). There are two ways that the SIJ maintains its integrity, these are form closure and force closure.
Form ClosureThis is due to the anatomical alignment of the bones of the Ilium and the sacrum. The anterior surfaces of the joint are relatively smooth to aid the transfer of compression forces and bending movements. This can cause weakness so the SIJ uses the wedge shape of the sacrum to help stabilize along with their irregular shaped surfaces that interlock to aid stabilization.
Force Closure
This is the effect that the ligaments and muscles have on the joint. The main ligaments that stabilize the joint are the sacrotuberous ligament, (this connects the sacrum to the ischium) as well as the long dorsal sacroiliac ligament that secures the sacrum to the posterior superior iliac spine.
The role of the core
The ligaments cannot stabilize the SIJ without the support of the number of groups of muscles. The two most important groups of muscles that contribute to the stability of the lower back and the pelvis are the inner system, called ‘the core’ or the local stabilizers. These are made up of transverse abdominis, multifidus, the diaphram and the pelvic floor. The outer system is called ‘the sling’ or the global stabilizers.
All of this results in something called a force couple. This is “a situation where two forces of equal magnitude, but opposite direction are applied to an object” (Abernethy et al., 2004). Force couples cause the joint to maintain integrity, but still be able to move. It is when this force couple fails and one force is stronger than another that an injury will result.
Thursday 5 January 2012
This month I am going to talk about hamstring stains. This injury has made the news recently when Leicester Tigers RFC of the Aviva Premiership lost two of their stars – Manu Tuilagi and Louis Deacon both with hamstring strains during their win over Worcester on December 27th.
There have been many studies looking at the frequency of hamstring strains in sport. Studies have found that as a percentage hamstring injuries peak at 33% of lower limb injuries in 16-25 year olds and they most often occur in sports where the hamstrings can be stretched eccentrically at high speed (1, 2). A study into injury rates found that out of 1614 individuals in Australia who suffered hamstring injuries it made up 54% of rugby injuries, 10% of football injuries and 14% of athletics injuries. But less than 2% of tennis, squash, ballet and gymnastics injuries (2).
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| Muscles of the posterior thigh |
What is a Hamstring Strain?
It is actually a tear in one, or multiple hamstring muscles. The hamstring in made up 3 main muscles: Semitendinosis, Semimembranosis and Biceps Femoris. The role of the hamstring is to flex the knee and extend the hip.
Symptoms of a Hamstring injury
- Sudden, sharp pain at the back of the leg, during activity.
- Pain when stretching the muscle
- Pain when contracting against resistance
- Possible swelling and bruising
- If severe, a gap maybe present in the muscle which can be felt
- Bruising after a hamstring tear
Hamstring injuries are graded in severity, based on the damage. A Grade 1 tear would consist of a minor tear within the muscle. Grade 2 is a partial tear of the muscle and a grade 3 tear is a complete rupture of the muscle.
Treatment
At the time of injury:
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| Injured hamstring 2-3 days post injury |
It is important to stop activity and apply the R.I.C.E principle of Rest, Ice, Compression and Elevation.
After 24-48 hours, it is important to see an injury specialist such as Sports Therapist or Physiotherapist who can correctly diagnose the injured muscles and begin a rehabilitation program. The treatment would include the use of Ultrasound, sports massage, progressive loading and stretching of the muscle as well as promoting early mobilisation of the limb.
References:
Clark RA. Hamstring injuries: risk assessment and injury prevention. Ann Acad Med Singapore. Apr 2008;37(4):341-6
Kujala UM, Orava S, Jarvinen M. Hamstring Injuries. Current trends in treatment and prevention. Sports Med. Jun 1997; 23(6): 397-404
Wednesday 21 December 2011
This is a case study of a patient that I have been working with for nearly a year. The patient, Tom has given his permission for me to discuss his case as well as using his full name and photos.
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| Tom being airlifted to hospital following the accident |
Tom first made contact with me when he emailed in early February regarding his rehabilitation for a hip injury. Tom’s background is as follows, he is a 56-year-old man, who is a keen cyclist and is very fit and active and he is retired from the US Military. On the 16th September 2009, whilst cycling in the French Alps Tom came off his bike whilst travelling at speed. The resulting accident left Tom with a dislocated hip and fractured acetabulum.
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| This is Tom stabilised, awaiting surgery. |
Due to his Military background Tom was able to be air lifted to a US military hospital where he underwent a number of operations to stabilize the pelvis. On the 10 March 2010 Tom was discharged from his US Air Force doctor, but was then subsequently admitted to the John Radcliffe Hospital for a MRSA infection that resulted in all his metal work having to be removed. He then under went physiotherapy through the NHS from May 2010 to August 2010.
Tom then began to see an acupuncturist as he was still in a large amount of pain and unable to walk without a limp. This is due to the complications suffered as a result of the surgeries and the healing process called heterotopic ossification around the acetabulum. This is a presence of bone in the soft tissue, where it should not normally exist. This and a huge amount of scar tissue were causing a lot of muscular tension that caused pain. This pain was so debilitating that Tom was still taking a cocktail of pain killers (tramadol and paracetamol) to help control this pain.
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| Adam from Revolution Sports Injuries Clinic treating Tom at his home. |
Adam from Revolution Sports Injuries Clinic, Wantage explains "as a Sports Therapist was to treat this muscular tension to reduce his pain, increase his range of movement and begin to get the damaged muscles firing correctly so he could start strengthening work, and get back on his bike."
Over the next 4 months Tom saw a huge reduction in his pain, which has resulted in Tom lowing his medications dramatically. The major success was to be able to get Tom back on a bike and he achieved his personal ambition of being able to cycle across the Pyrenees Mountains by June 2011!
Tom has now embarked on his next challenge, which is to cycle across America to raise money and awareness for American and British Military Charities. This event is called Sea 2 Sea.
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| Tom during his cycle trip across the Pyrenees Mountains in June 2001 |
Tom explains the event “This event will take place from 21st April to 8th July 2012. Departing the Repatriation Centre at Brize Norton, Oxfordshire, England, cycling to arrive at London Heathrow Airport. Arriving in the USA in Seattle, Washington then cycling east to finish the American leg towards Washington, DC. The total journey will be over 4000 miles.”
Tom goes on to say “To raise national and international awareness for UK and US veterans by having a joint UK/US nationwide cycling event 21 April - 08 July involving thousands of UK and US citizens.
My aim is to raise $10,000,000 for US military charities (i.e., Paralyzed Veterans of America, Wounded Warriors) and £5,000,000 for UK military charities (i.e., Army Benevolent Fund, British Legion, Help for Heroes) through their websites.”
For more information on Tom’s amazing new challenge go to www.sea2sea.org please view the video of when Tom met David Cameron to discuss this amazing charity event.
If you also like more information on Sports Therapy and the Sports Therapist who is helping Tom with his on going rehabilitation go to www.revolutionsportsinjuries.co.uk
Tuesday 22 November 2011
Every month I use the injuries that I am treating in my clinic to gain inspiration for writing this article. This month I have decided to focus on Carpal Tunnel Syndrome (CTS).
CTS is an entrapment of the Median nerve due to compression on the carpal tunnel. This is termed a neuropathy, which is a blanket term for nerve damage.
Causes of Carpal Tunnel Syndrome
There are a number of possible causes. It is important to correctly diagnose this because otherwise treatment will be less affective.
The main factors include:
- Traumatic wrist injury such as a sprain or fracture.
- Repetitive activity
- Pregnancy, this can cause increased fluid retention.
- Congenital, some people has smaller, narrower carpal tunnels
CTS is three times more common in woman compared with men. There is also a higher prevalence in people with diabetes as well as other conditions, which directly affect the nervous system.
Carpal Tunnel Symptoms
CTS usually has a gradual onset, it may affect one or both wrists. It can begin with only night pain. Other symptoms include:
- · Dull ache at wrist and forearm
- · Pain in thumb and fingers, excluding the little finger
- · Weakness in fingers and hand
- · Worse at night
- · Pain radiates into forearm, elbow and wrist.
Diagnosis of Carpal Tunnel
If you suspect that you may have CTS you should visit an injury professional such as sports therapist, physiotherapist or doctor. They will be able to give you a correct diagnosis
Treatment of Carpal Tunnel SyndromeInitially, total rest is required. This may involve immobilizing the wrist using a support. Cryotherapy and anti inflammatory’s, may also be required.
Following this phase, stretching and strengthening exercises should be used to help reduce of its reoccurrence, these should be prescribed by a sports therapist or physiotherapist.
For more information on Carpal Tunnel Syndrome, or to book an appointment at Revolution Sports Injuries Clinic, Grove Technology Park, Wantage, Oxfordshire please contact Adam on 07827324789 or go to www.revolutionsportsinjuries.co.uk
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