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Muscle Tears

 

The most common injury which I see in middle and long distance runners is the chronic muscle tear. These injuries are almost always localized to a large muscle group, either the buttock, groin, hamstring, or calf. I term chronic muscle tears insidious or menacing because they present in such a way that the athlete can continue to run daily, but when fast running is attempted, especially track workouts or racing, the chronic muscle tear interferes to the extent that either the speed work is painful or impossible.

In contrast to acute (sudden) muscle tears and bone and tendon injuries which improve with sufficient rest, chronic muscle tears never improve unless the correct treatment is prescribed.

The athlete can rest for months or even years without any improvement. This type of injury is usually reasonably easy to recognize. The characteristic feature is a gradual onset of pain, in contrast to the acute muscle tear's sudden onset of pain. At first the pain of the chronic muscle tear comes on after exercise. It develops to where the pain starts during exercise, with the athlete being able to run through the pain. Pain finally becomes a limiting factor, getting progressively worse, interfering with training to the point that speed work in particular becomes impossible.

The athletes describing their injury confirm a chronic muscle tear in their own simple way.

Eamonn Coghlan was aware of injuring his hamstring two years ago but it never became a serious injury until he upped his training last September in his quest toward masters greatness. He describes his injury as 'a drag in the leg and a pain in the butt'; "I cannot get full extension when running fast. There's a constant ache deep in there." Running slow didn't bother him but faster work became painful. Marty Liquori, the legendary US miler, had retired years ago from running due to a calf injury and on every attempt to resume running the calf acted up; his description of it "I get to about 3 or 4 days back running and the pain starts and I have to walk home; I can't get up on my toes". After working with Marty this winter he resumed running and recently ran a 4:46 mile.

Chronic muscle tears occur in muscle at sites that are exposed to high loading. This loading is especially high during faster running. Because the loading is so concentrated over a small section of the muscle, an initial small tear develops at that site. The tear is initially too small to cause discomfort. The athlete may be aware of a tightness or low grade soreness similar to delayed muscle fatigue in the muscle involved. However, once the initial tear has occurred, a cycle of repair and retear develops that leads ultimately to a large tender knot developing in the muscle, which comprises muscle fibres surrounded by scar tissue. I like to use the analogy of scar tissue as being like chewing gum stuck and hardened to a wool carpet.

Image: Minor muscle tears. The formation of intramuscular scarring (top and centre) can painfully limit broadening on contraction (bottom).

In the muscle the scar tissue is inflexible so when the muscle either contracts forcibly (shortens and broadens) or stretches (lengthens and narrows) the scar tissue re-tears and the cycle of repair and re-tear develops with increased irritation and a matrix of more scar tissue is laid down. Excessive Scar Tissue Formation at the site of tear inhibits normal contractibility and extensibility of muscle.

TREATMENT

To confirm that the injury is indeed a chronic muscle tear, a physiotherapist needs only to press firmly with a thumb or two fingers into the affected muscle. If it is possible to find a very tender hard "knot" in the muscle then the injury is definitely a chronic muscle tear. When palpated with digital pressure, the knot in question can be excruciatingly painful. Tim Noakes MD in the Lore of Running states, regarding chronic muscle tears: "Conventional treatment, including drugs and cortisone injections, is a waste of time in this injury; the only treatment that works is a physiotherapeutic maneuver known as cross fibre frictions. A better term would be 'crucifixions' because nothing, not even the runner's toughest ever race is as painful as cross fibre frictions applied to a chronic muscle tear. Therein lies the key to the treatment of these injuries.

A chronic muscle tear will only get better if (a) the cross fibre frictions are applied to the injury site, in this case the tender knot in the muscle, and (b) they are applied sufficiently vigorously. If the cross fibre friction treatment does not reduce the athlete to tears, either the diagnosis is wrong or the physiotherapist is being too kind. "This is the one treatment for which you must have a physiotherapist who has big hands, the forearms or a gorilla, and unbridled sadism."

Image: Deep Transverse Cyriax Friction Therapy. The muscle fibres are teased apart.

I have been named everything from Hitler, to 'thunder thumbs, magic fingers, Saddam Hussein and worse,' but the painful treatment is well appreciated by the athlete as chronic muscle tears respond rapidly to six or eight sessions of therapy. Physiotherapists who specialize in sports injuries usually have expertise in administering cross-fibre friction and because of the invasiveness of the therapy, which I term "bloodless surgery," it is important to go to a therapist with experience in the physiotherapeutic maneuver.

PREVENTION

To avoid chronic muscle tears the athlete should be fastidious about stretching, especially the main locomotive muscles which cross two joints, ie, the hamstrings, gastronemius, quadriceps and adductors. Muscle strength imbalances between opposing muscle groups should be corrected. The strength balance between hamstring and quadriceps is very important and serious athletes should have their strength ratios tested on a Cybex or similar strength testing machine. At all times, but especially when doing speed work, it is imperative to be adequately warmed up. Prevention is better than cure, but for the runner who has the symptoms of a developing chronic muscle tear a little treatment early on saves time out and a great deal of agony later on.

 
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