Sports Related Muscle Injuries
By Hal S. Blatman, MD

No matter our age or skill level, participation in athletic competition puts stress on the body that can lead to pain. Most of us have been taught that this pain should respond to ice and a few days of anti-inflammatory medication. Some of us wear braces to help our bodies compensate for the physical stresses and allow us to keep going. When this is not enough, we consult our physician, chiropractor or sports medicine specialist for stronger medicine, cortisone injections and physical therapy. Rehabilitation is often slow and incomplete. This leads some of us to quit, and others continue to play with pain, minimizing our problem with braces, and medication.

Professional athletes and those who are more competitive may have access to more sophisticated rehabilitation equipment and professional trainers. This treatment also brings slow results for some injuries. We regularly see professional athletes in the news who are temporarily disabled or side-lined because of a muscle injury like a groin strain or hamstring pull, while others develop inflammatory conditions of the forearm after hitting baseballs and tennis balls.

But, you don’t have to be an athletic “weekend warrior” to experience pain. There are many people who find that their back "goes out" after a weekend of yard work or serious fishing.

What causes this pain?

Inflammation
We generally recognize that inflammation is part of the pain. Repetitive use of parts of our bodies can cause joints and tendons to become inflamed. Television advertisements, magazines, therapists, and some doctors recommend anti-inflammatory medications for many conditions including tennis elbow, golfers’ elbow, plantar fascitis, and back pain. Many of us take these medications and know that they "keep us going."

Symptoms of inflammatory conditions include pain, swelling, warmth and tenderness. The pain may vary from aching to burning. It is typically worse after physical activity that stresses the particular joint or tendon.

Muscle Strain
Sudden voluntary contraction of a muscle or sudden overstretching can cause tearing of muscle tissue. Sometimes this tear creates separate parts of muscle tissue that will need to grow back together in order to heal, sometimes requiring surgery. More often there are micro-tears through the muscle that can be imagined to be like a fishnet sweater.

Symptoms of muscle strain injury include bruising from the injured muscle, bleeding at the site of the tear, pain and muscle spasm. The muscle might remain tight and difficult and painful to stretch out. Eventually, upon return to competition, the athlete experiences a return and worsening of symptoms that is called a “recurrent strain” injury. Hamstring, groin and calf muscles are particularly vulnerable in this regard. The pain pattern from these muscles can include burning, tingling, aching and cramping in lower back, groin and leg areas. The pain may seem to involve the muscle as well as a nearby joint. Sometimes the symptoms seem to be more than just a “strain” injury.

What is the response to conventional treatment?

Many sports injuries to muscle and ligament are successfully treated with medication and surgery with techniques that are based on traditional inflammation and muscle strain theories.

However, there are also many injuries that do not respond well to this usual and customary treatment. These players may seem to improve and then end up off the roster again as injuries recur or the condition worsens after a return to physical activity.

How does myofascial pain relate to athletic injury?

Sports injuries are not myofascial pain. But they cause myofascial pain, generated by the myofascial trigger points that form in muscle tissue after the injury. Trigger points can be felt as nodules or knots of tightness within a muscle. These knots cause ropy taut bands of muscle. These trigger points form in muscle tissue as a response to injury. They generate pain patterns that are felt as aching, burning, numbness, tingling, and cramping. This pain pattern may be felt in a muscle or a nearby joint. The trigger point also restricts motion, causing muscle weakness limited flexibility.

Repetitive strain and repetitive motion cause trigger points to form in the overused muscles. Trigger points in forearm muscles cause the pain of tennis elbow and golfer’s elbow. They also cause wrist pain and tenderness. Trigger points in buttocks muscles cause pain that is often diagnosed as bursitis and inflammation of the hip joint, or even sciatica.

When the therapist or trainer stretches these muscles, pain typically lessens and flexibility is increased. Unfortunately, these trigger points can be easily reactivated with the next physical effort such as running or picking up a bat or racquet again.

What does myofascial medicine and holistic care offer the injured athlete?

When the focus of treatment is broader and also includes the trigger points that generate the pain pattern, treatment is more effective and there is a greater resistance to re-injury.
Holistic care takes place at several levels.

• Stretching and myofascial release bodywork are performed to inactivate trigger points and prevent their recurrence.
• Fluori-methane spray and injection techniques are the most effective tools for inactivating myofascial trigger points.
• Myofascial trigger point injections without cortisone release the active trigger points causing the pain pattern and motion restriction.
• Herbal remedies and natural preparations reduce inflammation without risk of ulcer and bleeding.
• Thought Field Therapy and Biofeedback assist neurophysiologic change to speed healing.
• Photon Therapy modulates the nervous system and energizes the tissue to speed healing, reducing pain and inflammation.
• Nutrition is important because athletic performance and healing are dependent on the quality of “fuel” or food that is eaten.

Myofascial pain is often present several years after an injury. Pain patterns that are more diffuse and have been active for more years will typically require more personal effort over a longer period of time for treatment to be successful. Localized pain may improve with only a few visits. The duration of pain and the age of the patient should not discourage a person from this treatment. Pain can be lessened and function can be significantly restored, even if the condition has been present for many years.

What can I expect from treatment?

We believe that patient education and personal effort are the most important ingredients for successful treatment.

Generally, the process of unlocking trigger points starts with a complete assessment and medical history. Based on your input, we’ll identify your specific pain trigger points, “unlock” them and then stretch the injured muscles to their normal resting length. In many cases, healing can be accelerated by trigger point injections, where a local anesthetic (Novocain) is injected into muscle trigger points to help them release.

Once the trigger points are unlocked and pain is stabilized, physical conditioning and strengthening become possible. You will be taught a combination of stretches, exercises, dietary changes, and acupressure techniques to supplement the treatments you receive in our office. Treatment may also involve relaxation, guided imagery, biofeedback and physical therapy.

Aggressive athletes can get significant relief from painful cramped muscles in a week, and many muscle pull injuries can rehabilitate in 2-3 weeks. Recreational athletes with new and old injuries can often find significant return of flexibility and perhaps be pain free after 4-6 weeks. In others, an approach combining judicious use of medication, herbs, acutuncture, injections and lifestyle changes can dramatically improve mobility and quality of life.