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![ Various factors are seen in hamstring injury such
as
Older age
Previous hamstring injury
Limited hamstring flexibility]
Increased fatigue
Poor core stability
Strength imbalance
Previous calf injury
Previous substantial knee injury
Osteitis pubis](https://image.slidesharecdn.com/contusions-210523182107/85/Contusions-strain-in-hamstrings-quadriceps-calf-24-320.jpg)
![ During sporting activities such as sprinting,
these long, bi-articular muscles have to cope
with high internal forces and rapid changes in
muscle length and mode of contraction
leading to a higher risk of strain.
despite this, calf muscle strains have also
been reported to occur during slow-
lengthening muscle actions such as those
performed by ballet dancers, but also during
common daily activities.[9]](https://image.slidesharecdn.com/contusions-210523182107/85/Contusions-strain-in-hamstrings-quadriceps-calf-65-320.jpg)
![ Tape or a compressive wrap can be applied
and the leg elevated where possible. [23]
If major bleeding has occurred, the use of
NSAIDs has to be carefully controlled as they
have an anti-platelet effect
Gentle passive stretching exercises without
pain to maintain range of motion in the
plantar flexors.](https://image.slidesharecdn.com/contusions-210523182107/85/Contusions-strain-in-hamstrings-quadriceps-calf-84-320.jpg)
More Related Content
Similar to Contusions & strain in hamstrings, quadriceps , calf
Contusions & strain in hamstrings, quadriceps , calf
- 1. Presented by- NikhilGovind MPT 1 STYEAR
- 2. Contusion? Strainin hamstrings Strain in calf Strain in quadriceps
- 3. A contusionhappens when an injuried blood vessel is damaged and leaks blood in the area of injury It can also be defined as the process of a injury which has occurred due to a blunt force
- 4. Contusions canbe divided into two categories that is :- 1) bone contusions 2) muscle contusions
- 5. Bone contusionis also defined as common injury which occurs to the bone but less damaging to that of the fracture Bone contusion can occur in any bone and at any age
- 6. A bonebruise has three different types of bone injuries such as Sub perioestal hematoma Inter osseous bruising Sub condrial lesion The only way to say that a bone bruise is different from a fracture is in the trabculae of the bone
- 7. The mostcommon cause of bone bruise is trauma How ever it is always linked to normal stress loading and haemophiliaA and B It always affects the lower limbs Patients who have a bone bruise can see more bone effusion and slow return to motion
- 8. If wetake an example of bone brusing on such condition where you can see bone bruising is ACL In ACL Rupture , there is concurrent associated bone bruising at the femoral condyle and or tibial plateau
- 10. Bone injury typeCharacteristics Typical injury/ Mechanism Sub-periosteal hematoma A concentrated collection of blood underneath the periosteal of the bone Direct high-force trauma to the bone Inter-osseous bruising Damage of the bone marrow.The blood supply within the bone is damaged, and this causes internal bleeding Repetitive compressive force on the bone (extreme pressure on regular base) ub-chondral lesion Lesion occurs beneath the cartilage layer of a joint. Extreme compressive force or rotational mechanism such as testing (shearing force) that literally crushes the cellsForce causes
- 11. A Xraywould indicate whether there is a fracture or no But the current gold slandered is MRI to check whether the bone has a bruise or no
- 12. Medical management– It includes more of anti inflammatory medications Physical therapy management – RICE protocol Rest Icing Compression- Elevation
- 13. So amuscle contusion is a bruise which happens to a muscle Contusions are only secondary to strains Most contusions are only minor and heal quickly But in some cases severe contusions, they can cause severe tissue damage and lead to complications
- 14. Contusions occurwhen a direct blow or repeated blows by a blunt object strike part of the body, Thus crushing underlying muscle fibers and tissue without breaking the skin Now A contusion can result from falling or jamming the body against a hard surface.
- 15. swelling Pain You can also see bluish discoloursiation Weakness and stiffness
- 16. Physical examination CT scan MRI
- 17. REST ,ICE,COMPRESSION,ELEVATIONis also the treatment for muscle contusion REST – the injured area should be protected from further harm ICING- cold packs can be used in the injured area Compression- lightly wrap the injured area with bandage with a soft bandage Elevate the injured limb
- 18. It isa contraction-induced injury in which muscle fibers tear due to extensive mechanical stress.This mostly occurs as a result of a powerful eccentric contraction or over-stretching of the muscle. Muscles will most likely tear during sudden acceleration or deceleration
- 19. There arevarious types of muscle strain but this class will be more on Hamstring muscle strain Quadriceps muscle strain Calf muscle strain
- 20.
- 22. Hamstring strainsare caused by a rapid extensive contraction of the hamstring muscle which causes high mechanical stress This shows in varying degrees of rupture of the fiber
- 23. Hamstring strainsare common in sports such as sprinting, jumping, contact sports such as Australian Rules football (AFL), where quick eccentric contractions are seen But in football it is quite the common injury
- 24. Various factorsare seen in hamstring injury such as Older age Previous hamstring injury Limited hamstring flexibility] Increased fatigue Poor core stability Strength imbalance Previous calf injury Previous substantial knee injury Osteitis pubis
- 25. Severe paincan be present in the posterior thigh popping" or tearing impression can be described. Sometimes swelling and ecchymosis can be present Large hematoma or scar tissue can be presented
- 26. Other possiblesymptoms can be Pain Tenderness Loss of motion Decreased strength
- 27. They canbe divided into 4 classes such as Grade 1 Grade 2 Grade 3 Grade 4
- 28. Grade 1(mild): just a few fibres of the muscle are damaged or have ruptured.This rarely influences the muscle's power and endurance. Pain and sensitivity usually happen the day after the injury (depends from person to person) Patient can walk fine.There can be a small swelling, but the knee can still bend normally
- 29. Grade 2(medium): approximately half of the fiberes are torn. Symptoms are pain, swelling and a mild case of function loss. The walk of the patient will be influenced Bending the knee can also be painful
- 30. Grade 3(severe): ranging from more than half of the fiberes ruptured to complete rupture of the muscle Both the muscle belly and the tendon can suffer from this injury It causes massive swelling and pain The function of the hamstring muscle can't be performed anymore as the muscle shows more weakness
- 31. On examiningthe patient , the physio can misinterpret the posterior thigh pain into various problems such as Adductor strains Piriformis injury Sacroiliac dysfunction Sciatica Ischial bursitis
- 32. The onlyway to isolate the hamstring injuries from other injuries is to perform diagnostic procedures Radiographs Ultrasounds MRI scan
- 33. The FASH(Functionalassessment scale for acute Hamstring injuries) questionnaire is a self-administered questionnaire which now can only be used in Greek, English and German languages. Some other outcome measures which can be used are :-
- 34. LEFS: lowerextremity functional scale SFMA:-The Selective Functional Movement Assessment (SFMA) is a clinical assessment system designed to identify musculoskeletal dysfunction PSFS: Patient specific function scale VAS:Visual analog scale NPRS: Numerical pain rating scale
- 37. Running gait:Thephysical examination begins with an examination of the running gait. Patients with a hamstring strain usually show a shortened walking gait. Observation:- The posterior thigh is inspected for asymmetry, swelling, ecchymosis and deformity.
- 38. Palpation ofthe posterior thigh is useful for identifying the specific region injured through pain provocation, as well as determining the presence/absence of a palpable defect in the musculo tendon unit. With the knee maintained in full extension, the point of maximum pain with palpation can be determined and located relative to the ischial tuberosity
- 39. the moreproximal the site of maximum pain, the greater the time needed to return to pre- injury level.The proximity to the ischial tuberosity is believed to reflect the extent of involvement of the proximal tendon of the injured muscle, and therefore a greater recovery period.[
- 40. Range ofmotion: Range of motion tests should consider both the hip and knee joints. Passive straight leg raise (hip) and active knee extension test (knee) are commonly used together to estimate hamstring flexibility and maximum length typical hamstring length should allow the hip to flex 80° during the passive straight leg raise and the knee to extend to 20° on the active knee extension test so In the acutely injured athlete, these tests are often limited by pain and thus may not provide an accurate assessment of musculotendon extensibility
- 41. There are acertain tests in which you can confirm that a person is having a hamstring strain or no . There are as folllows Puranen-Orava test – Actively stretching the hamstring muscles in standing position with hip flexed at about 90*, the knee fully extended and foot on a solid surface. Positive – exacerbation of symptoms.
- 42. Bent-Knee stretchtest Modified Bent-knee stretch test Taking off the shoe test/hamstring-drag test
- 43. Only inchronic cases of hamstring strain where one of the muscle fiber is toren surgery is recommended Otherwise most of the cases are managed by physiotherapy
- 44. eccentric strengthening,at long muscle length exercises, as a rehabilitation tool worked wonders for the patient and showed a positive effect PATS which stands for progressive ability of trunk and stabilisation exercises It helps in promoting the return to sports and preventing injury recurrence in athletes suffering an acute hamstring strain.
- 45. Deep strippingmassage is another technique used as rehabilitation for hamstring strain injury DSMS increases hamstring length in less than 3 min but has no effect on strength. Furthermore, combining DSMS with eccentric resistance exercise produces more hamstring flexibility gains than DSMS alone
- 46. Functional dryneedling is a technique that has been reported to be beneficial in the management of pain and dysfunction after muscle strains and in combination with an eccentric training program, The impact of kinesiology tape has been demonstrated to be efficient at improving muscle flexibility, which can prevent or improve the risk of having injuries
- 47. Now letssee how a rehab protocol is set for hamstring strain It contains the following phases Phase 1 Phase 2 Phase 3
- 48. Phase I(week 0-3) 1-Goals Protect healing tissue Minimize atrophy and strength loss Prevent motion loss
- 49. 2-Precautions Avoidexcessive active or passive lengthening of the hamstrings Avoid antalgic gait pattern
- 50. 3- Rehab Ice – 2-3 times daily Stationary bike Sub-maximal isometric at 90, 60 and 30 Single leg balance Balance board Soft tissue mobs/IASTM Pulsed ultrasound (Duty cycle 50%, 1 MHz, 1.2W/cm2) Progressive hip strengthening Painfree isotonic knee flexion Active sciatic nerve flossing ConventionalTENS
- 51. Phase 2(week 3-12) Goals Regain pain-free hamstring strength, progressing through full ROM Develop neuromuscular control of trunk and pelvis with a progressive increase in movement and speed preparing for functional movements
- 52. Precautions Avoidend-range lengthening of hamstring if painful
- 53. Rehab Ice– post-exercise Stationary bike Treadmill at moderate to high-intensity pain-free speed and stride Iso kinetic eccentrics in the non-lengthened state Single limb balance windmill touches without weight Single leg stance with perturbations Supine hamstring curls on thera ball STM/IASTM Nordic hamstring Ex Shuttle jumps Prone leg drops Lateral and retro band walks Sciatic nerve tensioning
- 54. Eccentric protocol Once non-weight bearing exercises are tolerated start low-velocity eccentric activities such as stiff leg deadlifts, eccentric hamstring lowers/Nordic hamstring Ex, and split squats. Nordic Hamstring
- 55. Criteria forprogression Full strength 5/5 without pain during prone knee flexion at 90 Pain-free forward and backward, jog, moderate-intensity Strength deficit less than 20% compared to the normal limb Pain-free max eccentric in a non-lengthened state
- 56. Phase 3(week 12+) Goals Symptom-free during all activities Normal concentric and eccentric strength through full ROM and speed Improve neuromuscular control of trunk and pelvis Integrate postural control into sport-specific movements
- 57. Precautions Trainwithin symptoms free intensity
- 58. Rehab Ice– Post-exercise – as needed Treadmill moderate to high intensity as tolerated Isokinetic eccentric training at end ROM (in hyperflexion) STM/IASTM Plyometric jump training 5-10 yard accelerations/decelerations Single-limb balance windmill touches with weight on an unstable surface Sport-specific drills that incorporate postural control and progressive spe
- 59. Eccentric protocol Include higher velocity eccentric exercises that include plyometric and sports specific activities Examples: include squat jumps, split jumps, bounding and depth jumps, single leg bounding, backward skips, lateral hops, lateral bounding, zigzag hops, bounding, plyometric box jumps, eccentric backward steps, eccentric lunge drops, eccentric forward pulls, single and double leg deadlifts, and split stance deadlift (good morning E
- 60. Return tosport criteria:- Full strength without pain in the lengthened state testing position Bilateral symmetry in knee flexion angle of peak torque Full ROM without pain Replication of sport-specific movements at competition speed without symptoms. Isokinetic strength testing should be performed under both concentric and eccentric action conditions. Less than a 5% bilateral deficit should exist in the ratio of eccentric hamstring strength (30d/s) to concentric quadriceps strength (240d/s).
- 61.
- 63. Calf musclestrain injuries (CMSI) occur commonly in sports involving high-speed running which has acceleration and deceleration as well as during fatiguing conditions of play or performance
- 64. Calf strainis a common muscle injury and if not managed properly there is a risk of re- injury Muscle strains commonly occur in the medial head of the gastronemius or close to the musculotendinous junction.
- 65. During sportingactivities such as sprinting, these long, bi-articular muscles have to cope with high internal forces and rapid changes in muscle length and mode of contraction leading to a higher risk of strain. despite this, calf muscle strains have also been reported to occur during slow- lengthening muscle actions such as those performed by ballet dancers, but also during common daily activities.[9]
- 66. Various sportssuch as rugby, football, tennis, athletics and dancing are impacted by calf muscle strain injuries. In football, 92% of injuries are muscular injuries, 13% of these are calf injuries
- 67. Calf strainsare most commonly found in the medial head of the gastrocnemius A sudden pain is felt in the calf, and the patient often reports an audible "pop" in the medial aspect of the posterior calf, or they have a feeling as though someone has kicked them in the back of the leg.
- 68. Strains inthe gastrocnemius are also referred to as a “tennis leg” as the classic presentation is a middle-aged tennis player who suddenly extended the knee.
- 69. Gastrocnemius isconsidered at high risk for strains because it crosses two joints (the knee and ankle) and has a high density of type two fast-twitch muscle fibers. A tear of the medial head of the gastrocnemius muscle is due to an eccentric force being applied to the muscle when the knee is extended and the ankle is dorsiflexed
- 70. Symptoms ofgastrocnemius strain can include sudden sharp pain or tearing sensation at the back of the lower leg, tenderness to touch at the point of injury Swelling Bruising may appear within hours or days Stretching of the muscle will reproduce pain Pain on resisted plantarflexion
- 71. The soleusmuscle is injured while the knee is in flexion. Strains of the proximal medial musculotendinous junction are the most common type of soleus muscle injuries Soleus strains also tend to be less dramatic in clinical presentation and more subacute when compared to injuries of gastrocnemius It’s a low risk injury
- 72. Plantaris strains Plantaris is considered largely vestigial and rarely involved in calf strains, although it crosses both the knee and the ankle joint as well.
- 73. ISharp painat the time of activity or after. May have a feeling of tightness May be able to continue activity, without pain or with mild discomfort Post activity tightness and/or aching
- 74. Symtpoms Painon unilateral calf raise Average time to return to sports:- 10 - 12 day
- 75. Sharp painat the time of activity in calf Unable to continue activity Significant pain with walking afterwards May have swelling in muscle Mild to moderate bruising may be present
- 76. Signs Painwith active plantarflexion Pain and weakness with resisted plantarflexion Loss of dorsiflexion Bilateral calf raise pain
- 77. Average timeto return to sport:- 16 - 21 day
- 78. severe andimmediate pain in the calf, often at musculotendinous junction Unable to continue with activity May present with considerable bruising and swelling within hours of injury
- 79. Signs:- Inabilityto contract calf muscle May have palpable defect Thomson's test positive Average time to return to sport:- 6 months after surgery
- 80. (shin splints) Achilles tendinopathy Plantar fasciopathy muscles strains and/or joint sprains due to reduced ROM of the ankle. Other lower leg injuries related to sports with the same symptoms and treatment as a calf strain are discussed below. Chronic exertional syndrome (CECS). CECS begins with mild pain during periods of training and can disappear after training.
- 81. PoplitealArtery EntrapmentSyndrome (PAES). An abnormal relationship between the popliteal artery and the surrounding myofascial structures. Baker cyst
- 82. Calf strainsrarely require surgery however may be necessary in a complete rupture. Otherwise it can be treated conservatively Soft tissue injury management Steroid injection If hematoma is present it should be removed quickly so to prevent myositis ossificans
- 83. limit bleeding pain prevent complication
- 84. Tape ora compressive wrap can be applied and the leg elevated where possible. [23] If major bleeding has occurred, the use of NSAIDs has to be carefully controlled as they have an anti-platelet effect Gentle passive stretching exercises without pain to maintain range of motion in the plantar flexors.
- 85. Isotonic exercisesfor the antagonists tibialis anterior, and the peronei are recommended as well as light exercises for the injured muscle Shoes with a low heel are recommended to encourage improved heel-toe gait. When the calf muscles can be fully extended pain free, a shift can be made from gentle passive stretching to active stretches, in both a flexed knee position (soleus) and a straightened knee position (gastrocnemius). Gradual loading/strengthening exercises of the calf muscles should be given in order to have a full recovery.
- 86. Lower extremityfunctional scale Visual analog scale NPRS
- 87.
- 89. This injuryis usually due to an acute stretch of the muscle, often at the same time of a forceful contraction or repetitive functional overloading.
- 90. 1. Suddendeceleration of the leg (e.g. kicking), 2. violent contraction of the quadriceps (sprinting) and 3. rapid deceleration of an overstretched muscle (by quickly change of direction)
- 91. Divided into3 or more categories Grade 1 symptom Grade 2 symptom Grade 3 symptoms
- 92. Grade 1symptoms Symptoms of a grade 1 quadriceps strain are not always serious enough to stop training at the time of injury. A twinge may be felt in the thigh and a general feeling of tightness The athlete may feel mild discomfort on walking and running might be difficult.
- 93. The athletemay feel a sharp pain when running, jumping or kicking and be unable to play on. Pain will make walking difficult and swelling or mild bruising may be noticed.
- 94. Symptoms consistof a severe pain in the front of the thigh. The patient will be unable to walk without the aid of crutch
- 95. It includesdevices such as X rays Ct scans MRI
- 96. large intramuscularhematoma(s), a complete (III degree) strain or tear of a muscle with few or no agonist muscles, or a partial (II degree) strain if more than half of the muscle belly is torn. surgical intervention should be considered if a patient complains of persisting extension pain (duration, >4-6 months) in a previously injured muscle, particularly if the pain is accompanied by a clear extension deficit
- 97. The operatedmuscle is immobilized in a neutral position the duration of immobilization naturally depends on the severity of the trauma, but patients with a complete rupture of the m. quadriceps femoris or gastrocnemius are instructed not to bear any weight for 4 weeks,
- 98. Although oneis allowed to cautiously stretch the operated muscle within the limits of pain at 2 weeks postoperatively. Four weeks after operation, bearing weight and mobilization of the extremity are gradually initiated until approximately 6 weeks after the surgery,
- 99. It isdivided in three phases Phase 1 Phase 2 Phase 3
- 100. Diminish painand inflammation Gradually improve flexibility and ROM Retard muscular atrophy and strength loss Enhance healing of muscular strain The above metioned is goals in phase 1
- 101. RICE–Rest,Cryotherapy, compressionwrap, and elevation Use of crutches initially to facilitate rest and immobilization of the quadriceps NSAIDS Soft tissue mobs/IASTM Pulsed ultrasound (Duty cycle 50%, 1 MHz, 1.2 W/cm2) ConventionalTENS Ankle pumps, isometric quadriceps sets, hamstring sets, glut sets
- 102. Regain pain-freequadriceps strength, progressing through full ROM Develop neuromuscular control of trunk and pelvis with progressive increase in movement and speed preparing for functional movements
- 103. Cryotherapy NSAIDS Electrical stimulation Initial isometrics with quadriceps contractions done with the knee fully extended and in different positions at 20 degree increments as knee flexion improves May discontinue isometrics when can sit comfortably, perform straight leg raises at 0 degrees, 20 degrees, and 40 degrees Isotonics–begin with the lightest free weight that athlete can lift; three sets of 10 repetitions up to three times per day Terminal knee extensions instituted at 20 degree increments as comfort and knee flexion allow Once terminal knee extensions are done properly without extensor lag, free weights are added to the SLRs and terminal knee extensions
- 104. Symptom freeduring all activitiesNormal concentric and eccentric strength through full ROM and speed Improve neuromuscular control of trunk and pelvis Integrate postural control into sport-specific movements
- 105. Ice –Post exercise – as needed Treadmill moderate to high intensity as tolerated Isokinetic eccentric training at end ROM (in hyperflexion) STM/IASTM Plyometric jump training 5-10 yard accelerations/decelarations Single-limb balance windmill touches with weight on unstable surface Sport-specific drills that incorporate postural control and progressive speed
- 106.