In this essay there will be a numbers of topics discussed and broken down. These topics include the short, medium and long-term effects of sports-related injuries on skeletal muscle tissue, healing phases that are associated with the healing process of muscular tissue and 3 modalities to support soft tissue repair which are sports massage, cryotherapy and thermotherapy. These topics are going to be described over in the way they are placed in order above.
To begin with we are going to be going through the short and medium term effects sports injuries have on our skeletal muscles. These injuries can be caused by bruising, spraining or laceration. Muscle lacerations are seen as the least frequent injuries coming from all types of physical sports. “The inflammatory response is dependent on two factors, namely the extent of actual physical damage and the degree of muscle vascularisation at the time of injury.”(Smith, Kruger, Smith and Myburgh, 2008) There are three phases when an injury occurs on your skeletal muscles. These are known as the destruction, repair and remodelling phases. Repair and remodelling phase are very interrelated and tend to overlap each other at some point.
Throughout this phase known as the acute phase, the most used principle that is used is known as the PRICE principle. This principle stands for Protection, Rest, Ice, Compression and Elevation. This is most commonly used on short to medium injuries based around skeletal muscles or soft tissue. If you injure your leg in a soccer game then it is important to immediately put that limb at rest. This will help prevent muscle retraction later on or the build up of a larger muscle gap. This will help reduce the size of the hematoma and connective scar tissue. The use of ice should be considered as it has been shown that early use of cryotherapy closely corresponds to smaller hematoma in the gap of torn muscle fibres. It also shows signs of lessening inflammation and speeding up regeneration.
The facts that our skeletal muscle is the most common area for sports-related injuries, athletes sustain these muscle injuries through a wide amount of mechanisms. These include direct trauma which would be lacerations, strains, and contusions and indirect injuries.When a muscle is injured, the myofibers get ruptured badly and die off. This causes the formation of a haematoma. During this early phase, the inflammatory cells go straight to the where this injury has occurred because the blood vessels being torn. The most plentiful inflammatory cells are named polymorphonuclear leukocytes. Only after a couple of hours these are taken over by monocytes. After another period of time these cells eventually turn into macrophages. These cells are very important as they serve two functions. The first function they serve is that they remove the necrotic myofibers by phagocytosis.
For their second function known as the repair phase they have two processes. This first one is known as the build up of disrupted myofibers. The reason regeneration can occur is to do with the pool of undifferentiated reserve cells. These satellite cells then multiply and eventually change into myoblasts. As myoblasts fuse togetherwith the injured myofibers, the gap that was formed between the two ends of the ruptured myofiber is filled up again. This second process of this “repair phase” is the creation of connective scar tissue by fibrin and fibronectin. These were obtained from blood of the haematoma that was made quickly after the injury.
Moving onto the long term effects, the example of the muscle I’m going to be using is the hamstring. All of the functions and processes work in a similar way here as stated already but take longer to heal. The hamstring muscles are the least stretched muscles in the body. This contributes to the reason why they are commonly injured especially during eccentric muscle contraction. People tend to not take the hamstring sprain serious and most frequently during the acute phase.
To completely tear the hamstring muscle to their origin is not very common. To look after the hamstring, you need to be resting it by only going as intense as walking for a couple of weeks. Physiotherapy can help with the improvement of the hamstring strain. In rare cases the treatment with immobilization in flexion to surgery on the skeletal muscle later in the future. This surgery could lead to good results but the earlier you can possibly repair the hamstring leads to quicker recovery avoids the chance of neurological symptom of gluteal sciatica. Once fully recover their should be no lasting weakness because of the injury. “There are no significant differences between the previously injured and uninjured limbs were found in strength measures, peak hamstring stretch, or muscle activation patterns.”(Slider et al, 2010)
There are three healing phases. To begin with there is the “destruction phase”. This happens straight away after the injury happens, most commonly by a strain or contusion. A contusion is aligned force to the muscle that in injured and a strain is when the muscle is open to a force that leads to the failure of muscle fibers. No matter what type of injury it is, muscle fibers and small blood vessels tear which leads to filling the injured area with blood. In this blood are inflammatory cells that take over this freshly injured area. Muscle tissue has a mechanism that seals off where the injury is which makes the destruction and repair phases only happen at the injured spot. This process lasts for about 2-5 days after injury. During this time, there is usually help of use which can include splints, crutches and taping techniques. RICE (Rest, ice, compression, elevation) should be strictly followed.
During “repair phase”, a cell called a macrophage is identifiable at the injured site. This cleans away the dead tissue/blood from the injury. After this a cell named the satellite cell seen at the injured area. “Skeletal muscle development is a highly regulated process, involving the specification of mesoderm-derived precursors into myoblasts followed by the differentiation and fusion of these cells into multinucleated myotubes.”(Chinzei et al, 2015) These myotubes turn into myoblast cells, which in turn come together to make new muscle fibres. The fibroblast cell produces connective tissue at injury. It is both connective tissue and muscle fibers that repair the injured muscle. The formation of new blood vessels and nerves happen during this phase. The muscles of the injury should be mobilized to help with the regrowth of blood vessels and muscle fibers. It can also help reduce the severity of scars. During this phase, sports massage therapists and physical therapists can be of importance.
The final one named the “remodelling stage” has an overlap with the repair phase. In this phase there is muscle fibers and connective tissue that grow and mature into the final product which is the scar tissue. This particular stage is of importance in how the scar tissue is orientated. Muscle issue is oriented in straight lines so when tissue repairs itself,v creation of brand new connective tissue and muscles fibers is randomly orientated. An important treatment implication that should be considered could be manual therapy such as graston. This can help reduce restrictions in the scar tissue.
I am going to critically evaluate 3 different modalities of soft tissue repair. Firstly cryotherapy is a treatment that uses extreme cold to shatter imperfections you may have. This type of therapy is completely painless. These imperfections may include mole or warts that you want to get removed. There is a cryopen that releases nitrous. This is released under such high pressure which helps increase its precision. This destroys the tissue by rupturing the membrane and in turn destroying the cell. It causes no damage to surrounding healthy tissue. It is suitable for anyone but is recommended to wait until the person is over the age of 16 to make sure the imperfection is at full growth.
The methods of application start with cold bandages being placed around the body. The main purpose of this is the destruction of fatty tissue around the body. After this a special cream is placed on a mask of plaster for half an hour. It also has been proven to help treat skin diseases. Benefits of cryotherapy includes getting rid of extra fat around the body, improves overall blood circulation, helps reduce the amount of wrinkles on the skin and helps remove toxins. Contra-indications of cryotherapy can include hypertension Raynaud’s disease, rheumatoid arthritis, history of vascular impairment, such as frostbite or arteriosclerosis and Cold allergy. (Kaouk et al, 2006)
Secondly, thermotherapy is the appliance of heat or cold for the purpose of changing the core temperature of soft tissue with the purpose of enhancing the symptoms of certain conditions. Thermotherapy consists of applying heat or cold for the purpose of changing the temperature of soft tissue throughout the body. The reason behind this is to improve the symptoms of particular conditions. There have been studies done that say heat therapy can help reduce anorexia and mild depression. Thermotherapy accelerates recovery and healing. This treatment is regularly recommended and suitable to patients suffering from injury, chronic pain or arthritis.
Benefits of this type of therapy includes promotion of improved physical health, better sleep, stimulates the immune system Improves blood circulation, slows body ageing, encourages improved nutrient absorption and digestion.Contra-indications may include Impaired sensation or mentation, Infrared Irradiation of the eyes, bruising, thrombophlebitis which is a blood clot caused by a fast rate of heat circulation throughout the body and malignant tissue which would be cancer in an area. (Dugué et al, 2005)
Sport massage is the final modality that will be discussed. The purpose of sports massage is improving circulation, tissue elasticity and to reduce muscle tension. Sports therapists can also be used to help relieve tight muscles. Sports massage is performed by the therapist on a client using their hands, knuckles or elbows throughout the process. There is usually oil used to lubricate the injured part of the body that is being worked on. This type of treatment is suitable for anyone suffering from sports related injuries or people with tightness in muscles throughout the body and need some relieving.
Benefits of sports massage and improve flexibility, decrease pain and minimise possible future injuries. Sports massage may also help alleviate pain and prevent injuries that can affect movement, mobility, strength and performance in any type of training. “Massage finds its use in the management of chronic pain, soft tissue injury, swelling due to lymphatic and venous dysfunction, inactivity and paralysis”.(Goswami, et al 2020) Sports massage is also popular amongst people with tension and pain caused by modern working lifestyles, such as long sitting in an office. It can also reduce the stress of tension and anxiety.
Contra-indications for this include cuts and grazes. The scar should always be properly formed before working on. Another one would be muscle ruptures. In the acute stage of this, bleeding still may be occurring. It is important to not treat this as massage can increase the damage of the tissue by more unnecessary bleeding. It is also important to not massage a contusion as this may cause further damage and lead to Myositis Ossificans. This is bone growth within the muscle. Never massage over burns or broken bones as this will hurt the client or you could cause further damage. If there are any lumps and bumps in the muscle or skin then it is important to stay away from those areas.
Throughout the entirety of this essay there have been many important topics in relation to my sports massage module discussed. Firstly there were the short, medium and long-term effects of sports-related injuries on skeletal muscle tissue. We learned more about the PRICE principle and the the formation of new cells and how they come about. Then there was information about the healing phases with the headings of the “destruction phase”, “repair phase” and “remodelling phase”. Finally on the topic of the three modalities of soft tissue repair, “cryotherapy”, “thermotherapy” and “sports massage” was discussed. Accomplishing this essay has helped me become more educated on all of the above topics that I hope to bring with me into the work place.
Academic journal references
- Asis Goswami, P.K. Nag, A. G. K. Sinha, Jayanta Kumar Ghoshal, Use and Contraindications of Massage, pp.7-18. Available at: http://epgp.inflibnet.ac.in/epgpdata/uploads/epgp_content/S000834PN/P001517/M016135/ET/1465281499CH14M7.4usecontaindicationofmassage.pdf [Accessed 27/04/2020]
- Dugué, B., Smolander, J., Westerlund, T., Oksa, J., Nieminen, R., Moilanen, E. and Mikkelsson, M. (2005). Acute and long‐term effects of winter swimming and whole‐body cryotherapy on plasma antioxidative capacity in healthy women. Scandinavian Journal of Clinical and Laboratory Investigation, 65(5), pp.395-402. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16081362 [Accessed 19/04/2020]
- Kaouk, J, Aron, M, Rewcastle, J. and Gill, I. (2006). Cryotherapy: Clinical end points and their experimental foundations. Urology, 68(1), pp.38-44. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16857458 [Accessed 17/04/2020]
- Nobuaki Chinzei, Shinya Hayashi, Takeshi Ueha, Takaaki Fujishiro, Noriyuki Kanzaki, Shingo Hashimoto, Shuhei Sakata, Shinsuke Kihara, Masahiko Haneda, Yoshitada Sakai, Ryosuke Kuroda, Masahiro Kurosaka. P21 Deficiency Delays Regeneration of Skeletal Muscular Tissue, pp.1-16. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420284/[Accessed 25/04/2020]
- Silder, A., G.Thelan, D. and C.Heiderscheit, B., 2004. Announcement (ScienceDirect Article in Press). Assessing Writing, [online] 9(1), p.III-IV. Available at: [Accessed 28 April 2020].
- Smith, C., Kruger, M., Smith, R. and Myburgh, K., 2008. The Inflammatory Response to Skeletal Muscle Injury. Sports Medicine, 38(11), pp.947-969. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18937524[Accessed 20/04/2020]