Muscle Injuries in Sports

439 Pages·2013·30.54 MB·English

by  Hans-W. Mueller-Wohlfahrt

Muscle Injuries in Sports
Hans-Wilhelm Mueller-Wohlfahrt, MD
MWCenterforOrthopedicsandSportsMedicine
Munich,Germany
Peter Ueblacker, MD
MWCenterforOrthopedicsandSportsMedicine
Munich,Germany
Lutz Haensel, MD
MWCenterforOrthopedicsandSportsMedicine
Munich,Germany
William E. Garrett Jr., MD, PhD
DukeSportsMedicineCenter
Durham,USA
Withcontributionsby
AndreasBetthaeuser,AlfredBinder,WilhelmBloch,
DieterBlottner,JohannesBoeck,BernhardBrenner,
KlausEder,JanEkstrand,MartinFlueck,LutzHaensel,
HelmutHoffmann,J.MichaelHufnagl,Hans-Wilhelm
Mueller-Wohlfahrt,PeterMundinger,AndreasSchlumberger,
BenediktSchoser,PeterUeblacker
ForewordbyJiriDvorák,Zurich,Switzerland;
ChiefMedicalOfficer,FIFA
505illustrations
Thieme
Stuttgart·NewYork
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IV
TomydearwifeKarin,
mydaughterMarenandmysonKilian
fortheirsupportandunderstanding.
H.-W.Müller-Wohlfahrt
TomydearwifeAnika,
andmychildrenMalou,Elia,andLouis
fortheirlove,joiedevivre,andunderstanding.
P.Ueblacker
TomydearwifeGloria
forheruntiringsupport
andunderstanding.
L.Hänsel
V
Foreword
Itisanundisputedscientificfactthatsportsnotonlypro- Theeditorsofthisbook,Hans-WilhelmMüller-Wohl-
mote the enhancement of physical fitness, regardless of fahrt, PeterUeblacker, Lutz Hänsel, andWilliam Garrett,
ageorgender,butarealsothemosteffectivewayofpre- aswellasthecontributingauthors,havehaddecadesof
venting most cardiovascular diseases, diabetes, obesity, practicalexperienceincaringforthousandsofprofession-
andmanytypesofcancer(asoutlinedbyProf.StevenBlair al and amateur athletes. As a result, Muscle Injuries in
intheBritishJournalofSportsMedicine2009;43:1–2).Ex- Sportsoffersstate-of-the-artdiagnosticandtreatmentin-
tensivepromotionofrecreationalsportsforallagesisthe formation from the perspective of prominent sports
bestwayofimprovingpublichealthandreducinghealth- physicians.Thebookincludesanewsystemfortheclinical
carecosts. classification of muscle injuries based on the history,
Ifthishealthpotentialofcompetitiveandrecreational physical examination, and imaging findings. The bookʼs
sportsistobefullyexploited,theriskofinjurieshastobe therapeutic focus is on conservative treatment, both in
reducedasmuchaspossible.Particularlyinsportsthatare thesettingofacutemuscleinjuriesandinrehabilitation.
widelypopular,everyefforthastobemadetopreventin- As readers will see, the authors have gathered together
juries and their late sequelae. This should include ade- thebestandmostusefulinformationonthebasisofdec-
quate initial examinations, warm-up routines based on adesofexperience,withthegoalofhasteningtherecov-
specialexercises,andconceptsoffairplay,aswellasopti- eryofeveryinjuredathlete.
malmanagementofanyinjuriesthataresustained. Ipersonallyknowlittleaboutinterferencefieldsoren-
Football (soccer) is unquestionably the most popular ergyemissionanalysis,butthesechaptersclearlywarrant
sportintheworld.Withalmost300millionplayersworld- criticalevaluation.Thissuperblyillustratedbookiscom-
wide, any divergence from good practice is inevitably pleted by a chapter on preventive measures, which are
magnifiedonatremendousscale. definitelyasimportantastreatmentandmaybefarmore
On the basis of comprehensive epidemiologic studies important. Scientific studies with football players (Soli-
conductedbytheFIFAMedicalAssessmentandResearch gardetal.,BMJ2008;337:a2469)haveshownthatinjuries
Center(F‑MARC)oftheInternationalFederationofAssoci- can be reduced by 30–50% when preventive measures
ation Football (FIFA), the average soccer player sustains such as the 11+ exercise program, with proven efficacy,
approximatelytwoinjuriesperyear.Notonlydothesein- areappliedasanintegralpartofwarm-uproutinesbefore
juriesincur primarytreatmentcosts,butsignificantsec- trainingandcompetition(http://f-marc.com).
ondary costs also arise due to lost productivity and ab- Insummary,everyoneinvolvedinthecareofathletes
sence from work. The most common sports-related should not only read this book but also implement the
injuriesinvolvethe muscles, and even apparentlyminor practicalrecommendationsbyseasonedexpertsthatitof-
injuriesmayhaveseriousconsequenceswhentheyoccur fersontheprevention,diagnosis,treatment,andrehabili-
onarepetitivebasis.Astheworldʼslargestinternational tationofsports-relatedmuscleinjuries.
sports association, FIFA has taken a keen interest in the
prevention,diagnosis,andtreatmentofsports-relatedin-
juries.Trainers,physicaltherapists,andsportsphysicians
attherecreationalandamateurlevelmusthavesufficient
knowledgetoprovideoptimaldiagnosticandtherapeutic
care. Prof.JiriDvorák,MD
ChiefMedicalOfficer,FIFA;Chairman,F-MARC
VI
Preface
Morethanone-thirdofallinjuriesthatoccurinsoccerin- Interestingly,whilethemusculatureisthelargestpa-
volve the muscles; thigh muscle injuries represent the renchymalorganinthehumanbody,representingrough-
mostcommondiagnosisintrackandfieldathletes,Amer- ly40%ofthetotalbodyweightinadults,themuscleshave
icanfootball,andbasketball.However,muscleinjuriesare beenrelegatedtoasecondaryroleinthepast.Itisonlyre-
alsocommoninrecreationalsports,whereoverlookedor centlythattheyhavebecomeafocusofgrowinginterest
misunderstood muscle injuries may lead to persistent in research work, professional journals, and the press.
problems. More and more, the muscles are being recognized as a
Itisalsoafactthatinjuriestotheskeletalmusclesare centralorganthatisresponsiblefornumerousdisorders
often underestimated, misinterpreted, and improperly andcomplaintsandthatisalsoaccessibletotreatment.
treated.Thereasonsforthisincludealackoftrainingand Thistextbookisbeingpublishedatatimewhengreater
continuingeducation in this area,a lackofresearch,the attentionisbeinggiventothemusclesin“musculoskeletal
absence—so far—of a practical, comprehensive, universal medicine”—thefieldthatinthepastdealtextensivelywith
classificationsystemformuscleinjuries,andevenalack joints,ligaments,tendons,andbones.Ouraimistostimu-
ofuniformterminology.Moreover,guidelinesforclinical latediscussionaboutathleticmuscleinjuriesinorder to
or imaging diagnosis and treatment are lacking. For the promoteanewandimprovedunderstandingofthediag-
sakeofallinjuredathletes,thissituationmustchange! nosis,treatment,andpreventionofthesefrequentandin-
Inthepast,thespecializedknowledgeneededtodiag- terestingdisorders.
nose and treat muscle injuries could only be obtained TheoriginalpublicationofthisbookinGermaninJune
fromindividualpublications,withconsiderableinconsis- 2010 wasverysuccessful, witha positiveresponsefrom
tencyintheuseofmuscleinjuryterminology.Sofar,there manyphysiciansandtherapistsinthefieldofthediagno-
havebeen notextbooksproviding a comprehensive,un- sisandtreatmentofmuscleinjurieswhohadbeenlooking
derstandabledescription oftheanatomyandphysiology forabooklikethisforalongtime.Thisledustodiscuss
oftheskeletalmusclesortheclinicaldiagnosis,imaging, the possibility of producing an English edition with the
treatment,rehabilitation,andpreventionofmuscleinju- publishers.
ries. ThepresentEnglisheditionisafurtherdevelopmentof
Having long planned a book on diagnosis and treat- theGermanone,basedonthefollowingevents:Inearly
ment,wefelt it wastimetoundertakeacomprehensive 2011, we conducted a survey based on the hypothesis
projectofthistype.TheresultisMuscleInjuriesinSports, that the existing terminology for muscle injuries in the
whichdrawsuponmorethan35yearsofpracticalexperi- English language is highly inconsistent. Scientists and
ence in caring for professional soccer players and other teamdoctorsfromnationalandfirst-divisionprofessional
topathletes from track and field and manyothersports soccerteams,nativeEnglishspeakers,wereaskedtocom-
fromallovertheworld. plete a questionnaire. The responses confirmed our hy-
Themainprobleminevaluatingskeletalmusclesisthat pothesisthatthereismarkedvariabilityintheuseofmed-
they are so heterogeneous, from both the physiological ical terminology relating to muscle injury. The results
andpathologicalstandpoints.Thismakesitallthemore emphasized the need for a more uniform terminology
difficult to establish a comprehensive classification that andclassificationsystem.
covers all injuries, as there are more borderline cases Onthebasisofthesefindings,weorganizedaconsen-
thaninothertypesofinjurysuchasfractures. sus meeting of international sports medicine experts in
Onlyveryfewstudieshavebeenpublishedonmuscle Munich,Germany,onMarch3,2011.Thefollowingmem-
injuries.Muchoftheinformationinthisbook—particular- berstookpartinthemeeting(inalphabeticalorder):
ly the chapters on classification, clinical diagnosis, and l Prof.DieterBlottner(AssociateProfessor,Department
treatment—is thus admittedly based more on empirical of Vegetative Anatomy, Charité University Hospital,
knowledge than on scientific data. But isnʼt it also true Berlin,Germany)
thatothermedicalclassificationsareevidence-basedonly l Prof. Jan Ekstrand (Head of the UEFA Injury Study
to a limited degree, due to a lackof scientific research? Group,Vice-ChairmanoftheUEFAMedicalCommittee,
However,theempiricaldatausedinthisbookarebased UniversityofLinköping,Sweden)
onalargenumberofmuscleinjuries,astheauthorsand l Dr. Bryan English (teamphysicianof Chelsea Football
editorsregularlyseeandtreatcompetitiveathletes. Club,UK)
VII
l Prof.WilliamE.Garrett,Jr.(DukeSportsMedicineCen- Theaimofthenewclassificationsystemistoimprove
ter,Durham,NorthCarolina,USA) theclarityofcommunicationforbothdiagnosticandther-
l Dr.LutzHänsel(editorofthisbook,teamphysicianof apeuticpurposes.Thisisintendedtoserveasthebasisfor
BayernMunichFootballClub,Germany) futurecomparativestudiestoaddressthecontinuedlack
l Dr.GinoM.M.J.Kerkhoffs(DepartmentofOrthopedic ofsystematicinformationonmuscleinjuriesinthelitera-
Surgery, Orthopedic Research Center, Amsterdam, ture.Theresultsofthisconsensusconferencehavebeen
Netherlands) published in the British Journal of Sports Medicine (with
l Dr.SteveMcNally(teamphysicianforManchesterUnit- openaccessonbjsm.com).
ed,UK) Weareveryproudthattheclassificationhasbeenin-
l Dr. Kai Mithoefer (Harvard Vanguard Medical Associ- cluded in the UEFAChampions League Injury Study. We
ates, Harvard Medical School, US Soccer Federation, hopethatourworkwillstimulateresearch—basedonthe
Boston,Massachusetts,USA) suggestedterminologyandclassification—toprospective-
l Dr. Hans-Wilhelm Müller-Wohlfahrt (editor of this lyevaluatetheprognosticandtherapeuticimplicationsof
book,teamphysicianofBayernMunichFootballClub, the newclassification system, whichisbased onclinical
Germany, and team physician of Germanyʼs national experience.
footballteam) This book has been written for all sports physicians,
l Dr.JohnOrchard,MD,PhD(AssociateProfessor,School sports scientists, physical therapists, and many others
ofPublicHealth,UniversityofSydney;teamphysician whoareinterestedandinvolvedinthecareandtreatment
oftheAustraliancricketteamandSydneyRoostersrug- ofcompetitiveandrecreationalathletes.Ourhopeisthat
byleagueteam) bydescribingourownexperience,wemaybeabletoad-
l Dr.PatrickSchamasch(MedicalandScientificDirector vancethediagnosisandtreatmentofthesefrequentand
of the International Olympic Committee, Lausanne, interestinginjuries.
Switzerland) OurspecialthanksgotoDr.AlbrechtHauff,CEOofthe
l Dr.LeifSwaerd(AssociateProfessor,UniversityofGöte- ThiemePublishingGroup,forhisenthusiasticresponseto
borg, Sweden; team physician for Swedenʼs national ourideaofwritingacomprehensivetextbookonskeletal
football team and previously for Englandʼs national muscleinjuries.Weareparticularlygratefulforhisfore-
footballteam) sightandhissupport.
l PDDr.PeterUeblacker(editorofthisbook,teamphysi- WearealsoverygratefultothestaffatThiemePublish-
cianofBayernMunichFootballClub,Germany) ers—particularlyAngelikaFindgott,forgenerousandpro-
l Dr. Niek van Dijk (Head of the Orthopedics Depart- fessionalplanning;andtoAnne Lamparter,DeborahCe-
ment, Academic Medical Center, Amsterdam, Nether- cere,andSophiaHengst,fortheirtirelesshelpandsupport
lands) in seeing the project through tocompletion. Our thanks
also go to Gertrud Champe, Ruth Gutberlet, Alexandra
Practicalandsystematictermsforathleticmuscleinjuries Kuhn-Thiel,andTerryTelgerfortheprofessionaltransla-
wereestablishedattheconference. tions.TheentirestaffattheThiemePublishingGroupcon-
Itwasdecidednottorecommendtheuseoftheterm sistentlylookedafterourneedswithagreatdealofeffort
strainanymore,asit isabiomechanicaltermthatisnot and commitment andwere able tofind answers for our
definedandisusedindiscriminatelyforanatomicallyand mostchallengingquestions.Theyprovidedthehighdegree
functionally different muscle injuries. Instead of strain, ofcollaborationthatisessentialforcompletingaprojectof
the consensus panel proposed the use of the term tear, thiskind.
usedforstructuralmuscleinjuries—i.e.,injuriesinwhich Our sincere thanks also go, of course, to all of our
thereismacroscopicevidenceofmuscledamage. authors,whosecontributionsreflecttheveryhighestlevel
Inaddition,acomprehensivenewclassificationsystem oftechnicalcompetenceandexpertise.Wearegratefulto
wasdevelopedthatdifferentiatesbetween: themfortheirdedicatedandcomprehensiveworkonthe
l Functional muscle disorders—referring to disorders project,andparticularlyalsointhetranslationandediting
with no macroscopic evidence of fiber tear (type 1, tasksneededforthisEnglishedition.Weareproudtohave
overexertion-related;andtype2,neuromuscularmus- workedwithsuchanaccomplishedandexperiencedteam
cledisorders) ofexperts.
and
l Structuralmuscleinjuries—withmacroscopicevidence Hans-WilhelmMüller-Wohlfahrt
of a fiber tear, i.e. structural damage (type 3, partial PeterUeblacker
tears;andtype4,[sub]totaltears/tendinousavulsions) LutzHänsel
Subclassificationsweredefinedforeachtype.
VIII