Muscle strains and tears are very common injuries seen in our practice. The 2 most frequently affected muscles are the hamstring (thigh) and the gastrocnemius (calf) muscles. They have similar presentations and treatment options.
Muscle injuries, muscle tears— such as a “pulled hamstring” or “pulled calf” — occur frequently in athletes. They are especially common in athletes who participate in sports that require sprinting, such as track, soccer, and basketball.
Most muscle injuries respond well to simple, nonsurgical treatments.
Patient History and Physical Examination
The first symptom of a hamstring injury will be a sharp pain along the back of the leg, often resulting in the patient seeking immediate medical attention. Some patients hear a “pop” or a sensation of a sharp knife stabbing the back of the thigh. Physical examination will reveal some brusing and swelling at the site of injury with exquisite tenderness on palpation.
Sometimes an MRI or ultrasound scan may be undertaken to confirm diagnosis.
Treatment depends on the severity of the injury and the urgency with which the athlete needs to return to training or competition.
Initial Conservative Treatment
RICE. The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation.
- Rest. Take a break from the activity that caused the strain. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
- Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
- Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
- Elevation. To reduce swelling, recline and put your leg up higher than your heart while resting.
You may require a pair of crutches for the first couple of days. Once the initial pain and swelling has settled down, physical therapy can begin. In general, muscle tears take 6-12 weeks to heal completely and in that period of time, avoidance of sporting activities that require the lower limbs will be required.
This is Dr Lee’s treatment of choice for athletes who want to shorten their recovery period and have a quicker return to sports.
Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.
PRP is plasma with much more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.
To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. Then the increased concentration of platelets is combined with the remaining blood.
It can be directly injected into an area of injury to promote healing. For example, in an athlete with a hamstring muscle tear, we localise the exact site of injury with an ultrasound machine and then inject the PRP under direct visualisation. In our experience, this has helped many of our athlete patients shorten the healing time by half. We have treated runners, triathletes, MMA fighters, soccer players, cyclists and many athletes from other disciplines.
Most recently, one of our patients who was an MMA fighter in the heavyweight division tore his adductor longus muscle and tendon off the bone during a fight. He presented with severe groin pain and difficulty walking. In most cases, this severe injury would have been treated with surgery. He was adamant that he did not want surgery and wanted to try PRP therapy. He was given 3 injections of PRP under ultrasound guidance (weekly intervals) and he was back to doing weights and MMA training 2 weeks after the last injection.
Surgery is normally reserved for severe injuries such as tendon avulsion injuries where the tendon has pulled completely away from the bone. Surgery may also be required to repair a complete tear within the muscle.
In order to sucessfully address a tendon avulsion, the surgeon will pull the hamstring muscle back into place and remove the remaining scar tissue. Following this the tendon is affixed to the bone with the aid of large stitches or staples.
Recovery after Muscle Tear Treatment
Provided you have been treated properly with rest, physical therapy, PRP injections or surgery, most muscle tears heal very well. The earlier you begin the RICE process and consult your physician the quicker you can return to normal activities.
Be careful about returning to physical activities too soon after your injury as repeated injury can lead to a chronic condition leading to hampered physical performance.