Zanobbi M., Nanni G., Cattani A., Fazzini D.

London, April 21st, 2013

The treatment ofquadriceps muscle tears

• Classification

• Diagnosis

• Prognosis

• Management

• Complications

• Prevention

• Classification

• Diagnosis

• Prognosis

• Management

• Complications

• Prevention

What does happen in the injured muscle?

H. Jarvinen et al AJSM, 2005

The muscle healing process

For this reasonwe will have a scar offibrous tissue that wemust treat from the

beginning!

In muscles there is a“reparation” of the lesion

First goal!

Why it is so important to avoid an area

of inelastic scar tissue?

Because the muscle is as strong as his weakest part!

Step 1

Step 3

1. Post injury management2. Aerobic training and stretching

3. Strength training and complete R.O.M.

4. On field rehabilitation5. Maintenance

Step 2

The approach of our group

Step 1

• Rest• Ice• Compression• Elevation

Post injury managementReduce bleedinginto the muscle

tissue!

Calnton TO et al. J Am Acad Orthop Surg, 1998

Step 1• Avoid anti-inflammatory (pain is our guide)

• Avoid heat

• Avoid massage ON the lesion

• Pain free exercises (stretching, strength)

• Peripheral massage to reduce hyper tone

• Start bike or treadmill exercise as soon as possible

From Step 1 to Step 2Pain during light strengthening

exercises or running on the treadmill

Role

• Type of massage: - Distal and proximal - Linphatic - Myofascial - DFM

Relaxing massageafter training

Role of massage

Step 2

• Specific stretching

• Specific strengthening (eccentric) exercises

• Start running on the field

• Start exercises to increase neuromuscular control(agility and trunk stabilization)

Sherry MA et al. JOSPT, 2004

Step 2

• Quality of stretching - General static - More specific - PNF - Dynamic - Postures• Quantity of stretching - n. of repetitions - duration

Arnason A et al. Scand J Med Sci Sports 2008Dadebo B et al, BJSM 2004

Stretching

Snyder Mackler L et al. JOSPT 2003

• General strengthening• Eccentric• More specific• PNF• Hight speed

Mendiguchia J et al. Br J Sports Med 2013

Strengthening

R.O.M. still differentFrom Step 2 to Step 3

Step 3

• Has to be done overall on the field

• Aerobic and anaerobic reconditioning

• Specific sport patterns

• Perform the movement that caused injury

Step 3

• Progression is the key• Aerobic training• Fatigue prevention• Movements of the injury

On field rehab

Different feeling in the muscleduring or after training

From Step 3 to the returnwith the team

• Recover the competition intensity

• Communication is fundamental

• Specific training 2 times a week (11+)

• The physiotherapist monitoring

Maintenance with the team

Re-injury is a newinjury that occurs in

the same musclewithin 2 months from

the first lesion

In our database we have had86 re-injury on 1630 cases

(5,3%)That means 86 very bad experiences !

1988 - Aug 2000 Sep 2003 - Dec 2006Sep 2000 - Aug 2003

N=306 N=519N=292

15 recurrences 14 recurrences

Recurrence Incidence

43 recurrences

14,1% 2,7%

Jan 2007 - Dec 2011

N=513

14 recurrences

14,1%

5,1%2,7% 2,7%

0,0%

2,0%

4,0%

6,0%

8,0%

10,0%

12,0%

14,0%

16,0%

1998-2000 2000-2003 2003-2006 2007-2011

% recurrences

0

100

200

300

400

500

600

1998-2000 2000-2003 2003-2006 2007-2011

n° lesions n° recurrences

The key to reduce the re-injury has been increasingthe number of on field rehabilitation sessions!

Our experience

Average of 2 weeks of supervised“on field rehabilitation”

Take home message

Conclusions• Avoid inelastic scar in the muscle• Be selective and accurate in the exercises

• Maintenance

• Respect the traffic lights

• Respect the right progression on the field