radiation . It can also be used for comparison with other muscle groups ( for example , the opposite limb ), and with a skilled operator , can be used dynamically to study contraction and relaxation of the muscle in real time . 14

MRI use is increasing as it allows for the thorough assessment of musculoskeletal pathology due to its excellent tissue contrast and high definition of all soft tissues . 14

However , it currently remains a second-line option because of its high cost ( usually no Medicare rebate ), limited availability , and various rare , but important , contraindications . 14

Treatment and intervention Traditionally , first-aid teaching supports the RICE / RICER ( Rest , Ice , Compression , Elevation , ± Referral ) method for the acute management of soft tissue injuries .

This protocol focuses on the protection of the damaged muscle in the inflammatory phase , reduction of injury-associated bleeding and swelling , and the reduction of scar tissue formation . 13 It is believed that this is achieved by local vasoconstriction and reduction of

Recommended order of analgesia for acute muscle injuries

1 . Paracetamol or topical NSAIDs

2 . NSAIDs – COX2 selective then non-selective

3 . Opioids

secondary hypoxic damage , due to a decrease in the metabolic demands of the injured tissue . 15

Immobilisation then allows granulation tissue to form between the injured muscle fibres to withstand contraction-induced forces applied , minimising risk of re-injury . 16

Recently , these protocols have been challenged by the development of ‘ early mobilisation ’ protocols , where tissue loading is initiated within the limits of pain , to accelerate capillary in-growth , and to promote regeneration of the soft tissue . 16

Immediately after the inflammatory phase , mobilisation occurs 3-7 days postinjury to reduce the risk of poor organisation of regenerating myofibres and atrophy of healthy tissue adjacent

17 , 18

to the injured area . Early mobilisation should be started gradually with range-of-motion exercises , progressing to isotonic exercises , with clinical judgement essential to minimise the risk of further injury . 17

Splinting / crutches Splinting , crutches or frames may be used in the initial inflammatory and reparative stages to protect the injured muscle and to prevent falls . Gait aids are recommended if weight-bearing is painful , as they assist in optimal loading and range of motion of the affected soft tissues and reduce the development of a limp . 19 Once pain subsides , normal weight-bearing and walking gait should resume as soon as possible .

Stretching Stretching has long been recommended post-injury , particularly during the reparative and maturation phases , where stretching is thought to increase the extensibility of scar tissue and flexibility and aid with alignment of collagen . 6

However , expert opinion is divided due to poor quality research and mixed results .

The two main types of stretching are : dynamic stretching , where the joint and muscles are actively stretched through the full range of motion ( often repeatedly ); and static stretching , where the muscles are lengthened and held at the end point for a specific duration .

During the early stages of healing , basic pathophysiology dictates that stretching musculotendinous units to their limit is likely to induce re-injury and should be avoided .

Once the individual has reached the maturation / remodelling stage , dynamic stretching may be commenced as indicated and be included pre-exercise . It should be noted that prolonged stretching does not reduce risk of injury , and often does not reduce recovery times for activities with a high level of overuse injuries . 20-22

Medications Pain and swelling are mediated by the inflammatory process and as a result , pain is maximal during the inflammatory phase , then declining rapidly thereafter . 23

Traditionally , NSAIDs are the first-line treatment , due to their analgesic and anti-inflammatory effects . However , their use has been questioned because of potential interruption of the inflammatory cascade , which

23 , 24

is vital to healing .

Despite the paucity of evidence to support these claims , NSAIDs should be used judiciously due to their well-publicised side-effect profile . 24

CPD POINTS

Facilitated by a practising GP , in this seminar you ’ ll hear from leading obesity experts , endocrinologists and cardiologists about evidence-based strategies for preventing and managing cardio-metabolic disease in primary care .

ACCREDITED BY SUPPORTED BY AN INDEPENDENT EDUCATION SPONSORSHIP

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