GRADE II MUSCLE INJURIES TREATMENT IN ACUTE WITH CRYO MAG:

A PILOT STUDY

40° Congresso Nazionale SIMFER e 9th Mediterranean Congress of PRM

                                                                                 

Bellomo R.G., Panelli E., Di Stefano A., Di Pancrazio L., Santini S., Saggini R. School of Specialities in PRM, “G. D’Annunzio” University, Chieti – Pescara

Italy

Acute muscle injuries are commonly observed in many different sports and their incidence is between 10 and 30%

1

.

It was found an incidence of 30% in professional football players where the injury occurs often on quadriceps and hamstring muscles3.

Properties required in sports for muscular tissue are strength, endurance, responsiveness, speed, and flexibility; they’re often obtained with intense workout at the limit of muscles elastic resistance. 90% of injuries in sports is made up of muscle injuries2.

1 Costantino C., Imperio G. Recupero precoce nelle lesioni muscolari acute degli sportivi: nostra esperienza Eur + Phys 2006;42(Suppl. 1 To No. 2):779-82 2 Crisco Jj, Jokl P, Heinen Gt. Et Al. A Muscle Contusion Injury Model. Biomechanics, Physiology, and Histology. Am J Sports Med 1994;22(5):702-10 3 Volpi P, Melegati G, Tornese D, Bandi M. Muscle strains in soccer: A five-years survey of an italian major league team. Knee Surg Sports Traumatol Artrosc 2004;12(5):482-5. Epub 2004 Mar 31.

Muscle injuries can be divided into - direct trauma injuries - indirect trauma injuries. Indirect injuries are classified, according to the American Medical Association, in: - elongations - 1st, 2nd, and 3rd grade muscle strain

depending on: • amount of muscle fibers involved • extent of injury • condition of the surrounding connective tissue and

vascular structures.

PREDISPOSING FACTORS

• Lifestyle • Poor coordination within and between muscle and postural

imbalances; • Asymmetries and imbalances between the extensor and

flexor muscles; • Poor joint mobility and muscle flexibility; • Inadequate heating; • Incorrect diet; • Changes in the pattern of performance (> game speed); (Ekstrand1983, Heidt 2000, Junge 2002, Tropp1985, Surve1994, Södermann2000, Caraffa1996,

Hewett1999, Askling2003, Mandelbaum 2005, Arnason2007, Gilchrist2008, Soligard2008)

The healing of the lesion occurs with replacement of the destroyed tissue through two stages: lesion contraction and loss of substance mechanical reduction. Tissue replacement occurs with cells migration (repair) or division of adjacent cells (regeneration) with production of granulation tissue which evolves in a scar.

Phases Time

Acute phase 0-24 h

Regeneration and repair 48 h- 7/20gg

Remodeling and maturation 7/20ggà120gg

Restitutio ad integrum

The healing process is hindered by the hematoma at the site of lesion

à reduce pain and local edema,à improve the capillary and lymphatic microcirculation à exert a hemostatic action and colliquative to remove the necrotic material.

So it is necessary:

- Limit the consequences of the damage on the involved tissues; - Prevent future damage; - Return to competition as quickly as possible in accordance with the biological healing time.These three points are closely related one to each other and dependent on the treatment administered at an early stage (24-48 hours).

The REHABILITATION TREATMENT AIMS TO ....

Protection Rest Ice Compression Elevation Stabilization

Cryotherapy in the first 24-48 hours can reduce:- Spasm- Pain - Blood extravasation - Lesion extension

Effects: - Anti-inflammatory - Anti-edema for systemic vasoconstriction

MUSCLE INJURY TREATMENT – EARLY STAGE

RICE

Knight KL. Cryotherapy in Sport Injury Management. Champaign, IL: Human Kinetics; 1995. Merrick MA, Knight KL, Ingersoll CD, Potteiger JA. The effects of ice and compression wraps on intramuscular temperatures at various depths. J Athl Train. 1993;28(3):236–245. TTomchuk D, Rubley MD, Holcomb WR, Guadagnoli M, Tarno JM. J Athl Train. The magnitude of tissue cooling during cryotherapy with varied types of compression. 2010 May-Jun;45(3):230-7.

MUSCLE INJURY TREATMENT – LATER STAGESAfter the first 48-72 hours, it can be established exactly the extent of the lesion (with an ultrasound examination and / or by RMN) to program the recovery phase during the healing process.

à physical therapy to stimulate cell metabolism and tissue regeneration à progressive return to sports through specific programs for functional recovery

US is the first-line technique in the study of muscle traumas, as it is readily available, has a good cost-benefit profile, enables assessment of muscle dynamics and provides reliable assessment of the extent of damage.

MAGNETOTHERAPY

The Magnetic field creates an increase in the peripheral blood flow, leading to better cellular oxygenation, producing anti-inflammation and anti-edema action. Magnetotherapy makes a regenerating bone cells and it is extremely effective for the fixation of calcium by mechanical action called "piezoelectric effect”.

The therapeutic effect is then due the action of metabolic stimulation of the circle and structures with poor metabolism

Faustov LA, Nedel'ko NA, Morozova MV. Pathomorphology of regenerative processes in mandibular fracture after sodium succinate treatment and laser magnetotherapy in an experimental setting. 2001;80(6):8-11.

Aim of our study was to assess the ability of Cryo Mag applicators in

reducing time recovery in athletes with grade 2 muscle injuries.

AIM OF THE STUDY

CRYO MAG allows to use synergically

CRYOTHERAPY MAGNETO-THERAPY COMPRESSION

• Cryotherapy reduces spasm and pain, induces local vasoconstriction w i t h f i b r i n c o n t r a c t i o n a n d extravasation reduction, reducing the extent of the lesion, it also exerts antiphlogistic and anti-edema effect by systemic vasoconstrictive action.

•C o m p r e s s i o n p r e v e n t s t h e expansion of hematoma and edema. • Magnetotherapy induces an increase in the peripheral blood flow, w h i c h l e a d s t o b e t t e r c e l l oxygenation, with anti-edema and anti-inflammatory action.

The treatment protocol was performed on 5 male soccer players aged between 18 and 34 years (mean age 25 years) with grade 2 muscle injury. INCLUSION CRITERIA • minimum age of 18 • II grade muscle injury EXCLUSION CRITERIA • pregnancy • metal implants • pacemaker • metal valves • cancer

MATHERIALS AND METHODS

All athletes were treated with 10 daily sessions with Cryo Mag with the following protocol: •160 Gauss magnetic field strength; • frequency up to 50 Hz; • ice for 20 minutes; • 10 minutes of compression alternating with 5 minutes decompression for a total duration of 60 minutes.

MATHERIALS AND METHODS

We also assessed: • pain level (with VAS); • functional impairment (active and passive goniometric ROM); • muscle strength (MRC)

In all patients ultrasound examination was performed at the beginning and after 14 days.

MATHERIALS AND METHODS

Medical Research Council scale

0 No contraction

1 Flicker or trace contraction

2 Active movement, with gravity eliminated

3 Active movement against gravity

4 Active movement against gravity and

RESULTS

II grade muscle strain at the myofascial junction of the biceps femoris

T0

RESULTS

After 14 days and 10 CRYO MAG sessions we can see the coplete healing of the lesion with recovery of the cytoskeleton with just few edema

T1

RESULTS

Significant pain reduction (mean VAS T0= 7 – mean VAS T1= 1 )

RESULTSIncrease in active and passive ROM of ankle and knee without pain

Increase in muscle strength as noted in tests for strength (MRC T0= 4 + - MRC T1= 5)

RESULTS

The analysis of the results obtained with the visual analogue scale of pain before and after the treatment, showed a statistically significant change (p<0,05). Ultrasound monitoring showed complete resolution of the effusion with a 'good tissue repair without fibrotic phenomena with just few edema. The return to sports in athletes and 'took place with complete recovery of the ROM, and muscle strength in an average time of 27 days.

DISCUSSION

Cryo Mag therapy can take advantage of the positive effects of cryotherapy, compression and magnetic therapy in

muscle recovery after injury and proved to be an excellent therapeutic tool in

terms of effectiveness, easy of use and resolution of pain.

CONCLUSIONS