Maximizing healing of muscle injury using mechanical loading: a clinical perspective

ECSS Prague 2019
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23rd annual ECSS Congress Dublin/Ireland, July 4-7 2018
Maximizing healing of muscle injury using mechanical loading: a clinical perspective
Author: Glasgow, P.
Ulster University
Abstract:
Rehabilitation is a dynamic continuum during which the nature and difficulty of exercises are progressed in response to tissue healing and the functional abilities of the athlete. Pain is the most commonly used clinical outcome measure to progress rehabilitation. The level of discomfort tolerated during rehabilitation should be guided by the rationale for the specific exercise. For example, where the primary goal of the exercise is tissue loading some discomfort may be acceptable. In contrast, where the focus is on restoring movement quality it is more appropriate that for exercises to be painfree. A number of key questions assist in optimising load during rehabilitation. What is happening at a tissue level? What outcomes are you trying to achieve? And, what is the specific adaptation associated with different exercise types?
Muscle tissue is highly sensitive and adaptable to mechanical loading. Following injury, muscle undergoes a number of changes in architecture and function as a direct consequence of tissue insult and as an indirect consequence of reduced loading and recruitment. Architectural characteristics of muscle are related to a range of performance variables. Muscle force is proportional to PSCA, while muscle velocity is proportional to muscle fibre length. Following injury there are reductions in fascicle length and physiological cross-sectional area (PSCA) as well as alterations in neuromuscular activation). Rehabilitation should therefore focus on restoring muscle structure.
Key goals during the acute stage are to limit the size of the haematoma and scar formation as well as facilitating re-capillarisation and neuronal resprouting. Early loading should be viewed as a way of enhancing stimulus for regeneration. There is good evidence from animal studies that progressive early loading of muscle results in enhanced histological and mechanical outcomes.
Eccentric exercise has become the primary mechanism by which these adaptations are achieved. Low-level, controlled eccentric exercises performed early in rehabilitation have the potential to reduce pain inhibition and facilitate tissue adaptation. These should then be progressed in line with healing and adaptation.
Restoration of neuromuscular deficits is also important. Prolonged deficits in NMC following muscle injury may have a role to play in recurrence. Reduced activation of previously injured muscle may further compound architecture components as well as limit function.
Early inclusion of simple dynamic recruitment of muscles throughout range during functional movements often help to restore pain free range of motion and normalise pain. Sport-specific function is further developed through progressive neuromuscular rehabilitation aimed at improving the central nervous system’s ability to fine tune muscle coordination and improve the skill execution.

[@ANDREWGEN_]

Brilliant stuff. I’m a personal trainer for primarily seniors. I see all kinds of replacements, chronics musculoskeletal pathologies and , soft tissue pain.
What you said about neuromuscular changes occurring after injury is so incredibly true. Sometimes strength isn’t lost as much as we think, but rather the ability to fully trust activation and acceptance of load.
Great Leecture!!

[@mutleyb]

Thanks very much for this. Really useful.

[@Ariel-oo1nc]

I don't know much about this subject, but this was a fantastic talk. Thank you for sharing ECSS! You've got some great content.