Lesions Musculaires Sion 2010

Dr P.-E.
Fournier Centre Thermal - Yverdon-les-Bains
Performance Characteristics According to Playing Position in Elite Soccer
5696 to 13746 m covered

Positional role Independent of position Central defender External defender Central midfield External midfield Forward Mean distance covered (m) 11393 10627 11410 12027 11990 11254 S 1016 893 708 625 776 894
More distance covered at the lowest work intensity during the 2nd half No difference > 19 km/h
Di Salvo et al. Int J Sports Med 2007; 28: 222-227
17.3 7.7 (range 3-40) bursts of high intensity activity (>23km/h)
19.3 3.2 meters (range 9.9 32.5) External defenders (20 7.0), external midfield (22.0 6.7), forward (20.7 6.9) significantly more burst of high internsity than central defender (11.2 5.2) and central midfield (13.7 6.2)

Total distance covered in possession of the ball
Positional role Central defender Distance covered (m) 11967 % 1.20.6
External defender
Central midfield External midfield Forward
22099
23092 286114 21292
1.90.9
1.90.8 2.41.1 1.90.8
No difference between 1st and 2nd half except for forward
Injury Incidence and Injury Pattern in Professional Football The UEFA Injury Study
23 teams belonging to the 50 best European teams 2001-2008, 5 clubs trough all 7 seasons
34 matches and 162 training sessions each season
254 hours (213 training, 41 match hours)

4483 injuries during 566 000 hours of exposure 8.0 injuries / 1000 hours 27.5 /1000 hours matches 4.1 / 1000 hours training
Ekstrand et al. Br J Sport Med 2009
INJURY
THIGH STRAINS
%
17 % (12 % HAMSTRINGS) ( 5 % QUADRICEPS)
ADDUCTOR PAIN/STRAIN
ANKLE SPRAIN MCL INJURIES
9%
7% 5%
UEFA Champions Leage Study: A Prospective Study of Injuries in Professional Football During The 2001-2002 Season
11 teams, 7 countries
Arsenal, Manchester U, Paris St Germain, St Rennais, Lens, AC Milan, Juventus, Inter Milan, Eindhoven, Real Madrid, Ajax
69 707 hours of exposure (58 149 training, 11 558 match) Highest number of match played by one player : 69
30.5 injuries / 1000 hours Match, 5.8 / 1000 hours Training

148 players in national teams
Tendency of lower incidence in training
No difference in match play Walden et al. Br J Sports Med 2005; 39: 542-546
The Association Football Medical Research Programme: An Audit of Injuries In Professional Football

91 clubs 6030 injuries (2 seasons) 1.3 injuries/player
34 % training, 63 % competition
24.2 days absent of training, 4 missed games 78 % of injured at least one match missed Reinjury 25.1 vs 19.1 missed days
Hawkins et al. Br J Sports Med 2001; 35: 43-47
The Association Football Medical Research Programme: An Audit of Injuries In Professional Football
Final 15 min first half, last 30 min. second half More injuries in the first month of competition 50 % dominant side versus 37 % 38 % contact with another player or the ball
Hawkins et al. Br J Sports Med 2001; 35: 43-47
10 % of the squad unable to train Financial loss due to injury (season 1999-2000) ~ 74.7 million (747 million wages and salaries)
+ medical fees, increased insurance premiums first choices players unable to play : reduced club income reduced match attendance, diminished price money, lower league position
Woods et al. Br J Sports Med 2002; 36: 436-441
STRAIN
MUSCLE INJURIES
CONTUSION
LACERATION
Risk Factors For Injuries In Football
8.4 injuries / 1000 player hours during matches
0.8 injuries / 1000 player hours during training
Arnason et al. Am J Sports Med 2004; 32: 5s-16s
LOCALISATION OF MOST COMMON MUSCLES INJURIES

HAMSTRING
QUADRICEPS CALF
BICEPS FEMORIS
RECTUS FEMORIS MEDIAL HEAD GASTROCNEMIUS DISTAL MUSCLE-TENDON JUNCTION OR MIDBELLY OF THE MUSCLE ADDUCTOR LONGUS
ADDUCTORS
5-6 Hamstring injuries/club/season 12 16 % all injuries 18 days, 3 3.5 matches missed /hamstring strain 90 days, 15 21 matches missed /club 3.0 4.1 injury /1000 h of match play 0.4 0.5 injury /1000 h of training
Petersen et al. Br J Sports Med 2005, Arnason et al. Am J Sports Med 2004 Woods et al Br J Sports Med 2004
Risk Factors For Hamstring Injuries
Previous hamstring strain

Arnason et al. Am J Sports Med 2004; 32: 5s-16s
Hamstring flexibility
Witvrouw et al. Am J Sports Med 2003; 31: 41-46
Muscle imbalance
Croisier et al. Am J Sports Med 2008; 36: 1469-1475
Older, more powerful, less flexible

Henderson et al. J Sci Med Sport 2010; 13: 397-402
No single risk factor

Foreman et al. Phys Ther Sport 2006;7: 101-109
DANCERS
SPRINTERS
Dancers : Slow-speed stretch (sagittal split)

Sprinters : High speed
Askling et al. Am J Sports Med 2007; 35: 1716-1724 -- Am J Sports Med 2007; 35: 197206 -- Br J Sports Med 2006; 40: 40-44 -- Scand J Med Sci Sports 2000; 10: 304-307
DANCERS
SPRINTERS
Dancers :

Proximal lesions ~ 2cm ischial tuberosity 87 % semimembranous Seldom restricted to 1 muscle-tendon complex Slow-speed stretch (sagittal split) No correlation IRM and time to return Mean time to return 50 weeks
DANCERS
SPRINTERS
Sprinters :

Lesions ~ 12cm ischial tuberosity 18/18 long head of biceps 44 % lesion of another muscle-tendon complex (
tendinosous)
Proximal tendon injured, or more proximal lesion -> longer time back to sport Mean time to return 16 weeks
Neuromusculoskeletal Models Provide Insights Into The Mechanism And Rehabilitation of Hamstring Strains

Whole body kinematics collected in 14 subjects Sprint on a high-speed treadmill, 80-100 % of their maximum speed
Thelen et al. Exerc Sport Sci Rev 2006; 34: 135-141
End of swing phase ecc con

Magnitude of peak stretch significantly greater for biceps femoris long head than semimembranosus ou semitendinosus
Peak stretch independant of speed Negative musculotendon work increased with speed Influence of controlateral hip flexors, and of other muscles acting on pelvis (abdominal obliques, erector spinae) on hamstring stretch
The Effect of Sport Specific Training on Reducing The Incidence of Hamstring Injuries In Professional Australian Rules Football Players
Verrall et al. Br J Sports Med 2005; 39: 363-368
MYOFIBERS
MUSCLE
CONNECTIVE TISSUE
Muscle injuries: Biology and treatment. Jrvinen et al. Am J Sports Med 2005; 33: 745-764
Bone heals by a regeneration process healing tissue identical to preexisting tissue Most of the other tissues in the body including muscle heal with a scar
Hematoma
Regeneration zone
Huard et al. J Bone J Surg [Am] 2002; 84: 822-832
Each myofiber contains of molecules called dystrophin, which contractile myofilament through the sarcolemma
specific chains integrins and connect the to the ECM
The majority of integrin are located at the myotendinous junction
MOBILISATION
Restoration of vascular supply is the first sign of regeneration

Young myotube have an increased anaerobic metabolism, during final stages of regeneration aerobic metabolism constitute the principal pathway
IMMOBILISATION
In mobilized muscle intensive ingrowth of new capillaries
Stages
Pain
Reversible Limited lesion No more reversible, some muscle ff., connective tissue not injured No more reversible, some muscle ff., connective tissue not injured No more reversible, numerous muscle ff. injured, connective tissue injured HEMATOMA Moderate
Clinical Ex.
Contracture
Strength
() ()
Recovery
Hours
0 1
(+)
Contracture
Days
+ +
Sports activity no more possible
Contracture
10 15 Days
Contracture Tumefaction
4-12 weeks
+ 4
Partial or total rupture scattered hematoma Sports activity no more possible gap ?
Rodineau J. in Muscle traumatique et mcanique. Masson 2005
Avulsion Fracture
No false negativ
Overestimation
A Comparison Between Clinical Assessment And Magnetic Resonance Imaging of Acute Hamstring Injuries
58 players, Hamstring injury (team physician) within 3 days MRI and clinical evaluation by an independant physiotherapist
MRI
Muscle(s) involved, site of injury within the muscle, injured area, injured length, intra-, intermuscular hemorrhage
Clinical assessement
Passive straight leg raise, active knee extension, manual testing,
active slump
Schneider-Kolsky et al. Am J Sports Med 2006; 34: 1008-1015
A Comparison Between Clinical Assessment And Magnetic Resonance Imaging of Acute Hamstring Injuries
Diagnosis

65.5 % in accordance
31 % clinical assessment +, IRM 3.5 % (2 cases) clinical assessement -, IRM +
Time until return to competition
Significative positive correlation, better for clinical assessment, particularly for minor lesions
Schneider-Kolsky et al. Am J Sports Med 2006; 34: 1008-1015
lack of firm scientific basis
Recommended but.. No randomized study to prove effectivness of RICE
More rapid and intensive capillary ingrowth Better regeneration of muscle fibers Parallelel orientation of regenerating myofiber Less muscle atrophy
More rapid restoration of biomecanical properties

Jrvinen 2005, Ziltener 2006
Immediate mobilisation could be deleterious Larger connective tissue scar Penetration of muscles fibers through the scar impaired Delayed restoration of mecanical strength (Risk of re-rupture increased)
Short relative immobilisation D 0 D 2-3 5 Rest period allows the scar to gain the strength to withstand the contraction-induced forces applied on it without a rerupture
Relative immobilisation (Tape, cast, ) Crutches Carefull mobilisation Days 3 5 (7)
Jrvinen 2005, Ziltener 2006
Painfree Contractions against weak load, concentric work
Decreasing resistance for one exercise, increasing from one

session to the other Contractions speed initially rapid concentric then slow to
rapid with eccentric work
Pliometry
Ziltener 2006
Phase 2 : J4-J10
Arrt temporaire activit physique Bandage et contention Cryothrapie pluriquotidienne Drainage lymphatique
Phase 3 : J10-J21
Antalgie Bandage et contention Cryothrapie pluriquotidienne Drainage lymphatique
Phase 4 : > 21 jours

Antalgie+cicatrisation+ lutte contre fibroblastie Bandage : sevrage Cryothrapie aprs sances Drainage lymphatique (si ncessaire)
lectrothrapie
Fonction musculaire (cannes, travail actif sans rsistance)
tirements progressifs
Fonction musculaire (travail actif avec rsistance manuelle)
tirements isomtriques
Fonction musculaire renforcement, rentranement leffort
Chanussot et al. Rducation en traumatologie du Sport, Masson 2003
ANALGESICS ?
Mehallo et al. Clin J Sport Med 2006 Fournier et al. Rev Med suisse 2008 Ziltener et al. Ann Phys Rehabil Med. 2010
US O2 hyperbaric Inhibitors of fibrous scar formation (Decorin, Suramin) Gene therapy Stem Cells Growth factors
Growth Factor Delivery Methods In The Management of Sports Injuries : The State of The Play
Platelet Rich Plasma Autologous Blood Injection Autologous Conditioned Serum
Platelet-derived growth factor, Vascular endothelial growth factor, Tranforming growth factor beta-1, Epidermal growth factor, Basic fibroblast growth factor, Insulin-like growth factor-1, Hepatocyte growth factor
Creaney et al. Br J Sports Med. 2008;42(5):314-20
Growth Factor Delivery Methods In The Management of Sports Injuries : The State of The Play
Short half-life Quick sytemic lavage Effects mostly confined to site of delivery
Muscle injuries and PRP: what does the science say ?

Harmon Br J Sports Med 2010; 44: 616-617
Platelet-rich plasma: any substance into it ?

Mei-Dan et al. Br J Sports Med 2010; 44: 616-617
Sawn muscle knackered muscle outdated Banks suture, drain hematoma and necrotic material Microsurgery (less scar tissue)
Stage 4
Persistence of hematoma, cyst Seroma Myositis ossificans Hypertrophic scar
SECURITY PRECISE
REINJURY
GUIDE LINES NOT DESCRIBED
Labareyre et al. J Traumatol Sport 2005 22; 232-235
12.1 % recurrence the first week of return to sport
30.6 % cummulative risk for reinjury in the 22
week-season
Initial Evaluation imprecise delays
Roughly :
muscle strain 3 weeks

torn muscle 6 weeks
From 2 (4) weeks on field
60 %
Progression each 2-4 days if :
No pain at rest, at 60 %, no pain when stretching, when isometric contraction or at palpation No palpable mass
Echography
doesnt give any information on scar strength for follow up particurlaly if delayed evolution delay between clinical evolution and MRI appearance
Useful
MRI
Lower Reinjury Rate With a Coach-controlled Rehabilitation Program In Amateur Male Soccer a Randomized Controlled Trial
Information about risk factors for reinjury Rehabilitation principles 10-steps progressive rehabilitation programm including return to play criteria
Hgglund et al. Am J Sports Med : 2007; 35: 1433-1442
Program introduced when walking was possible without pain and limping Gradually increasing load
Next step when exercises possible without pain or swelling

at the injured site If pain return to pain free step 1 to 6 without ball Then skill training with ball Slow pace then increasing speed
Reinjury 2.3 / 1000 hours (intervention group) 8 / 1000 hours (control group)
66 %
85 % lower limb injuries
Prevention of Hamstring Strains In Elite Soccer: An Intervention Study
Iceland 17, 15, 16, 10 teams for 1999 to 2002 Norway : 14 teams for 2001 and 2002 Hamstring injuries recorded (contact injuries excluded) Clinical assessment (MRI not required)
Arnason et al. Scand J Med Sci Sports. 2008;18(1):40-8
All teams both countries
Before sprinting or shooting before every training or game

After training 3x / week preseason
1-2 times during the competitive season
5 week introductory period, load gradually increased
3 sets of 12, 10 and 8 repetition 3 x / week preseason, 1-2 during competitive period
I I I W, F, S W,F W,S W,S Incidence, Warm-up, Flexibility, Strength

Human Hamstring Muscle Adapt To Eccentric Exercise By Changing Optimum Length
10 Subjects Eccentric hamstring exercise :

12 sets of 6 repetitions 10 between repetition 2-3 minutes between sets
Isokinetic evaluation
Brockett et al. Med Sci Sports Exerc 2001; 33: 783-790
Human Hamstring Muscle Adapt To Eccentric Exercise By Changing Optimum Length
Brockett et al. Med Sci Sports Exerc 2001; 33: 783-790
Consquences et Prdiction des Lsions Musculaires des Ischiojambiers Partir de Paramtres Isocintiques Concentriques et Excentriques du Joueur de Football Professionnel

28 players (11 players with Hamstrings injury history) Isokinetic evaluation 60/sec (Quad, Hamstring Conc, Ecc) Ratio Qconc/Hcon, Hconc/Hconc, Hecc/Hecc, Hecc/Qconc
No predictive value of new muscle injury Ratio Hecc/Qconc < 0.6 highly suggestive of old Hamstring injury (77.5%)
Dauty et al. Ann Radapt Med Phys 2003; 46: 601-606
Strength Imbalance and Prevention of Hamstring Injury in Professional Soccer Players
462 players with complete follow up from Belgian, Brazilian

and French professional teams
Isokinetic evaluation (60/sec and 240/sec

30/sec 120/sec Hamstring ecc)
Quad, Hamstring Conc, Ecc,
Preseason cutoffs :

bilateral difference > 15 % (conc and/or ecc Hamstrings) concentric ratio < 0.47 Cybex, 0.45 Biodex Mixed ratio (H ecc 30sec/ Q conc 240/sec) < 0.8 Cybex, 0.89 Biodex
Strength Imbalance and Prevention of Hamstring Injury in Professional Soccer Players

Lesions Musculaires Sion 2010

Încărcat de

Informații document

Descriere originală:

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Lesions Musculaires Sion 2010

Încărcat de

Drepturi de autor:

Formate disponibile

Dr P.-E.

Fournier Centre Thermal - Yverdon-les-Bains

Performance Characteristics According to Playing Position in Elite Soccer

5696 to 13746 m covered

Di Salvo et al. Int J Sports Med 2007; 28: 222-227

Performance Characteristics According to Playing Position in Elite Soccer

17.3 7.7 (range 3-40) bursts of high intensity activity (>23km/h)

Di Salvo et al. Int J Sports Med 2007; 28: 222-227

Performance Characteristics According to Playing Position in Elite Soccer

No difference between 1st and 2nd half except for forward

Di Salvo et al. Int J Sports Med 2007; 28: 222-227

254 hours (213 training, 41 match hours)

Ekstrand et al. Br J Sport Med 2009

Ekstrand et al. Br J Sport Med 2009

30.5 injuries / 1000 hours Match, 5.8 / 1000 hours Training

Tendency of lower incidence in training

91 clubs 6030 injuries (2 seasons) 1.3 injuries/player

Hawkins et al. Br J Sports Med 2001; 35: 43-47

Risk Factors For Injuries In Football

8.4 injuries / 1000 player hours during matches

0.8 injuries / 1000 player hours during training

Arnason et al. Am J Sports Med 2004; 32: 5s-16s

LOCALISATION OF MOST COMMON MUSCLES INJURIES

Risk Factors For Hamstring Injuries

Previous hamstring strain

Older, more powerful, less flexible

No single risk factor

Dancers : Slow-speed stretch (sagittal split)

Thelen et al. Exerc Sport Sci Rev 2006; 34: 135-141

End of swing phase ecc con

Thelen et al. Exerc Sport Sci Rev 2006; 34: 135-141

Verrall et al. Br J Sports Med 2005; 39: 363-368

Huard et al. J Bone J Surg [Am] 2002; 84: 822-832

specific chains integrins and connect the to the ECM

The majority of integrin are located at the myotendinous junction

Restoration of vascular supply is the first sign of regeneration

In mobilized muscle intensive ingrowth of new capillaries

Rodineau J. in Muscle traumatique et mcanique. Masson 2005

Rodineau J. in Muscle traumatique et mcanique. Masson 2005

Rodineau J. in Muscle traumatique et mcanique. Masson 2005

Rodineau J. in Muscle traumatique et mcanique. Masson 2005

Passive straight leg raise, active knee extension, manual testing,

Schneider-Kolsky et al. Am J Sports Med 2006; 34: 1008-1015

Time until return to competition

lack of firm scientific basis

Recommended but.. No randomized study to prove effectivness of RICE

More rapid restoration of biomecanical properties

Relative immobilisation (Tape, cast, ) Crutches Carefull mobilisation Days 3 5 (7)

Jrvinen 2005, Ziltener 2006

Painfree Contractions against weak load, concentric work

Decreasing resistance for one exercise, increasing from one

rapid with eccentric work

Phase 4 : > 21 jours

Chanussot et al. Rducation en traumatologie du Sport, Masson 2003

Creaney et al. Br J Sports Med. 2008;42(5):314-20

Creaney et al. Br J Sports Med. 2008;42(5):314-20

Creaney et al. Br J Sports Med. 2008;42(5):314-20

Muscle injuries and PRP: what does the science say ?

Platelet-rich plasma: any substance into it ?

Persistence of hematoma, cyst Seroma Myositis ossificans Hypertrophic scar

GUIDE LINES NOT DESCRIBED

Labareyre et al. J Traumatol Sport 2005 22; 232-235

12.1 % recurrence the first week of return to sport