Musculo-skeletal   [back to the Category]

General comments on muscular trauma and microtrauma   [read the french version]

Author :   Docteur Anne Thiescé

Cramp, stiffness and contractures are not anatomical lesions.

The clinical picture is benign, addition examinations are not necessary. Evolution is quickly favourable taking only a few days and the therapeutic measures are simple to put into practice.

Cramp is an abrupt and painful contraction, spontaneously resolvent after a few minutes, treatment lies in stretching, heat treatments and massage.

Stiffness is muscular pain occurring 12 to 24 hours after exertion. Palpation and movement, both passive and active, are painful for 5 to 7 days. The best treatments are balneotherapy, heat treatments, massage, counterirritant ointments and the continuation of a moderate activity.

Contractures are involuntary and non-resolvent contractions. Muscle palpation shows a painful, hard faiscicle. Evolution takes 5 to 10 days. The recovery process can be speeded up with cold compresses, stretching-relaxing exercises, myorelaxants applied locally or taken orally and massage.

Muscular injuries with anatomical lesions are elongations, torn muscles, ruptures and muscular disinsertions.

Serious factors can be noted during examination: syncopic pain, perception of strain, visible bruising, immediate functional disability. Isometric contraction and passive muscular stretching are painful, if not impossible. Recourse to an echographia may be necessary. It should not, however, be carried out before the 2nd or 3rd day. It will allow the diagnosis of the lesion to be made and, if necessary, a controlled puncture of the bruise to be performed. The immediate course of action is IREC: ice, rest, elevation, contention compression. Anti-inflammatories can be used as of the 4th day. Massage of the pain centre is strictly forbidden for the first 6 days.

Elongation is the 1st stage of these lesions, there is no bruising, evolution takes between 10 and 15 days. On the 3rd day, begin progressive contraction and stretching, always following the no-pain rule.

With torn muscles, 2nd stage of these lesions, there is a bruise and a serious functional disability. Evolution takes 21 days. Physiotherapy starts on the 6th day, isometric contractions and progressive stretching must not start before the 10th day. Progressive training can resume after 5 weeks.

Ruptures have syncopic pain, a bruise and sometimes a muscular incision. Evolution takes between 45 and 60 days. Immobilisation must be strict, active re-education must not start before the 15th day. Training can resume after 6 to 10 weeks.