Citation

Guillodo Y, Saraux A. Ann. Phys. Rehabil. Med. 2009; 52(3): 246-255.

Affiliation

Service de rhumatologie, CHU de la Cavale-Blanche, 29609 Brest cedex, France; Cabinet de medecine du sport du Questel, ZA du Questel, 29200 Brest, France.

Copyright

(Copyright © 2009, Elsevier Publishing)

DOI

10.1016/j.rehab.2008.12.014

PMID

19410532

Abstract

OBJECTIVE: Muscle trauma mainly results from sporting activities and accounts for 10 to 55% of sports injuries. However, information on optimal muscle trauma management is scarce. The present study sought to assess the initial treatment of muscle injury in sportspeople, evaluate rehabilitation programs and observe the impact on healing. METHODS: We included consecutive patients consulting for severe muscle pain with a physician at the Questel Sports Medicine Surgery in the city of Brest (western France). The study examined the circumstances of the injury, possible antecedents and the initial treatment (with the RICE protocol). After clinical and ultrasound examinations, each patient was referred to the physiotherapist of his/her choice with an identical recovery program (muscle strengthening exercises, cycling on an exercise bike and guidance on resuming sport). The patient was subsequently interviewed by phone at two time points: four months after the injury, to ascertain the date of resumption of gentle sporting activity (e.g., jogging) or return to the pre-injury sporting level (i.e., full recovery) and to establish whether the patient and the physiotherapist had respectively complied with the prescribed treatment and 15 months after the injury, to investigate any re-injury and/or any other muscle injuries. The patients were classified into two groups: those who were able to resume full sporting activity within 40 days (minor muscle injuries: Group 1) and those who were also able to resume full sporting activity but only after more than 40 days (major muscle injuries: Group 2). We, then, compared the two groups in order to identify factors potentially related to recovery. RESULTS: Ninety-five cases were included in the study; this corresponded to 93 patients, two of whom had two different injuries each. The RICE protocol: sport was immediately discontinued in 90 cases and shortly afterwards in five cases. Ice was applied in 57 cases (60%) and compression was applied in 17 cases (17.8%). There were 34 patients (35.8%) in Group 1, with an average return to gentle sporting activity (jogging) on day 11 post-injury and full resumption of their sport on day 23. There were 61 cases (64.2%) in Group 2, with an average return to jogging on day 39 and full resumption of their sport on day 69. Compliance with the prescription: rehabilitation was performed in only 62 cases (64.5%), with no major difference between the two groups. In terms of the physiotherapist's compliance with the prescription, 40 of the 62 patients did some weight training, 29 performed cycling and 58 were given advice on the resumption of sporting activity. Resumption of sport: in both groups, the duration of incapacity did not depend on whether rehabilitation had been performed or not. The second phone interview yielded a total of 84 replies (88%): seven patients (8%) had suffered re-injury in the same muscle group (no difference between Groups 1 and 2) and 22 patients (26%) had incurred injuries in another muscle group. CONCLUSION: The RICE protocol might give better results if compression were to be used more extensively. In terms of rehabilitation, therapeutic compliance is rather weak and physiotherapists do not fully comply with physician's prescription. However, for both minor and major injuries, rehabilitation (to the extent that it was implemented by the physiotherapists in the present study) did not lead to quicker recovery.

Language: en