Tune up the brakes – Optimise the muscle
(Dr. med. Andreas Krüger @polotimes.co.uk) Polodoc Medical Insight September 2017
Stopping the horse and keeping the position in the saddle while changing direction can create extreme tension to the thigh musculature. This peak tension can damage a cold or not prepared muscle. A strain, muscle pull, or even a muscle tear refers to damage to a muscle or its attaching tendons. You can put undue pressure on muscles during normal riding, normal daily activities, with sudden heavy lifting, during sports, or while performing work tasks.
Muscle damage can be in the form of tearing (part or all) of the muscle bres and the tendons attached to the muscle. The tearing of the muscle can also damage small blood vessels, causing local bleeding, or bruising and pain caused by irritation of the nerve endings in the area. Typical injury happens when the player is not warmed up and pre-riding stretching was left out, in particular, the half seat and braking, needs maximum contraction of the adductor muscles.
Symptoms of muscle strain
Swelling, bruising, or redness due to the injury
Pain at rest
Pain when the speci c muscle or the joint in relation to that muscle is used
Weakness of the muscle or tendons
Inability to use the muscle at all
In most of the cases, the injury history, the injury pattern and clinical examination help to de ne the diagnosis.
First line treatment
Protect the strained muscle from further injury and rest the strained muscle. Avoid the activities which caused the strain and other painful activities. Ice the muscle area (20 minutes every hour while awake). Ice is a very effective anti-in ammatory and pain- reliever. Small ice packs, such as packages of frozen vegetables or water frozen in foam coffee cups, applied to the area may help decrease in ammation. Compression can be gently applied with an Ace or other elastic bandage, which can both provide support and decrease swelling. Do not wrap tightly and elevate the injured area to decrease swelling, propping up a strained leg muscle while sitting, for example. Activities that increase muscle pain or work the affected body part are not recommended until the pain has signi cantly improved.
The most important key to treatment is the early diagnostic proof of a working diagnosis from clinical examination. Ultrasound is the best form of examination where the exact point of maximum pain can be detected, while the MRI (Magnetic Resonance Imaging) is most precise in de ning the extent of injury in a standardised fashion. Following this a computer tomography guided in ltration can deliver painkillers (Ketorolac) directly to the spot of the lesion with additional PRP (Platet-riched Plasma - ACP or Hyaloron Tendon) for accelerated healing. After treatment, physical workouts should be limited the frst 48 hours. A physiotherapeutic workout should consist of an eccentric training with local analgesic treatment (Ultrasound, TENS). The new Compex® SP 8.0 treatment programmes can alleviate pain, measuring the individual impulse needed to optimally stimulate the muscle. At the same time, muscle training should also be undertaken. Beyond this manual treatment, auxiliary local compression with thigh sleeves may also reduce the symptoms.
Return to play
The intervals between injury and a return to sport are different for each individual. After a minimum of three weeks recovery, pain free normal gait and a less than few seconds squeeze test are mandatory perquisites to go back in the saddle. In the worst cases of muscle injury, even longer periods are recommended.
Most muscle injuries are due to a neglected preparation timetable for the maximum load and strain on the tissue. Also, repetitive micro injuries can lead to chronic impairment. Elasticity of the muscle is key, so adequate stretching before and after the game is crucial. Optimal preparation with additional workout through electrical stimulation may also be helpful.
When to see your doctor
Hematoma in the region of pain
Palpable cavity in the muscle
Ongoing pain for more than one week
Rule out symphysis injury
For more information contact Dr. med. Andreas Krüger