• home
• Chronic muscle tear
• Swedish
• Deep Tissue
• Trigger Point
• Rates
• Links

What hurts so bad?

As stated in "The Lore of Running" by Tim Noakes M.D. pgs 820-22 "Chronic muscle tears (or muscle knots) are probably the most common injuries seen in elite long-distance runners. The importance of chronic muscle tears is that they are probably the third most common injury among all groups of runners (Pinshaw et al. 1983) and are especially common among elite runners; they are usually misdiagnosed; they can be very debilitating; and they will respond only to one specific form of treatment. Remarkably, this group of injuries is seldom adequately described in English-language textbooks of sports medicine. One early German textbook (Krejci and Koch 1979) included an adequate description of this injury. The injury is usually reasonably easy to recognize. The characteristic features are that the pain starts gradually, in contrast to the acute muscle tear, in which the onset of pain is sudden. At first, the pain comes on after exercise. When the pain starts to occur during exercise, it is possible at first to run through it. But the pain grows progressively worse until it becomes sufficiently severe to interfere with training, so that speedwork, in particular, becomes impossible. The pain is almost always localized to a large muscle group--either the buttock, groin, hamstring, or calf muscles. The pain is deep-seated and can be very severe but passes off rapidly with rest. Typically, there are other features suggesting that the damaged muscle has gone into protective spasm (for example, the inability to push off properly with the toes). In contrast to bone or tendon injuries, both of which improve if sufficient rest is allowed, chronic muscle tears never improve unless the correct treatment is prescribed. As a result, the patient can rest for months or even years without any improvement. Indeed, I have seen one runner who struggled for five years with a chronic muscle injury, having given up all hope that he could ever be cured. To confirm that the injury is indeed a chronic muscle tear, all the runner, or preferably, a physiotherapist need do is to press firmly with two fingers into the affected muscle in the area in which the pain is felt. If it is possible to find a tender hard "knot" in the muscle, the injury is definitely a chronic muscle tear. I cannot emphasize sufficiently just how sore these knots are--they are excruciating. Finally, because the injury occurs in muscle, it will not show up on X ray. Thus, attempting to diagnose this injury with X rays is futile. But magnetic resonance imaging may well show the abnormality. Nevertheless, such sophisticated diagnostic techniques are unnecessary as the diagnosis can be made with certainty on the vases of the history and the typical finding of one or more painful muscle knots int he affected muscle. The mechanism of injury in chronic muscle tears is currently unknown but is probably related to the same mechanism causing acute muscle injuries: namely, weekness of the affected muscles during eccentric contraction. I am impressed by the fact that the person who has recurrent chronic muscle tears will tent to tear the same muscles at the same site every time, usually when starting to do eithermore speed work or more distance training. I developed five such sites during my running career. Similarly, Bruce Fordyce suffered from chronic tears of his calf muscles virtually every March, as he began his intensive Comrades Marathon preparation. In fact, he credits his victory in the 1982 Comrades Marathon to the treatment he received fro a chronic calf muscle tear (in particular, cross-frictions that made him scream; Cameron Dow 2001) I conclude that chronic muscle tears occur in the various muscles at specific sites that, for reasons unknown, develop eccentric muscle weakness. This weakness is exposed during faster running. When the eccentric loading exceeds the muscle's eccentric strength, a small section of the muscle is strained and develops an inflammatory response, as also seen in acute muscle injuries. This initial tear is too small to cause discomfort. However, once the initial tear has occurred, a cycle of repair and reinjury and reinflammation develops that leads ultimately to the large tneder knot, probably comprising muscle fibers surrounded by inflammatory scar tissue as found in experimental muscle injuries (Nikolaou et al. 1987). While neither stretching nor strengthening exercises will cure a chronic muscle tear, appropriate stretching and strengthening exercises for the specific injured muscle may prevent recurrences of the injury. In particular, eccentric strengthening exercises are especially important in muscle injuries. Conventional treatment, including drugs and cortisone injections, is a waste of time in this injury. The only treatment that works is a physiotherapeutic maneuver known as cross-frictions, as first popularized by Cyriax (1978). A better term would be crucifictions, because nothing, not even the runner's toughest race ever, is as painful as cross-frictions applied, however gently, to a chronic muscle tear. And therein lies the key to the treatment of these injuries. A chronic muscle tear will only resolve if the cross-frictions are applied to the injury site (in this case the tender knot in the muscle) and applied with the correct pressure. Most chronic muscle tears respond rapidly to a few sessions of cross-frictions. The treatment is correct if the pain while running becomes gradually less so that progressively greater distances can be covered. Most injuries will require between 5 and 10 sessions of therapy, each lasting 5 to 10 minutes, afer which most runners should be able to rin entirely free of pain. Injuries that have lasted for six months or more may require a longer period of treatment. I have mentioned that these injuries tent to recur. To prevent recurrence, runner should be especially fastidious about stretching the muscles that tend to be injured, especially before any fast running, in particular before early morning races. Furthermore,it is essential that at the first sign of reinjury, you go immediatly for more massage. A little treatment early o in these injuries saves a great deal of agony later.