The MLG-R muscle injury classification for hamstrings. Examples and guidelines for its use

Abstract

Muscle injuries are very common in sport. In soccer, the most popular sport in the world, the majority of muscle injuries are located in the lower extremity (92–97%); hamstrings (28–37%), quadriceps (19–32%), adductors (19–23%), and calf muscles (12–13%), all of them are biarticular muscles, with a complex architecture and containing a high proportion of fast-twitch fibers.

Football teams have important budgets and spend great amounts of money to win titles; it has been proved that injuries had a significant influence on performance in male professional football, but muscle injuries seem to keep growing. The reason to this is multivariable: there is no consensus regarding hamstring muscle injuries (HMIs) return to play (RTP) criteria in the literature, the time for recovery is highly variable, the increased physical demands during games, or the influence of congested period of games on players health.

Autores: Xavier Valle, Sandra Mechó, Ricard Pruna, Carles Pedret, Jaime Isern, Joan Carles Monllau, Gil Rodas.

Revista: Apunts. Medicina de l’esport

Año de publicación: 2018

Displacement of the nervous system through articular movement by ultrasound. Bibliographic review

Abstract

The nervous system has the capacity to adapt to the mechanical forces of tension, compression and shearing to which it is exposed in daily movements. Reduction of nerve slide may alter its function by increasing neural tension, which may have an adverse effect, contributing to the onset of pain. The objective of the study was to review the current literature regarding the movement of the nervous system and how to measure it. To do this, a search was undertaken in Pubmed and PEDro of articles where neural displacement is measured by the “frame-by-frame cross correlation system” technique. Twenty studies were selected: 14 measured displacement in healthy subjects, and 6 compared some form of peripheral neuropathy. The results show that the peripheral nervous system is displaced during the different movements of body segments to adapt to the space through which it runs, although there is no significant difference in displacement between healthy people and patients with nerve involvement.

Autores: Carle Munné, Carles Pedret.

Revista: Apunts. Medicina de l’esport

Año de publicación: 2018

Support strategies for high competition performance

Abstract

In high-level competition sports one of the most important aims throughout the season is that the player is able to recover as fast as possible to his or her physical and mental baseline condition after exercise so as to safely tackle their sport anew.

Advances in technology and the availability of increasingly more precise diagnostic tests (obtained from blood, urine or saliva samples) have led to a personalised approach to the sportsperson and individualised study of the training/match-recovery balance from a different, more realistic outlook of the situation.

Autores: Ricard Pruna, Antonia Lizarraga, Luis Vergara, Carles Pedret.

Revista: Apunts. Medicina de l’esport

Año de publicación: 2018

Does cognition play a role in injury prevention and return to play in the elite football player? A perspective from the field

Abstract

Cognitive ability is an important, and sometimes underrated, part of football performance. During a match, football players interact with multiple stimuli that target different sensory organs and triggers high cognitive demands that need to be linked with previous knowledge and experience and making and acting on decisions.

Autores: Khatija Bahdur, Ricard Pruna, Henrico Erasmus, Carles Pedret.

Revista: Apunts. Medicina de l’esport

Año de publicación: 2018

Role of the Extracellular Matrix in Muscle Injuries. Histoarchitectural Considerations for Muscle Injuries.

Abstract

In recent years, different classifications of muscle injury have been proposed based on topographic location within the bone-tendon-muscle chain. Furthermore, because the degree and level of extracellular matrix (ECM) involvement might vary greatly, we propose to include histoarchitectural considerations in the gross anatomic description of muscle injuries.

Autores: Balius R, Alomar X, Pedret C, Blasi M, Rodas G, Pruna R, Peña-Amaro J, Fernández-Jaén T.

Revista: Orthopaedic Journal of Sports Medicine

Año de publicación: 2018

A 3-Arm Randomized Trial for Achilles Tendinopathy: Eccentric Training, Eccentric Training Plus a Dietary Supplement Containing Mucopolysaccharides, or Passive Stretching Plus a Dietary Supplement Containing Mucopolysaccharides

Abstract

Tendinopathy is an overuse tendon injury that occurs in loaded tendons and results in pain and functional impairment. Although many treatments for painful tendons are described, the scientific evidence for most of the conservative and surgical treatments is not always conclusive.

Autores: Balius, R, Álvarez G, Baró F, Jiménez F, Pedret C, Costa E, Martínez-Puig D

Revista: Current Therapeutic Research, Clinical and Experimental

Año de publicación: 2016

Efficacy and Tolerability of Peritendinous Hyaluronic Acid in Patients with Supraspinatus Tendinopathy: a Multicenter, Randomized, Controlled Trial

Abstract

Physical therapy and peritendinous hyaluronic acid (HA) injections have both shown promising results in the treatment of shoulder tendinopathies. However, the superiority of treatment combining physical therapy and HA is unclear.

Autores: Flores C, Balius R, Álvarez G, Buil MA, Varela L, Cano C, Casariego J

Revista: Sports Med Open

Año de publicación: 2018

Gemelli-obturator complex in the deep gluteal space: an anatomic and dynamic study.

Abstract

OBJECTIVE:

To investigate the behavior of the sciatic nerve during hip rotation at subgluteal space.

MATERIALS AND METHODS:

Sonographic examination (high-resolution ultrasound machine at 5.0-14 MHZ) of the gemelli-obturator internus complex following two approaches: (1) a study on cadavers and (2) a study on healthy volunteers. The cadavers were examined in pronation, pelvis-fixed position by forcing internal and external rotations of the hip with the knee in 90° flexion. Healthy volunteers were examined during passive internal and external hip rotation (prone position; lumbar and pelvic regions fixed). Subjects with a history of major trauma, surgery or pathologies affecting the examined regions were excluded.

RESULTS:

The analysis included eight hemipelvis from six fresh cadavers and 31 healthy volunteers. The anatomical study revealed the presence of connective tissue attaching the sciatic nerve to the structures of the gemellus-obturator system at deep subgluteal space. The amplitude of the nerve curvature during rotating position was significantly greater than during resting position. During passive internal rotation, the sciatic nerve of both cadavers and healthy volunteers transformed from a straight structure to a curved structure tethered at two points as the tendon of the obturator internus contracted downwards. Conversely, external hip rotation caused the nerve to relax.

CONCLUSION:

Anatomically, the sciatic nerve is closely related to the gemelli-obturator internus complex. This relationship results in a reproducible dynamic behavior of the sciatic nerve during passive hip rotation, which may contribute to explain the pathological mechanisms of the obturator internal gemellus syndrome.

Autores: Balius R, Susín A, Morros C, Pujol M, Pérez-Cuenca D, Sala-Blanch X

Revista: Skeletal Radiol

Año de publicación: 2018

Time Course and Association of Functional and Biochemical Markers in Severe Semitendinosus Damage Following Intensive Eccentric Leg Curls: Differences between and within Subjects.

Abstract

To investigate the extent and evolution of hamstring muscle damage caused by an intensive bout of eccentric leg curls (ELCs) by (1) assessing the time course and association of different indirect markers of muscle damage such as changes in the force-generating capacity (FGC), functional magnetic resonance (fMRI), and serum muscle enzyme levels and (2) analyzing differences in the degree of hamstring muscle damage between and within subjects (limb-to-limb comparison). Methods: Thirteen male participants performed six sets of 10 repetitions of an ELC with each leg. Before and at regular intervals over 7 days after the exercise, FGC was measured with maximal isometric voluntary contraction (MVC). Serum enzyme levels, fMRI transverse relaxation time (T2) and perceived muscle soreness were also assessed and compared against the FGC. Results: Two groups of subjects were identified according to the extent of hamstring muscle damage based on decreased FGC and increased serum enzyme levels: high responders (n = 10, severe muscle damage) and moderate responders (n = 3, moderate muscle damage). In the high responders, fMRI T2 analysis revealed that the semitendinosus (ST) muscle suffered severe damage in the three regions measured (proximal, middle, and distal). The biceps femoris short head (BFsh) muscle was also damaged and there were significant differences in the FGC within subjects in the high responders. Conclusion: FGC and serum enzyme levels measured in 10 of the subjects from the sample were consistent with severe muscle damage. However, the results showed a wide range of peak MVC reductions, reflecting different degrees of damage between subjects (high and moderate responders). fMRI analysis confirmed that the ST was the hamstring muscle most damaged by ELCs, with uniform T2 changes across all the measured sections of this muscle. During intensive ELCs, the ST muscle could suffer an anomalous recruitment pattern due to fatigue and damage, placing an excessive load on the BFsh and causing it to perform a synergistic compensation that leads to structural damage. Finally, T2 and MVC values did not correlate for the leg with the smaller FGC decrease in the hamstring muscles, suggesting that long-lasting increases in T2 signals after FGC markers have returned to baseline values might indicate an adaptive process rather than damage.

Autores: Carmona G, Mendiguchía J, Alomar X, Padullés JM, Serrano D, Nescolarde L, Rodas G, Cussó R, Balius R, Cadefau JA.

Revista: Front Physiol. 2018 Feb 5; 9:54. doi: 10.3389/fphys.2018.00054. eCollection 2018.

Año de publicación: 2018

Time Course and Association of Functional and Biochemical Markers in Severe Semitendinosus Damage Following Intensive Eccentric Leg Curls: Differences between and within Subjects.

Abstract

OBJECTIVES:

To use ultrasound imaging to show how the needles in dry needling applied in the carpal tunnel can reach the transverse carpal ligament, acting on it in the form of traction-stretching when the fascial winding technique is performed. The potential associated risks are also assessed.

DESIGN:

Validation study.

PARTICIPANTS:

Healthy volunteers (n = 18).

METHODS:

Four dry needling needles were applied to the carpal tunnel, only using anatomical references, according to the original approach known as “four-pole carpal dry needling”, and manipulating the needles following the so-called fascial winding technique according to the authors, in the form of unidirectional rotation. An ultrasound recording of the distance reached was then performed, and compared with the mechanical action achieved on the transverse carpal ligament.

RESULTS:

93.1% of the needles placed came into contact with the transverse carpal ligament with traction-stretching of the ligament observed when the needles were manipulated with the fascial winding technique in 80.6%. The mean distance from the tip of the needle to the median nerve was 3.75 mm, with CI95% [3.10, 4.41] and it was 7.78 mm with CI95% [6.64, 8.91] to the ulnar artery. Pain immediately after the technique concluded was of mild intensity, almost nil 10 min later, and non-existent after one week.

CONCLUSION:

Dry needling with fascial winding technique in the carpal tunnel using the four-pole carpal dry needling approach is valid for reaching and traction of the transverse carpal ligament, and may stretch it and relax it. It is also safe with regard to the median nerve and ulnar artery, with a very mild level of pain.

Autores: Gascon-Garcia J, Bagur-Calafat C, Girabent-Farr M. Balius R.

Revista: Journal of Bodywork & Movement Therapies 22  348e353

Año de publicación: 2018

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