Muscle Injuries in Sports PDF
Preview Muscle Injuries in Sports
Muscle Injuries in Sports Hans-Wilhelm Mueller-Wohlfahrt, MD MWCenterforOrthopedicsandSportsMedicine Munich,Germany Peter Ueblacker, MD MWCenterforOrthopedicsandSportsMedicine Munich,Germany Lutz Haensel, MD MWCenterforOrthopedicsandSportsMedicine Munich,Germany William E. Garrett Jr., MD, PhD DukeSportsMedicineCenter Durham,USA Withcontributionsby AndreasBetthaeuser,AlfredBinder,WilhelmBloch, DieterBlottner,JohannesBoeck,BernhardBrenner, KlausEder,JanEkstrand,MartinFlueck,LutzHaensel, HelmutHoffmann,J.MichaelHufnagl,Hans-Wilhelm Mueller-Wohlfahrt,PeterMundinger,AndreasSchlumberger, BenediktSchoser,PeterUeblacker ForewordbyJiriDvorák,Zurich,Switzerland; ChiefMedicalOfficer,FIFA 505illustrations Thieme Stuttgart·NewYork LibraryofCongressCataloging-in-PublicationData Importantnote:Medicineisanever-changingscienceundergoing isavailablefromthepublisher. continualdevelopment.Researchandclinicalexperiencearecontin- ually expanding our knowledge, in particular our knowledge of ThisbookisanauthorizedtranslationoftheGermanedition propertreatmentanddrugtherapy.Insofarasthisbookmentions publishedandcopyrighted2010byGeorgThiemeVerlag,Stuttgart. anydosageorapplication,readersmayrestassuredthattheauthors, TitleoftheGermanedition:MuskelverletzungenimSport. editors,andpublishershavemadeeveryefforttoensurethatsuch references are in accordance with the state of knowledge at the Translators:TerryTelger,FortWorth,Texas,USA; timeofproductionofthebook. GertrudG.Champe,Surry,Maine,USA;RuthGutberlet,Chom, Nevertheless,thisdoesnotinvolve,imply,orexpressanyguarantee NCTMB,Hofbieber,Germany;AlexandraKuhn-Thiel,MD, orresponsibilityonthepartofthepublishersinrespecttoanydos- Wachenheim,Germany ageinstructionsandformsofapplicationsstatedinthebook.Every userisrequestedtoexaminecarefullythemanufacturersʼleafletsac- Illustrators:MarkusVoll,Munich,Germany; companyingeach drug and to check, if necessary in consultation AndreaSchnitzler,Innsbruck,Austria withaphysicianorspecialist,whetherthedosageschedulesmen- tionedthereinorthecontraindicationsstatedbythemanufacturers differfromthestatementsmadeinthepresentbook.Suchexamina- tionisparticularlyimportantwithdrugsthatareeitherrarelyused orhavebeennewlyreleasedonthemarket.Everydosageschedule oreveryformofapplicationusedisentirelyattheuserʼsownrisk andresponsibility.Theauthorsandpublishersrequesteveryuserto reporttothepublishersanydiscrepanciesorinaccuraciesnoticed.If errorsinthisworkarefoundafterpublication,erratawillbeposted atwww.thieme.comontheproductdescriptionpage. ©2013GeorgThiemeVerlagKG, Someoftheproductnames,patents,andregistereddesignsreferred Rüdigerstrasse14,70469Stuttgart,Germany to in this book are in fact registered trademarks or proprietary http://www.thieme.de names even though specific reference to this fact is not always ThiemeMedicalPublishers,Inc.,333SeventhAvenue, madeinthetext.Therefore,theappearanceofanamewithoutdes- NewYork,NY10001,USA ignationasproprietaryisnottobeconstruedasarepresentationby http://www.thieme.com thepublisherthatitisinthepublicdomain. Thisbook,includingallpartsthereof,islegallyprotectedbycopy- Coverdesign:ThiemePublishingGroup right.Anyuse,exploitation,orcommercializationoutsidethenar- TypesettingbyZieglerundMüller,Kirchentellinsfurt,Germany rowlimitssetbycopyrightlegislation,withoutthepublisherʼscon- PrintedinChinabyEverbestPrintingLtd.,HongKong sent,isillegalandliabletoprosecution.Thisappliesinparticularto photostat reproduction, copying, mimeographing, preparation of ISBN978-3-13-162471-0 microfilms,andelectronicdataprocessingandstorage. Alsoavailablease-book: eISBN978-3-13-169661-8 IV TomydearwifeKarin, mydaughterMarenandmysonKilian fortheirsupportandunderstanding. H.-W.Müller-Wohlfahrt TomydearwifeAnika, andmychildrenMalou,Elia,andLouis fortheirlove,joiedevivre,andunderstanding. P.Ueblacker TomydearwifeGloria forheruntiringsupport andunderstanding. L.Hänsel V Foreword Itisanundisputedscientificfactthatsportsnotonlypro- Theeditorsofthisbook,Hans-WilhelmMüller-Wohl- mote the enhancement of physical fitness, regardless of fahrt, PeterUeblacker, Lutz Hänsel, andWilliam Garrett, ageorgender,butarealsothemosteffectivewayofpre- aswellasthecontributingauthors,havehaddecadesof venting most cardiovascular diseases, diabetes, obesity, practicalexperienceincaringforthousandsofprofession- andmanytypesofcancer(asoutlinedbyProf.StevenBlair al and amateur athletes. As a result, Muscle Injuries in intheBritishJournalofSportsMedicine2009;43:1–2).Ex- Sportsoffersstate-of-the-artdiagnosticandtreatmentin- tensivepromotionofrecreationalsportsforallagesisthe formation from the perspective of prominent sports bestwayofimprovingpublichealthandreducinghealth- physicians.Thebookincludesanewsystemfortheclinical carecosts. classification of muscle injuries based on the history, Ifthishealthpotentialofcompetitiveandrecreational physical examination, and imaging findings. The bookʼs sportsistobefullyexploited,theriskofinjurieshastobe therapeutic focus is on conservative treatment, both in reducedasmuchaspossible.Particularlyinsportsthatare thesettingofacutemuscleinjuriesandinrehabilitation. widelypopular,everyefforthastobemadetopreventin- As readers will see, the authors have gathered together juries and their late sequelae. This should include ade- thebestandmostusefulinformationonthebasisofdec- quate initial examinations, warm-up routines based on adesofexperience,withthegoalofhasteningtherecov- specialexercises,andconceptsoffairplay,aswellasopti- eryofeveryinjuredathlete. malmanagementofanyinjuriesthataresustained. Ipersonallyknowlittleaboutinterferencefieldsoren- Football (soccer) is unquestionably the most popular ergyemissionanalysis,butthesechaptersclearlywarrant sportintheworld.Withalmost300millionplayersworld- criticalevaluation.Thissuperblyillustratedbookiscom- wide, any divergence from good practice is inevitably pleted by a chapter on preventive measures, which are magnifiedonatremendousscale. definitelyasimportantastreatmentandmaybefarmore On the basis of comprehensive epidemiologic studies important. Scientific studies with football players (Soli- conductedbytheFIFAMedicalAssessmentandResearch gardetal.,BMJ2008;337:a2469)haveshownthatinjuries Center(F‑MARC)oftheInternationalFederationofAssoci- can be reduced by 30–50% when preventive measures ation Football (FIFA), the average soccer player sustains such as the 11+ exercise program, with proven efficacy, approximatelytwoinjuriesperyear.Notonlydothesein- areappliedasanintegralpartofwarm-uproutinesbefore juriesincur primarytreatmentcosts,butsignificantsec- trainingandcompetition(http://f-marc.com). ondary costs also arise due to lost productivity and ab- Insummary,everyoneinvolvedinthecareofathletes sence from work. The most common sports-related should not only read this book but also implement the injuriesinvolvethe muscles, and even apparentlyminor practicalrecommendationsbyseasonedexpertsthatitof- injuriesmayhaveseriousconsequenceswhentheyoccur fersontheprevention,diagnosis,treatment,andrehabili- onarepetitivebasis.Astheworldʼslargestinternational tationofsports-relatedmuscleinjuries. sports association, FIFA has taken a keen interest in the prevention,diagnosis,andtreatmentofsports-relatedin- juries.Trainers,physicaltherapists,andsportsphysicians attherecreationalandamateurlevelmusthavesufficient knowledgetoprovideoptimaldiagnosticandtherapeutic care. Prof.JiriDvorák,MD ChiefMedicalOfficer,FIFA;Chairman,F-MARC VI Preface Morethanone-thirdofallinjuriesthatoccurinsoccerin- Interestingly,whilethemusculatureisthelargestpa- volve the muscles; thigh muscle injuries represent the renchymalorganinthehumanbody,representingrough- mostcommondiagnosisintrackandfieldathletes,Amer- ly40%ofthetotalbodyweightinadults,themuscleshave icanfootball,andbasketball.However,muscleinjuriesare beenrelegatedtoasecondaryroleinthepast.Itisonlyre- alsocommoninrecreationalsports,whereoverlookedor centlythattheyhavebecomeafocusofgrowinginterest misunderstood muscle injuries may lead to persistent in research work, professional journals, and the press. problems. More and more, the muscles are being recognized as a Itisalsoafactthatinjuriestotheskeletalmusclesare centralorganthatisresponsiblefornumerousdisorders often underestimated, misinterpreted, and improperly andcomplaintsandthatisalsoaccessibletotreatment. treated.Thereasonsforthisincludealackoftrainingand Thistextbookisbeingpublishedatatimewhengreater continuingeducation in this area,a lackofresearch,the attentionisbeinggiventothemusclesin“musculoskeletal absence—so far—of a practical, comprehensive, universal medicine”—thefieldthatinthepastdealtextensivelywith classificationsystemformuscleinjuries,andevenalack joints,ligaments,tendons,andbones.Ouraimistostimu- ofuniformterminology.Moreover,guidelinesforclinical latediscussionaboutathleticmuscleinjuriesinorder to or imaging diagnosis and treatment are lacking. For the promoteanewandimprovedunderstandingofthediag- sakeofallinjuredathletes,thissituationmustchange! nosis,treatment,andpreventionofthesefrequentandin- Inthepast,thespecializedknowledgeneededtodiag- terestingdisorders. nose and treat muscle injuries could only be obtained TheoriginalpublicationofthisbookinGermaninJune fromindividualpublications,withconsiderableinconsis- 2010 wasverysuccessful, witha positiveresponsefrom tencyintheuseofmuscleinjuryterminology.Sofar,there manyphysiciansandtherapistsinthefieldofthediagno- havebeen notextbooksproviding a comprehensive,un- sisandtreatmentofmuscleinjurieswhohadbeenlooking derstandabledescription oftheanatomyandphysiology forabooklikethisforalongtime.Thisledustodiscuss oftheskeletalmusclesortheclinicaldiagnosis,imaging, the possibility of producing an English edition with the treatment,rehabilitation,andpreventionofmuscleinju- publishers. ries. ThepresentEnglisheditionisafurtherdevelopmentof Having long planned a book on diagnosis and treat- theGermanone,basedonthefollowingevents:Inearly ment,wefelt it wastimetoundertakeacomprehensive 2011, we conducted a survey based on the hypothesis projectofthistype.TheresultisMuscleInjuriesinSports, that the existing terminology for muscle injuries in the whichdrawsuponmorethan35yearsofpracticalexperi- English language is highly inconsistent. Scientists and ence in caring for professional soccer players and other teamdoctorsfromnationalandfirst-divisionprofessional topathletes from track and field and manyothersports soccerteams,nativeEnglishspeakers,wereaskedtocom- fromallovertheworld. plete a questionnaire. The responses confirmed our hy- Themainprobleminevaluatingskeletalmusclesisthat pothesisthatthereismarkedvariabilityintheuseofmed- they are so heterogeneous, from both the physiological ical terminology relating to muscle injury. The results andpathologicalstandpoints.Thismakesitallthemore emphasized the need for a more uniform terminology difficult to establish a comprehensive classification that andclassificationsystem. covers all injuries, as there are more borderline cases Onthebasisofthesefindings,weorganizedaconsen- thaninothertypesofinjurysuchasfractures. sus meeting of international sports medicine experts in Onlyveryfewstudieshavebeenpublishedonmuscle Munich,Germany,onMarch3,2011.Thefollowingmem- injuries.Muchoftheinformationinthisbook—particular- berstookpartinthemeeting(inalphabeticalorder): ly the chapters on classification, clinical diagnosis, and l Prof.DieterBlottner(AssociateProfessor,Department treatment—is thus admittedly based more on empirical of Vegetative Anatomy, Charité University Hospital, knowledge than on scientific data. But isnʼt it also true Berlin,Germany) thatothermedicalclassificationsareevidence-basedonly l Prof. Jan Ekstrand (Head of the UEFA Injury Study to a limited degree, due to a lackof scientific research? Group,Vice-ChairmanoftheUEFAMedicalCommittee, However,theempiricaldatausedinthisbookarebased UniversityofLinköping,Sweden) onalargenumberofmuscleinjuries,astheauthorsand l Dr. Bryan English (teamphysicianof Chelsea Football editorsregularlyseeandtreatcompetitiveathletes. Club,UK) VII l Prof.WilliamE.Garrett,Jr.(DukeSportsMedicineCen- Theaimofthenewclassificationsystemistoimprove ter,Durham,NorthCarolina,USA) theclarityofcommunicationforbothdiagnosticandther- l Dr.LutzHänsel(editorofthisbook,teamphysicianof apeuticpurposes.Thisisintendedtoserveasthebasisfor BayernMunichFootballClub,Germany) futurecomparativestudiestoaddressthecontinuedlack l Dr.GinoM.M.J.Kerkhoffs(DepartmentofOrthopedic ofsystematicinformationonmuscleinjuriesinthelitera- Surgery, Orthopedic Research Center, Amsterdam, ture.Theresultsofthisconsensusconferencehavebeen Netherlands) published in the British Journal of Sports Medicine (with l Dr.SteveMcNally(teamphysicianforManchesterUnit- openaccessonbjsm.com). ed,UK) Weareveryproudthattheclassificationhasbeenin- l Dr. Kai Mithoefer (Harvard Vanguard Medical Associ- cluded in the UEFAChampions League Injury Study. We ates, Harvard Medical School, US Soccer Federation, hopethatourworkwillstimulateresearch—basedonthe Boston,Massachusetts,USA) suggestedterminologyandclassification—toprospective- l Dr. Hans-Wilhelm Müller-Wohlfahrt (editor of this lyevaluatetheprognosticandtherapeuticimplicationsof book,teamphysicianofBayernMunichFootballClub, the newclassification system, whichisbased onclinical Germany, and team physician of Germanyʼs national experience. footballteam) This book has been written for all sports physicians, l Dr.JohnOrchard,MD,PhD(AssociateProfessor,School sports scientists, physical therapists, and many others ofPublicHealth,UniversityofSydney;teamphysician whoareinterestedandinvolvedinthecareandtreatment oftheAustraliancricketteamandSydneyRoostersrug- ofcompetitiveandrecreationalathletes.Ourhopeisthat byleagueteam) bydescribingourownexperience,wemaybeabletoad- l Dr.PatrickSchamasch(MedicalandScientificDirector vancethediagnosisandtreatmentofthesefrequentand of the International Olympic Committee, Lausanne, interestinginjuries. Switzerland) OurspecialthanksgotoDr.AlbrechtHauff,CEOofthe l Dr.LeifSwaerd(AssociateProfessor,UniversityofGöte- ThiemePublishingGroup,forhisenthusiasticresponseto borg, Sweden; team physician for Swedenʼs national ourideaofwritingacomprehensivetextbookonskeletal football team and previously for Englandʼs national muscleinjuries.Weareparticularlygratefulforhisfore- footballteam) sightandhissupport. l PDDr.PeterUeblacker(editorofthisbook,teamphysi- WearealsoverygratefultothestaffatThiemePublish- cianofBayernMunichFootballClub,Germany) ers—particularlyAngelikaFindgott,forgenerousandpro- l Dr. Niek van Dijk (Head of the Orthopedics Depart- fessionalplanning;andtoAnne Lamparter,DeborahCe- ment, Academic Medical Center, Amsterdam, Nether- cere,andSophiaHengst,fortheirtirelesshelpandsupport lands) in seeing the project through tocompletion. Our thanks also go to Gertrud Champe, Ruth Gutberlet, Alexandra Practicalandsystematictermsforathleticmuscleinjuries Kuhn-Thiel,andTerryTelgerfortheprofessionaltransla- wereestablishedattheconference. tions.TheentirestaffattheThiemePublishingGroupcon- Itwasdecidednottorecommendtheuseoftheterm sistentlylookedafterourneedswithagreatdealofeffort strainanymore,asit isabiomechanicaltermthatisnot and commitment andwere able tofind answers for our definedandisusedindiscriminatelyforanatomicallyand mostchallengingquestions.Theyprovidedthehighdegree functionally different muscle injuries. Instead of strain, ofcollaborationthatisessentialforcompletingaprojectof the consensus panel proposed the use of the term tear, thiskind. usedforstructuralmuscleinjuries—i.e.,injuriesinwhich Our sincere thanks also go, of course, to all of our thereismacroscopicevidenceofmuscledamage. authors,whosecontributionsreflecttheveryhighestlevel Inaddition,acomprehensivenewclassificationsystem oftechnicalcompetenceandexpertise.Wearegratefulto wasdevelopedthatdifferentiatesbetween: themfortheirdedicatedandcomprehensiveworkonthe l Functional muscle disorders—referring to disorders project,andparticularlyalsointhetranslationandediting with no macroscopic evidence of fiber tear (type 1, tasksneededforthisEnglishedition.Weareproudtohave overexertion-related;andtype2,neuromuscularmus- workedwithsuchanaccomplishedandexperiencedteam cledisorders) ofexperts. and l Structuralmuscleinjuries—withmacroscopicevidence Hans-WilhelmMüller-Wohlfahrt of a fiber tear, i.e. structural damage (type 3, partial PeterUeblacker tears;andtype4,[sub]totaltears/tendinousavulsions) LutzHänsel Subclassificationsweredefinedforeachtype. VIII
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