Don’t Forget the Fascia
By Dr. Jennifer Lyon are two outs, a runner on third, and you’re up to bat. Your bat swings at the perfect velocity and smacks head on with a well placed pitch. All you have to do is make it to first base.
You imagine yourself already there but with your first step you experience a tight cramp in your leg and then feel a pop at your Achilles. Quickly, you realize you are not going anywhere! This is the classic story for a tendon injury. I have heard this again and again from all types of athletes. A strain can be a seasonender and it can also become a chronic aliment that limits your activity level for seasons to come! So, how can you prevent this injury and how can you help the healing process if you experience a strain? Let’s start with getting educated on the diagnosis. What is the difference between a strain and a sprain? A sprain is an injury to a ligament (which connects bone to bone). The most common sprain is an ankle sprain. A strain is an injury to a tendon (which connects muscle to bone) or an injury to the actual muscle fibers. The most common strains are to the Hamstring and Achilles tendons. Strains typically occur when the athlete attempts to make a quick acceleration or deceleration, stretching the tendon fibers beyond their limit. There are three grades of strains. A Grade 1 strain is diagnosed when a few tendon fibers have been damaged. Many times these athletes have mild stiffness and soreness but have normal range of motion of 24
NM3 MAGAZINE ■ SEPTEMBER 2010
the injured area. Within two-three weeks they are back to full activity and often never are seen by a physician. Grade 1 strains typically do not result in chronic symptoms. A Grade 2 strain has more extensive damage to the muscle and tendon fibers but is still not a complete tear. This injury is more likely to lead to bruising and swelling. The athlete will have their range of motion affected and usually the healing time is closer to three-six weeks. A Grade 3 strain is a complete muscle or tendon tear. This injury causes pain at rest and large restrictions in range of motion with a large amount of swelling and bruising. Often, this requires surgical repair for healing. We’ll focus on the Grade 1 and 2 strains and provide helpful tips on how to rehabilitate these injuries in order to avoid the chronic symptoms which prevents athletes from returning to their sport. Hamstring strains are a great example. When the hamstring symptoms become chronic the athlete typically has no pain at rest but is unable to exercise due to their symptoms returning with activity. Typically the muscle and tendon injuries are addressed with rehabilitation however the fascia is not. What is fascia? I describe it as “saran wrap” that covers all of our muscles from head to toe. The fascia becomes restricted (scars) and does not allow the muscle and tendon to move as they should, which causes chronic irritation. So the key to recovery is to rehabilitate the facia. Treatment is usually the RICE pnemonic: Rest, Ice, Compression, and Elevation. I do recommended that this is where the treatment of strains should start however once the bruising, swelling, and range of motion have improved I believe the most important treatment you can do is to address the fascia. Well, how do you do that? Two words: foam roller. These are similar in make-up to a water noodle but stronger and larger in diameter. The athlete rolls the affected area over the foam roller to release the fascia. Another way to address the fascia is to see an Osteopathic physician or an expert in myofascial release. These professionals will use their hands to release the fascial restrictions. Now, I know this “fascia” stuff seems a bit foreign. Believe me, when these strains become chronic, athletes become very frustrated with their pain, the length of time it takes to recover, and the lack of improvement even with rest and physical therapy. Most of us would prefer to prevent ever experiencing this injury. There are no clear scientific answers on how to prevent strains. We believe the best prevention is by attempting to achieve “body balance”. Body balance is a balance between strength and flexibility. So, stretch and strengthen those hamstrings and quadriceps. Know your body. Do you have weak hamstrings? Tight hamstrings? Overtly strong quadriceps compared to your hamstrings? These are all things to monitor and attempt to modify. Beware of overtraining, this leads to muscle fatigue which almost always ends in injury. To recap: Attempt to balance your flexibility and your strength. If you still develop a strain start with the RICE treatment immediately. Seek medical attention to help with grading the injury and to discuss timing of progression back to activity. Don’t forget to address the fascia! The goal is to keep your body in motion so you can enjoy an active healthy life! Dr. Lyon is a Sports Medicine Physician at Creekside Sports Medicine Institute in Traverse City, and formerly a Sports Team Physician for Michigan State University.
September 2010, designed by Godwin Jabangwe