Lesions Musculaires Sion 2010

7/30/2019 Lesions Musculaires Sion 2010

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Dr P.-E. Fournier Centre Thermal - Yverdon-les-Bains


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5696 to 13746 m covered

Di Salvo et al. Int J Sports Med 2007; 28: 222-227

Performance Characteristics According toPlaying Position in Elite Soccer

Positional roleMean distancecovered (m)

S

Independent of position 11393 1016Central defender 10627 893

External defender 11410 708

Central midfield 12027 625

External midfield 11990 776

Forward 11254 894

More distance covered at the lowest work intensity during the 2nd halfNo difference > 19 km/h


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17.3 7.7 (range 3-40) bursts of high intensity activity

(>23km/h)

19.3 3.2 meters (range 9.9 32.5)

External defenders (20 7.0), external midfield (22.0 6.7),

forward (20.7 6.9) significantly more burst of high internsity

than central defender (11.2 5.2) and central midfield (13.7

6.2)




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Total distance covered in possession of the ball



Positional roleDistance covered

(m)%

Central defender 11967 1.20.6

External defender 22099 1.90.9

Central midfield 23092 1.90.8

External midfield 286114 2.41.1

Forward 21292 1.90.8

No difference between 1st and 2nd half except for forward


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23 teams belonging to the 50 best European teams2001-2008, 5 clubs trough all 7 seasons

34 matches and 162 training sessions each season

254 hours (213 training, 41 match hours)

4483 injuries during 566 000 hours of exposure

8.0 injuries / 1000 hours 27.5 /1000 hours matches 4.1 / 1000 hours training

Injury Incidence and Injury Pattern inProfessional Football The UEFA Injury Study

Ekstrand et al. Br J Sport Med 2009
http://images.google.ch/imgres?imgurl=http://www.bloc.com/images_administrables/bibliotheque/grande/psv-eindhoven.jpg&imgrefurl=http://www.bloc.com/article/sport/club/le-psv-eindhoven-l-un-des-meilleurs-clubs-des-pays-bas-20080409.html&usg=__n_tEWCHGgVxDtw-i0t0xt3Vpy_s=&h=311&w=401&sz=31&hl=fr&start=15&um=1&tbnid=hfpZB-lcSKd8BM:&tbnh=96&tbnw=124&prev=/images?q=eindhoven+psv&hl=fr&rlz=1T4SUNA_frCH236CH236&um=1http://images.google.ch/imgres?imgurl=http://bajnokokligaja.lapunk.hu/tarhely/bajnokokligaja/kepek/real_madrid_logo_1_.png&imgrefurl=http://bajnokokligaja.lapunk.hu/&usg=__CWRn89cx8ZTYuHdBz5Dnjw-pwT8=&h=599&w=428&sz=114&hl=fr&start=4&um=1&tbnid=NVhtjtZTMaK-JM:&tbnh=135&tbnw=96&prev=/images?q=real+madrid&hl=fr&rlz=1T4SUNA_frCH236CH236&um=1http://images.google.ch/imgres?imgurl=http://www.pronoplus.com/blog/wp-content/uploads/2008/05/intermilan-299x300.jpg&imgrefurl=http://www.pronoplus.com/blog/tag/inter-milan/&usg=__MI64mrTvKdNkgzlCLDn9OUVOb6Q=&h=300&w=299&sz=29&hl=fr&start=9&um=1&tbnid=WzJzdpv7uQsLtM:&tbnh=116&tbnw=116&prev=/images?q=inter+milan&hl=fr&rlz=1T4SUNA_frCH236CH236&um=1http://images.google.ch/imgres?imgurl=http://upload.wikimedia.org/wikipedia/fi/thumb/9/9f/Manchester_United_Football_Clubin_logo.svg/632px-Manchester_United_Football_Clubin_logo.svg.png&imgrefurl=http://www.blognow.com.au/ManUnited/&usg=__sDEmAObM_raUBWOsLHNtqOQqyrQ=&h=600&w=632&sz=78&hl=fr&start=11&um=1&tbnid=D4C8QWrUnUJFVM:&tbnh=130&tbnw=137&prev=/images?q=manchester+united+fc&hl=fr&rlz=1T4SUNA_frCH236CH236&sa=N&um=1http://images.google.ch/imgres?imgurl=http://www.buffalocityfc.com/images/Arsenal_FC.png&imgrefurl=http://www.afamarbella.com/afa_partners.asp&usg=__CDEjKE27CImBWdrVG72_UTO3OoE=&h=384&w=328&sz=32&hl=fr&start=2&um=1&tbnid=0aF0a7ZVQ-pRdM:&tbnh=123&tbnw=105&prev=/images?q=arsenal+fc&hl=fr&rlz=1T4SUNA_frCH236CH236&sa=N&um=1


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INJURY %

THIGH STRAINS 17 %(12 % HAMSTRINGS)( 5 % QUADRICEPS)

ADDUCTOR PAIN/STRAIN 9 %

ANKLE SPRAIN 7 %

MCL INJURIES 5 %

Injury Incidence and Injury Pattern inProfessional Football The UEFA Injury Study

Ekstrand et al. Br J Sport Med 2009


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11 teams, 7 countries

Arsenal, Manchester U, Paris St Germain, St Rennais, Lens, AC Milan,

Juventus, Inter Milan, Eindhoven, Real Madrid, Ajax

69 707 hours of exposure (58 149 training, 11 558 match)

Highest number of match played by one player : 69

30.5 injuries / 1000 hours Match, 5.8 / 1000 hours Training

148 players in national teams

Tendency of lower incidence in training

No difference in match play

Walden et al. Br J Sports Med 2005; 39: 542-546

UEFA Champions Leage Study: A ProspectiveStudy of Injuries in Professional Football During

The 2001-2002 Season


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Final 15 min first half, last 30 min. second half

More injuries in the first month of competition

50 % dominant side versus 37 %

38 % contact with another player or the ball

Hawkins et al. Br J Sports Med 2001; 35: 43-47

The Association Football Medical ResearchProgramme: An Audit of Injuries In

Professional Football


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MUSCLEINJURIES

STRAIN

LACERATIONCONTUSION


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LOCALISATION OF MOST COMMON MUSCLESINJURIES

HAMSTRING BICEPS FEMORIS

QUADRICEPS RECTUS FEMORIS

CALF MEDIAL HEAD GASTROCNEMIUS

DISTAL MUSCLE-TENDON JUNCTIONOR MIDBELLY OF THE MUSCLE

ADDUCTORS ADDUCTOR LONGUS


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DANCERS SPRINTERS

Dancers :

Proximal lesions ~ 2cm ischial tuberosity

87 % semimembranous Seldom restricted to 1 muscle-tendon complex

Slow-speed stretch (sagittal split)

No correlation IRM and time to return

Mean time to return 50 weeks

Askling et al.Am J Sports Med 2007; 35: 1716-1724 -- Am J Sports Med 2007; 35: 197-

206 -- Br J Sports Med 2006; 40: 40-44 -- Scand J Med Sci Sports 2000; 10: 304-307


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Whole body kinematics collected in 14 subjects

Sprint on a high-speed treadmill, 80-100 % of their

maximum speed

Thelen et al. Exerc Sport Sci Rev 2006; 34: 135-141

Neuromusculoskeletal Models Provide InsightsInto The Mechanism And Rehabilitation

of Hamstring Strains


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Thelen et al. Exerc Sport Sci Rev 2006; 34: 135-141

Neuromusculoskeletal Models Provide InsightsInto The Mechanism And Rehabilitation

of Hamstring Strains

End of swing phase ecc con


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Muscle injuries: Biology and treatment. Jrvinen et al. Am J Sports Med 2005; 33: 745-764


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Bone heals by a regeneration process healing tissue identical to

preexisting tissue

Most of the other tissues in the body

including muscle heal with a scar


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Huard et al. J Bone J Surg [Am] 2002; 84: 822-832


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Each myofiber contains specific chainsof molecules called integrins anddystrophin, which connect thecontractile myofilament to the ECMthrough the sarcolemma

The majority of integrin are located atthe myotendinous junction


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Restoration of vascular supply isthe first sign of regeneration

Young myotube have anincreased anaerobic metabolism,during final stages ofregeneration aerobic metabolismconstitute the principal pathway

In mobilized muscle intensiveingrowth of new capillaries


IMMOBILISATION

MOBILISATION


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Stages Pain Clinical Ex. Strength Recovery

0Reversible

Limited lesionModerate Contracture () Hours

1

No more reversible,some muscle ff.,

connective tissue notinjured

(+) Contracture()

Days

2

No more reversible,some muscle ff.,

connective tissue notinjured

+ Contracture 10 15 Days

3

No more reversible,numerous muscle ff.injured, connective

tissue injuredHEMATOMA

+Sports

activity nomore

possible

ContractureTumefaction

4-12 weeks

4Partial or total rupturescattered hematoma

+Sports

activity nomore

possible

gap ?

Rodineau J. in Muscle traumatique et mcanique. Masson 2005


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Avulsion FractureRodineau J. in Muscle traumatique et mcanique. Masson 2005


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No false negativ

Overestimation


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58 players, Hamstring injury (team physician) within 3 days

MRI and clinical evaluation by an independant physiotherapist

MRI

Muscle(s) involved, site of injury within the muscle, injured area,

injured length, intra-, intermuscular hemorrhage

Clinical assessement Passive straight leg raise, active knee extension, manual testing,

active slump

Schneider-Kolsky et al. Am J Sports Med 2006; 34: 1008-1015

A Comparison Between Clinical Assessment AndMagnetic Resonance Imaging of Acute

Hamstring Injuries


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Diagnosis

65.5 % in accordance

31 % clinical assessment +, IRM

3.5 % (2 cases) clinical assessement -, IRM +

Time until return to competition Significative positive correlation, better for clinical assessment,

particularly for minor lesions

Schneider-Kolsky et al. Am J Sports Med 2006; 34: 1008-1015

A Comparison Between Clinical Assessment AndMagnetic Resonance Imaging of Acute

Hamstring Injuries


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lack of firm scientific basis



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Recommended but.. No randomized

study to prove effectivness of RICE


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Immediate mobilisation could be deleterious Larger connective tissue scar

Penetration of muscles fibers through the scar impaired

Delayed restoration of mecanical strength (Risk of re-ruptureincreased)

Short relative immobilisation D 0D 2-3 5

Rest period allows the scar to gain the strength to withstand thecontraction-induced forces applied on it without a rerupture



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Relative immobilisation (Tape, cast, )

Crutches

Carefull mobilisation Days 3 5 (7)

Jrvinen 2005, Ziltener 2006


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Painfree

Contractions against weak load, concentric work

Decreasing resistance for one exercise, increasing from one

session to the other Contractions speed initially rapid concentric then slow to

rapid with eccentric work

PliometryZiltener 2006


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Phase 2 : J4-J10 Phase 3 : J10-J21 Phase 4 : > 21 jours

Arrt temporaire activitphysique

Antalgie Antalgie+cicatrisation+lutte contre fibroblastie

Bandage et contention Bandage et contention Bandage : sevrageCryothrapiepluriquotidienne

Cryothrapiepluriquotidienne

Cryothrapie aprssances

Drainage lymphatique Drainage lymphatique Drainage lymphatique(si ncessaire)

lectrothrapie tirements progressifs tirements isomtriques

Fonction musculaire(cannes, travail actifsans rsistance)

Fonction musculaire(travail actif avecrsistance manuelle)

Fonction musculairerenforcement,rentranement leffort

Chanussot et al. Rducation en traumatologie du Sport, Masson 2003


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G th F t D li M th d I Th


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Creaney et al. Br J Sports Med. 2008;42(5):314-20

Growth Factor Delivery Methods In TheManagement of Sports Injuries :

The State of The Play

Platelet Rich Plasma

Autologous Blood Injection

Autologous Conditioned Serum

Platelet-derived growth factor, Vascular endothelial growth factor,

Tranforming growth factor beta-1, Epidermal growth factor, Basic

fibroblast growth factor, Insulin-like growth factor-1, Hepatocyte

growth factor


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G th F t D li M th d I Th


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Growth Factor Delivery Methods In TheManagement of Sports Injuries :

The State of The Play

Short half-life

Quick sytemic lavage

Effects mostly confined to site of delivery



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Creaney et al.Br J Sports Med.2008;42(5):314-20


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Muscle injuries and PRP: what does the science say ?

Harmon Br J Sports Med 2010; 44: 616-617

Platelet-rich plasma: any substance into it ?

Mei-Dan et al. Br J Sports Med 2010; 44: 616-617


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Sawn muscle knackered muscle outdated

Banks suture, drain hematoma and necrotic material

Microsurgery (less scar tissue)

Stage 4


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Persistence of hematoma, cyst

Seroma

Myositis ossificans

Hypertrophic scar


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SECURITY REINJURY

PRECISE GUIDE LINES NOT DESCRIBED

Labareyre et al. J Traumatol Sport 2005 22; 232-235


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12.1 % recurrence the first week of return to sport

30.6 % cummulative risk for reinjury in the 22

week-season


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Initial Evaluation imprecise delays

Roughly : muscle strain 3 weeks

torn muscle 6 weeks

From 2 (4) weeks on field 60 %

Progression each 2-4 days if : No pain at rest, at 60 %, no pain when stretching,

when isometric contraction or at palpation

No palpable mass



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Echography doesnt give any information on

scar strength

Useful for follow up particurlaly if delayedevolution

MRI delay between clinical evolution and MRIappearance


Lower Reinjury Rate With a Coach-controlled


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Hgglund et al. Am J Sports Med : 2007; 35: 1433-1442

Lower Reinjury Rate With a Coach controlledRehabilitation Program In Amateur Male Soccer a

Randomized Controlled Trial

Information about risk factors for reinjury

Rehabilitation principles

10-steps progressive rehabilitation programm including

return to play criteria


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Hgglund et al.

Am J Sports Med :2007; 35: 1433-1442



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Program introduced when walking was possible without pain

and limping

Gradually increasing loadNext step when exercises possible without pain or swelling

at the injured site

If pain return to pain free step

1 to 6 without ball

Then skill training with ball

Slow pace then increasing speed



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Reinjury 2.3 / 1000 hours (intervention group)

8 / 1000 hours (control group)

66 %

85 % lower limb injuries


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Prevention of Hamstring Strains In Elite Soccer:


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Iceland 17, 15, 16, 10 teams for 1999 to 2002

Norway : 14 teams for 2001 and 2002

Hamstring injuries recorded (contact injuries excluded)

Clinical assessment (MRI not required)

Arnason et al. Scand J Med Sci Sports. 2008;18(1):40-8

Prevention of Hamstring Strains In Elite Soccer:An Intervention Study



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All teams both countries

Before sprinting or shooting before every trainingor game




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After training 3x / week preseason

1-2 times during the competitive season




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5 week introductory period, load gradually increased

3 sets of 12, 10 and 8 repetition 3 x / week preseason, 1-2 during competitive period




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eve t o o a st g St a s l te Socce :An Intervention Study

III

W, F, SW,F

W,SW,S

Incidence, Warm-up, Flexibility, Strength


Human Hamstring Muscle Adapt To Eccentric


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Brockett et al. Med Sci Sports Exerc 2001; 33: 783-790

g pExercise By Changing Optimum Length

10 Subjects

Eccentric hamstring exercise :

12 sets of 6 repetitions10 between repetition 2-3 minutes between sets

Isokinetic evaluation

Human Hamstring Muscle Adapt To Eccentric


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g pExercise By Changing Optimum Length

Brockett et al. Med Sci Sports Exerc 2001; 33: 783-790

Consquences et Prdiction des Lsions Musculaires desI hi j bi P ti d P t I i ti


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28 players (11 players with Hamstrings injury history)

Isokinetic evaluation 60/sec (Quad, Hamstring Conc, Ecc)

Ratio Qconc/Hcon, Hconc/Hconc, Hecc/Hecc, Hecc/Qconc

No predictive value of new muscle injury

Ratio Hecc/Qconc < 0.6 highly suggestive of old

Hamstring injury (77.5%)

Dauty et al. Ann Radapt Med Phys 2003; 46: 601-606

Ischiojambiers Partir de Paramtres IsocintiquesConcentriques et Excentriques du Joueur de Football

Professionnel

Strength Imbalance and Prevention of Hamstring


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462 players with complete follow up from Belgian, Brazilian

and French professional teams

Isokinetic evaluation (60/sec and 240/sec Quad, Hamstring Conc, Ecc,30/sec 120/sec Hamstring ecc)

Preseason cutoffs :

bilateral difference > 15 % (conc and/or ecc Hamstrings)

concentric ratio < 0.47 Cybex, 0.45 Biodex

Mixed ratio (H ecc 30sec/ Q conc 240/sec) < 0.8 Cybex, 0.89 Biodex

Croisier et al. Am J Sports Med 2008; 36: 1469-1475

Injury in Professional Soccer Players

Strength Imbalance and Prevention of Hamstring


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Croisier et al. Am J Sports Med 2008; 36: 1469-1475

Injury in Professional Soccer Players


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Documents

Lesions Musculaires Sion 2010