In this article, we will discuss athletes, muscle injuries and diagnosis.
What criteria do you use to diagnose a minor muscle injury and inform the athlete of the situation?
My experience has been that there is a difference between the degree of injury that I determine and the degree of injury that another medical professional determines.
The reason for this is simply that there are different diagnostic criteria.
I myself have only been in clinical practice for a few years, so I can only judge the degree of injury based on Western medicine, such as orthopedics and sports medicine.
In fact, there was a case where I was massaged on the affected area because it was judged as a moderate separation when it could have been judged as a mild myofasciitis.
Oh, man! But as you might expect, the healing process took a long time after that.
This is an editorial, but I would like to see more research like this, because it could be a solution to this kind of thing! So I would like to introduce it to you.
Contents
Among soccer players, muscle strains account for about 30% of all injuries, and medical professionals have to go through a complex process of diagnosis and management.
In approximately 90% of cases, muscle strains have been found to affect the hamstrings, rectus femoris, adductor, soleus, and gastrocnemius muscles.
A subgroup of mild muscle injuries has been identified, defined as "non-structural muscle injuries" (NSI).
NSIs do not show visible myofiber lesions on MRI and ultrasound and are classified as grade 1a, 1b or zero according to the most recent classification.
Since NSIs account for 30% to 40% of all recorded muscle lesions, they are not rare and may have functional sequelae despite the fact that they are not detected on imaging studies.For this reason, health care providers look for "muscle tightness" and "muscle weakness" in patients during imaging tests.
It has been speculated that complaints of feeling "muscle weakness" may reflect the autophagy of damaged fibers, from weakness caused by both enzyme leakage and possible metabolic exhaustion.
These mechanisms occur in muscle fibers that experience depletion of glycogen stores after intense physical activity.
Under such conditions, the tremendous loss of sarcomere tissue and damage to the ultrastructure of the muscle, an entity due to microstructure, is thought to be metabolic rather than mechanical aetiopathogenesis.
Complaints of feeling "muscle tension" can be seen on imaging tests, but are too small to be realistic.It can be seen with an electron microscope, but it is speculated that this slight muscle damage may be related to the injury.
This injury is caused by a mechanical process that is more powerful than the one causing the sensation of muscle weakness.
Such mechanical injuries caused by the ultrastructure of muscles can be further divided into two phases.
The first phase occurs during physical activity, while the later phase is associated with a secondary inflammatory response, resulting in a painful condition about 24 hours after the triggering event.
The biological consequences of mechanical damage inflicted on the ultrastructure of muscle include damage to the sarcoplasmic reticulum, perturbation of excitation-contraction coupling mechanisms, and a situation of calcium overload caused by Ca2+ spilling from the damaged sarcoplasmic reticulum into the cytosol.
From a practical standpoint, most clinics do not have MRI machines in their facilities, which puts the medical professional in a difficult position as the athlete, or someone around the athlete, will dispute the physical diagnosis and request an unreasonable recovery time.However, underestimating the clinical condition can lead to ultramicrostructure damage deteriorating into structural damage.
Biological markers of such muscle damage, especially to ultrastructure, may improve the challenge of managing this delicate situation, even if in practice the correct diagnosis does not always lead to a better outcome.
Serum Creatine Kinase (CKMM Isoform)
Aldolase
Aspartate aminotransferase
Lactate dehydrogenases (LDH-1 and LDH-2) are classically considered the most convenient and sensitive serological biomarkers of muscle damage.
However, due to their high interindividual variability and lack of sensitivity and specificity, the utilization of their serological markers is problematic.
Summary
Musculoskeletal disorders affect a high percentage of athletes, and muscle overstrain or weakness can be an important clinical indicator.
However, due to the difficulty in confirming muscle damage by diagnostic imaging, most of the time we are forced to judge the degree of muscle damage based on physical examination.
However, it is not uncommon for muscle injuries to become severe due to underestimation, so why not introduce biomarker tests as a way to make diagnostic decisions?Since there are some issues with biomarker tests, it is hoped that future research will improve their accuracy.
This was the topic of our discussion.
