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Muscle injuries are common, and they can occur in several ways, including direct trauma like lacerations and contusions, indirect insults like strains, and degenerative diseases like muscular dystrophies. Muscle healing is a complex process that involves three main phases: destruction, repair, and remodelling. The destruction phase involves muscle degeneration and inflammation, which is part of the body's natural response to injury. The repair phase involves regenerating muscle fibres, which can be aided by early mobilisation and physical therapy. However, scar tissue forms during this phase, which can impair muscle function and make the muscle more susceptible to reinjury. The remodelling phase involves the maturation of regenerated muscle fibres and connective tissue, which helps prevent further injury. While complete muscle regeneration is possible for minor injuries, severe injuries may result in incomplete healing with fibrotic tissue formation.
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What You'll Learn
Muscle regeneration
The inflammatory response plays a crucial role in bridging the initial injury responses and timely muscle reparation. Pro-inflammatory M1 macrophages are predominant at the site of the lesion, contributing to cell lysis and the removal of cellular debris. After a few days, anti-inflammatory M2 macrophages attenuate the inflammatory response and promote muscle repair by stimulating myotube formation. Regulatory T cells (Treg) also play a role in regulating the inflammatory response and influencing satellite cell behaviour.
The formation of scar tissue is a natural part of the healing process, but it can impair muscle function and flexibility. Minimising scar tissue formation is important to help the muscle remain flexible after healing. Suturing the muscle can aid in better healing and less scar formation. Therapeutic ultrasound, laser treatments, and hyperbaric oxygen chambers have been found to stimulate healing.
Additionally, physical therapy is crucial for increasing strength and range of motion without overstressing the recovering muscle. It is important to give adequate time for the muscle to heal and avoid activities that may cause further injury.
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Surgical repair
In cases of muscle tears, debridement is often performed to cut away any damaged or inflamed tissue. This may include removing calcium deposits (bone spurs) from the bone if the muscle is ruptured at the tendon. Scar tissue may also be removed from the muscle fibres, tendons, and surrounding tissue. Debulking or debridement is typically a last resort for chronic muscle conditions when other conservative treatment options have been exhausted.
During a mini-open repair, the surgeon makes a long incision in the skin and/or smaller vertical incisions, commonly referred to as "stab incisions." These smaller incisions are made with surgical scissors or a surgical needle to free up soft tissue tightened by scar tissue. Once the incisions are made, the surgeon places precise sutures in the muscle tissue with non-absorbable stitches to strengthen the damaged area.
Suturing techniques vary and include conventional methods such as Kessler stitches, horizontal mattress, and figure-eight stitches. The optimal goal is to restore function, but it is challenging to achieve full restoration of the muscle to pre-injury strength and flexibility. The formation of scar tissue can lead to incomplete muscle functional recovery, and the muscle may be prone to future injury.
In addition to suturing, a small screw or anchor may be used to reattach the tendon or muscle back to the bone in cases of complete rupture. Surgeons use strong nylon or polyester material with a locking-loop or three-loop pulley pattern to prevent muscle tissue gapping and provide the necessary tension for stronger muscle fibre healing.
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Physical therapy
In the early days after a muscle injury, the body goes through an inflammatory response phase, also known as the destructive phase. During this time, macrophages are released by the immune system to destroy damaged or injured cells. The recommended treatment during this acute phase is the R.I.C.E approach: Rest, Ice, Compression, and Elevation.
After the initial inflammatory phase, the muscle begins its healing process by regenerating muscle fibres. However, scar tissue also forms at the site of the injury, which can make the muscle prone to future injuries. To aid the healing process and prevent chronic pain, physical therapy can be introduced.
For muscle lacerations, physical therapy typically begins after about six weeks of rest and healing. Slow and gentle stretching of the healed muscle helps increase strength and range of motion without overstressing the recovering muscle. Physical manipulation of injured skeletal muscles has been shown to have multiple beneficial effects on muscle biology and function.
The type and severity of the injury play a crucial role in determining the specific physical therapy treatments. For athletes, the goal is to develop treatment plans that align with the body's healing responses, minimising the time needed to return to sports. Overall, physical therapy is a progressive and functional process that aids in muscle recovery and helps individuals regain strength and function.
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Anti-inflammatory medication
NSAIDs are available over the counter, but they do have potential serious side effects. The most frequently reported side effects of NSAIDs are gastrointestinal (stomach and gut) symptoms, such as feeling bloated, stomach pain, nausea and vomiting, and constipation. Taking NSAIDs with food, milk, or antacids may reduce the risk of these gastrointestinal symptoms. However, if these symptoms persist for several days, it is recommended to consult a healthcare provider. Other side effects include feeling lightheaded, balance issues, and difficulty concentrating. It is important to follow the proper dosage instructions for NSAIDs and to speak with a doctor before taking any pain relief medication, including complementary and alternative medicines.
The use of anti-inflammatory medication can be beneficial in the short term to control pain, but long-term use is discouraged. Additionally, NSAIDs are not recommended for use before or during endurance sports. Several studies have found little performance benefit to taking ibuprofen and caution that it may mask pain, leading to an increased risk of injury. Other studies have associated the use of NSAIDs during ultra-distance exercise with an increased risk of exertional hyponatremia. NSAIDs are meant to be used for the short-term and immediate treatment of muscle pain and injury.
Athletes should be cautious when using anti-inflammatory medication to treat muscle pain. While anti-inflammatories can reduce the pain caused by an injury, they may negatively impact the recovery process. Inflammation plays an important role in the healing process, as it helps to absorb and get rid of damaged cells, making way for new cells to rebuild the injured muscle. By taking anti-inflammatories, the inflammation process is inhibited, compromising the healing process. Therefore, while anti-inflammatory medications can provide short-term pain relief, they may not be beneficial for the long-term healing of muscle injuries.
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Scar tissue formation
Scar tissue forms as part of the body's natural healing process. When a muscle is injured, the brain sends special cells to the site of the injury, slowly building a bridge of new tissue, called a collagen scaffold, across the dissected area. Repair cells are sent to fill in tissue across the scaffold, and some scar tissue will always form in this area.
The formation of scar tissue can be influenced by several factors. The depth and severity of the cut, for instance, will impact the amount of scar tissue that forms. For deep and severe cuts, full restoration of the muscle to pre-injury strength and flexibility is challenging to achieve. Transverse cuts through muscle will scar together and become fibrotic and less stretchy.
Orthopaedic surgeons aim to minimize scar tissue formation and help patients rehabilitate their muscles to maintain flexibility after healing. Suturing the muscle is preferred for better healing and less scar formation within the muscle. Therapeutic ultrasound, laser treatments, and hyperbaric oxygen chambers have also been found to be beneficial in stimulating healing.
Scar tissue can also be managed through physical therapy and stretching exercises. Holding the scar in a stretched position through positioning, exercise, or splinting can increase the length of the scar and other soft tissues, helping to prevent joint contracture.
In some cases, scar tissue may require medical intervention for treatment. Pressure therapy, for example, can be used to reduce blood supply to the scar tissue, helping to flatten it. Scar massage is another technique used to improve the function and appearance of scarring. Additionally, drugs such as verteporfin and bleomycin have been studied for their potential in preventing stiffness and reducing collagen production at the site of the injury, respectively.
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Frequently asked questions
A muscle laceration is a cut that goes through the skin and fascia down to the muscle. This is the least common type of muscle injury.
Muscle healing occurs in three phases: destruction, repair, and remodelling. The destruction phase starts when the injury occurs, and the muscle fibres and small blood vessels tear, filling the injured area with blood. This blood contains inflammatory cells that infiltrate the injured area. The repair phase involves the regrowth of blood vessels and muscle fibres, and the remodelling phase involves the maturation of the regenerated muscle fibres and connective tissue.
The treatment for a muscle laceration depends on its severity. For deep and severe cuts, sutures are usually used to repair the muscle and minimise scar tissue formation. Antibiotics and pain medication are often given, and the patient must rest to allow the muscle to heal. Physical therapy can also help increase strength and range of motion without overstressing the recovering muscle.
The time it takes for a cut muscle to heal varies depending on the severity of the injury. Muscle regeneration usually starts within the first 4-5 days after injury, peaks at 2 weeks, and gradually diminishes after 3-4 weeks. However, the remodelling phase can extend from week 7 to several months following the initial trauma.
