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What is muscle contracture?

Muscle contracture is classed as a muscle injury and is the least serious kind of muscle injury because no fibre damage occurs. It makes it particularly difficult for the muscle to drain away the excess incoming blood flow, which then makes it difficult for the muscle in question to contract autonomously.

THE PATIENT
gender: male
age: 20
sport played: football
details: lanky build

SYMPTOMS

The patient experienced pain after a football match accompanied by functional deficit, discomfort upon palpation and particularly marked pain in the affected area: the rectus femoris in the right thigh.

Diagnostic investigations

The patient visited the physiotherapist the day after the match, which was a Monday. Given that the signs and symptoms clearly indicated muscle contracture, there being no effusion or tissue swelling suggestive of a second or third-degree injury, the patient underwent an ultrasound. The ultrasound confirmed muscle contracture, which can be either simple or complex. In this case the patient had developed a complex contracture and the prognosis involved more than five days of therapy. As regards the pathological anatomy, upon palpation the tissue in the area was more rigid than usual and paler, almost yellowish in colour. In these circumstances, rehabilitative treatment is the only way to restore the muscle to its original condition.

The patient could have been exposed to a risk of contracture by factors such as poor training in the run-up to the match or a flu-like illness. Other possible factors could have included missing a few training sessions during the week, having had previous injuries, or even hypotonic muscles unable to meet the demands placed on them during the match.

These risk factors can often be associated with postural factors that can have a negative effect, such as an anterior-posterior imbalance between the extensor chain and the flexor chain.

In this specific case the right rectus femoris was affected, raising the possibility that the athlete may have a potential imbalance able to cause the onset of muscle contracture.

It ultimately emerged that the patient’s contracture was the result of stress. He had subjected his body to extreme activity during the week without adequate recovery that would enable him to relax his muscles, which were extremely acidified by the intense muscular activity carried out. Unfortunately, this is another risk factor, especially for amateur athletes who are not properly monitored and can therefore overwork the muscle structures without being aware of it.

PROGNOSIS

In this case, as the patient had a complex contracture the prognosis exceeded five days from the onset of the contracture (with the potential to last from five to seven or five to nine days depending on the circumstances).

TREATMENT

On the very day the patient first experienced the muscular discomfort he had to place ice on the affected area (therefore immediate cryotherapy is required) and then rest to facilitate the muscle in the drainage process.

The ultrasound was performed the following day and the patient moved directly on to therapeutic treatment. In this case he underwent tecar therapy using the Fisiowarm Vogue model. During the first application we used a capacitive bipolar electrode at a frequency of 1 MHz for around thirty minutes at low dosage, to help speed up the drainage process. From the second application onwards the patient combined the physiotherapy with some dietary supplements that enabled us to improve vasodilation. In greater detail, he used an amino acid called arginine to stimulate nitric oxide production, as this boosts vasodilation, leading to an increased blood flow that helps to drain the contracted area and improve its superficial vascularisation.

On the third day (second session) after the injury occurred, the treatment was once again performed with a capacitive bipolar electrode for a total duration of twenty minutes, raising the dose slightly above 20–25 watts. This produced a higher temperature that enabled us to increase vasodilation within the structure itself (always at a frequency of 1 MHz), before proceeding cautiously with manual treatments such as superficial lymphatic drainage and subsequent kneading of the muscle upstream and downstream from the contracture, making it possible to open the outlets that can help to increase the blood flow and thereby drain the contracture.

From the third to the sixth session, on the other hand, the capacitive unipolar patient underwent treatment. The neutral plate was placed under the thigh, selecting gradually decreasing frequencies from 1 MHz to 900 kHZ, 800 kHz and 750 kHz, so as to gradually start stimulating the tissue just beneath the surface layer and thus increase local vascularisation.

This was followed by manual tissue squeezing and friction treatments in the contracted region to improve the possibility of obtaining more intense muscle activity.

As regards any additional sessions that could be necessary depending on the severity of the case, treatment with tecar therapy can always be used: you could opt for capacitive bipolar treatment with automatic frequency scanning (from 500 kHz to 1 MHz), in continuous output, followed by manual treatment and muscle strengthening exercises designed to stretch the structure itself and increase its flexibility to aid the recovery of the athlete and his or her return to action.

In the case in question the treatment was effective. After the sixth session the athlete was able to start training again with no discomfort at all.

It is important to bear in mind that dietary supplements should only be taken under medical supervision. Following medical consultation we achieved an excellent result with arginine supplementation because, combined with bicarbonate, it helped to increase tissue acidification and thus improve muscle contractility.

arginine a semi-essential amino acid. Arginine is involved in numerous metabolic processes and is important in the treatment of cardiac diseases and high blood pressure.