Fit & Proper: Don't ignore the injured muscle

Your weekly health guide

Sunil Bagga, 32, was rushing down the stairs of his office to make it in time for a meeting when he twisted his foot. He felt a searing pain, but limped through it. The pain persisted and the foot became red and swollen, but all he did was apply balm . A few days later, the pain became so severe that he was unable to walk. The doctor found Bagga had injured a muscle. The injury had become worse due to neglect. Recovery, he was told, would be a long process.
Broken bones, if set and fixed properly, heal so well that they are as strong as before the fracture. The same is sadly not true for the other component of our musculoskeletal system - the muscle. Muscles are responsible for all the movements of our body. Bones cannot move by themselves. It's the muscles that propel them and enable our body to move and function.

Bones heal by a regenerative process and the healing tissue is identical to the one that existed previously. Muscles heal differently. A muscle tear is often unpredictable and usually happens when the muscle is stretched too quickly. Usually this occurs while the muscle is in motion, such as when running, working or participating in some form of physical activity.

Muscle injuries are also often poorly diagnosed and inadequately managed.

The repair of muscle injury involves two processes. One is regeneration of the disrupted muscle fibres (myofibres) and the other is formation of connective tissue scar during the process of repair. A balanced progression is a prerequisite for optimal recovery of the contractile function of the muscle.

Muscles do not actually heal with muscle tissue but with "foreign" substances, including collagen. The resulting scar tissue is weaker, less elastic, and highly prone to re-injury. (Scar tissue is formed as part of the normal healing process when we injure our muscles, ligaments and tendons. It binds and ties down tissues that need to move freely and as the scar tissue builds up, muscles become shorter and weaker).

Although a majority of skeletal muscle injuries heal without formation of a disabling functional scar, sometimes this scar may be excessive within the injured muscle. This would lead to the muscle function being less than before the injury. This might also lead to chronic pain which persist for months - or even years. Once a muscle is damaged, it can become the source of a great deal of pain.

In a complete muscle tear, the torn muscle ends are not in contact and even repair by scarring might not happen, leading to a complete loss of muscle function unless treated properly.

QUICK TIPS

• Although diagnosis of muscle injury is usually through clinical examination, MRI or ultrasound might be required for a more detailed characterisation of the injury.
• When recovering from a muscle tear, the first thing you need to do is cease the activity that caused it.
• The amount of swelling can best be managed early by applying ice packs and maintaining the strained muscle in a stretched position.
• Compression can be gently applied with an elastic bandage, which can both provide support and decrease swelling.
• You need to give your body adequate rest and proper recuperation time to heal it. However, remaining completely sedentary is also not the answer.
• You should begin to move the joints and the muscle as soon as possible to prevent stiffness, atrophy, and weakness. Once you can do these without pain, you can begin some light activity, warming up properly beforehand.
• If you hear a "popping" sound with the injury, cannot walk or there is significant swelling, pain, fever or open cuts, you should be examined in a hospital's emergency department.
• Finally, sometimes surgery could be required to remove large blood clots or repair complete tear of muscles.

SKS Marya
Chairman and chief surgeon, Max Institute of Musculoskeletal Sciences, Max Super Speciality Hospital, Saket, New Delhi