Physiotherapy Spotlight: Recurrent muscle tears

This week Essendon player Jordan Ridley tore the same quad muscle he tore 4 weeks, doubling his time on the sidelines. As physios we often see that once you tear a muscle once you tear a muscle once you are at much higher risk of tearing it again. Why is this?

First lets look at the healing process:

The healing process after a muscle tear typically involves several stages:

  1. Acute Phase (Inflammatory Phase): This phase begins immediately after the injury and can last up to 72 hours. During this phase, inflammation occurs as the body’s natural response to injury. Blood flow increases to the injured area, bringing with it white blood cells, nutrients, and other substances needed for tissue repair. Swelling, pain, and limited range of motion are common during this phase.
  2. Subacute Phase (Repair Phase): This phase typically lasts from about 72 hours to 3 weeks after the injury. During this time, the body begins to repair the damaged tissue. Fibroblasts, specialized cells involved in tissue repair, migrate to the injured area and begin to lay down new collagen fibers to rebuild the torn muscle fibers. As this process progresses, scar tissue forms to bridge the gap in the muscle.
  3. Remodeling Phase (Maturation Phase): This phase can last from several weeks to several months, depending on the severity of the injury. During this phase, the newly formed tissue undergoes remodeling. The scar tissue gradually aligns itself along the lines of stress in the muscle, becoming stronger and more organized. Physical therapy and rehabilitation exercises are often introduced during this phase to help restore strength, flexibility, and function to the injured muscle.
We can see from this that the muscle repair process can last up to many months and scar tissue forms at the site.
So what are the reasons for re tearing?
  1. Previous Injury: A history of muscle strains increases the risk of future tears due to potential weakening of the muscle and scar tissue formation. (Reference: Orchard JW. Muscle strains in sports: a new evidence-informed classification system. Aust J Physiother. 2007;53(4):220-223.)
  2. Age: Older individuals may have decreased muscle strength and flexibility, making them more susceptible to muscle tears. (Reference: Best TM, Garrett WE. Muscle strains. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, PA: Saunders Elsevier; 2009: chap 19.)
  3. Muscle Imbalance: Weakness or imbalance between agonist and antagonist muscles can lead to excessive strain on certain muscles, increasing the risk of tears. (Reference: Knapik JJ, Bauman CL, Jones BH, Harris JM, Vaughan L. Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes. Am J Sports Med. 1991;19(1):76-81.)
  4. Inadequate Warm-up: Failing to properly warm up before physical activity can leave muscles less prepared for exertion, increasing the risk of tears. (Reference: Woods K, Bishop P, Jones E. Warm-up and stretching in the prevention of muscular injury. Sports Med. 2007;37(12):1089-1099.)
  5. Fatigue: Muscle fatigue reduces strength and coordination, increasing the likelihood of overloading muscles and causing tears. (Reference: Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic risk factors for hamstring injuries among male soccer players: a prospective cohort study. Am J Sports Med. 2010;38(6):1147-1153.)
  6. Inadequate Rehabilitation: Insufficient rehabilitation after a previous injury can leave muscles weakened or improperly healed, predisposing them to tears upon return to activity. (Reference: Orchard JW, Best TM. The management of muscle strain injuries: an early return versus the risk of recurrence. Clin J Sport Med. 2002;12(1):3-5.)
  7. Training Errors: Overtraining, sudden increases in intensity or volume, or inappropriate technique during training can overload muscles and increase the risk of tears. (Reference: Hreljac A. Etiology, prevention, and early intervention of overuse injuries in runners: a biomechanical perspective. Phys Med Rehabil Clin N Am. 2005;16(3):651-667.)
So whats the take away?
In private practice the reasons for reinjury may be different to elite athletes who are pushing timeframes as quickly as possible and pushing the limits of what their body can do. In our clinic more often we see that once the pain is gone people stop their rehab, as the healing process can take months it is important to continue rehab and strengthening after the pain is gone to not only prevent recurrence but resolve why the tear happened in the first place.
Contact our physio team with any questions!