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This study sought to assess how post-game creatine kinase (CK) levels correlate with the number of sprints and the impact of the ACTN3 polymorphism on this response. This research constituted a descriptive/observational, retrospective cross-sectional study. DNA was extracted from blood samples for ACTN3 polymorphism genotyping. CK was measured 48 h after official matches, and the number of sprints (>19 km/h) was tracked using Global Positioning System (GPS) technology. The main cohort included 23 professional soccer players from the top tier of the Brazilian Championship. We analyzed 115 GPS + CK data sets. The replication cohort comprised 18 professional soccer players from the First Division of the Championship, had the same methodology applied, and featured a total of 90 GPS (sprints > 25.2 km/h) + CK data sets. For the main cohort, a significant positive correlation was seen between the number of sprints and the CK levels (p = 0.009). Athletes with the ACTN3 RR genotype had higher CK levels as more sprints were performed during the match (p = 0.017). However, the relationship was not found for X allele carriers (p > 0.05). For the replication cohort, there was a near-significant correlation between CK levels and the number of sprints (p = 0.05), and RR individuals showed a significant association (p = 0.01), whereas X allele carriers did not (p = 0.06). A greater number of sprints during matches is linked to higher CK levels, primarily among players with the ACTN3 RR genotype, which is potentially due to an increased presence of type II muscle fibers. These findings were replicated for both cohorts of elite Brazilian soccer players, emphasizing the importance of genetic factors in injury prevention.

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INTRODUCTION: Previous studies have suggested that a reduced length of the biceps femoris long head (BFlh) fascicles may increase the risk of hamstring strain injury (HSI). However, it remains unclear whether the BFlh fascicles of the injured limb are shorter than those of the contralateral limb in athletes with an acute HSI. OBJECTIVE: To investigate the between-limb asymmetry of BFlh fascicle length in amateur athletes with an acute HSI. METHODS: Male amateur athletes were evaluated using ultrasound scans within five days following an HSI. The BFlh fascicle length was estimated using a validated equation. RESULTS: Eighteen injured athletes participated in this study. There was no significant difference (p = 0.27) in the length of BFlh fascicles between the injured limb (9.53 ± 2.55 cm; 95%CI 8.26 to 10.80 cm) and the uninjured limb (10.54 ± 2.87 cm; 95%CI 9.11 to 11.97 cm). Individual analysis revealed high heterogeneity, with between-limb asymmetries (percentage difference of the injured limb compared to the uninjured limb) ranging from -42% to 25%. Nine out of the 18 athletes had a fascicle length that was more than 10% shorter in the injured limb compared to the uninjured limb, five athletes had a difference of less than 10%, and four athletes had a fascicle length that was more than 10% longer in the injured limb compared to the uninjured limb. CONCLUSION: The architecture characteristics of injured and uninjured muscles is not consistent among athletes with HSI. Therefore, rehabilitation programs focused on fascicle lengthening should be evaluated on a case-by-case basis.

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OBJECTIVE: To describe perceptions and practices of physical therapists from elite men's football clubs on the management of athletes with hamstring strain injury (HSI). DESIGN: Cross-sectional study. SETTING: Online survey. PARTICIPANTS: Physical therapists from clubs engaged in the two main divisions of Brazilian men's football. MAIN OUTCOME MEASURES: Practices for assessment and rehabilitation of athletes with HSI. RESULTS: This survey had 62 physical therapists from 35 of the 40 eligible clubs (87.5% representativeness). Despite heterogeneity on assessment practices, all respondents use imaging exams, adopt injury classification scales, and evaluate aspects related to pain, range of motion, muscle strength, and functional status of athletes with HSI. Rehabilitation programs are usually divided into 3 to 4 phases. All respondents usually apply electrophysical agents and stretching in HSI rehabilitation programs, 98.4% apply strengthening exercises (93.5% include eccentrics), 96.8% manual therapy, 95.2% exercises that mimic the functional demands of football, and 93.5% lumbopelvic stabilization exercises. Muscle strength was the most reported return to play criterion (71% of respondents). CONCLUSION: The present study allowed the sports physical therapy community to become aware of the approaches usually adopted for management of athletes with HSI who play in the highest level of Brazilian men's football.

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PURPOSE: Musculoskeletal injuries are common, and peripheral nerve injury (PNI) causes significant muscle and bone loss within weeks. After PNI, 4-aminopyridine (4-AP) improves functional recovery and muscle atrophy. However, it is unknown whether 4-AP has any effect on isolated traumatic muscle injury and PNI-induced bone loss. METHODS: A standardized crush injury was performed on the sciatic nerve and muscles in mice, and the mice were assigned to receive normal saline or 4-AP treatment daily for 21 days. The postinjury motor and sensory function recovery was assessed, injured muscles were processed for histomorphometry, and the tibial bone was scanned for bone density. RESULTS: 4-Aminopyridine significantly accelerated the postinjury motor and sensory function recovery, improved muscle histomorphometry, increased muscle satellite cell numbers, and shifted muscle fiber types after combined nerve and muscle injury. Importantly, the 4-AP treatment significantly reduced PNI-induced bone loss. In contrast, in the case of isolated muscle injury, 4-AP had no effect on functional recovery and bone density, but it improved muscle-specific histomorphometry to a limited extent. CONCLUSIONS: These findings demonstrate the potential beneficial effects of 4-AP on the recovery of muscle morphology and bone density after combined muscle and nerve injury. CLINICAL RELEVANCE: Nerve injuries frequently involve muscle and result in rapid muscle and bone atrophy. In this scenario, 4-AP, in addition to accelerating nerve functional recovery, might work as an adjunctive agent to improve the recovery of injured muscle and attenuate PNI-induced bone loss.

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Background: The peroneus tertius muscle is responsible for tarsal flexion and coordinate extension of the stifle joint. The most common causes of rupture are excessive effort when trying to rise on a slippery surface, mounting, or being mounted. Rupture of the peroneus tertius muscle is characterized by an inability to flex the hock. Most cases are not curable, presenting an unfavorable to poor prognosis, and the animal has to be euthanized. This study aimed to report the clinical picture and treatment of a bilateral rupture of the peroneus tertius muscle in a cow from the municipality of Castanhal, state of Pará (Amazonian biome). Case: We report the clinical picture and treatment of a bilateral rupture of the peroneus tertius muscle in a 4-year-old cow, mixed breed, weighing approximately 400 kg, calved 3 months ago, belonging to a batch of 40 cattle kept on extensive breeding system in a pasture of Urochloa (Brachiaria) brizantha. The clinical signs appeared after the cow was mounted by a 1,100 kg bull and consisted of lameness, falling into sternal decubitus with hind limbs extended backward, hyperextension of the hocks with flexed stifle, with the tibia and metatarsus in a straight line, which lead to a 90-degree position of the femur and knee. Abrasions in the dorsal region of the fetlocks reinforce evidence of dragging hooves. Diagnosis of bilateral rupture of the peroneus tertius muscle was performed by a clinical examination and semiological test. Nonsteroidal anti-inflammatory drugs (flunixin meglumine, 2,2 mg/kg, every 24 h for 4 days) were prescribed for treatment, in addition to resting in a paddock with good availability of pasture, water, and mineral salt. After 3 months, we observed an improvement of the clinical signs, and after 6 months, an almost complete recovery. Only a slight difficulty in flexing the hock when moving remained. Discussion: In the present report, bull mounting was the probable cause of the hyperextension of both hocks and the bilateral rupture of the peroneus tertius muscle. According to the handler, these clinical signs were only evidenced after the animal was mounted. As stated in the literature, accidents such as falls, slips, mounting or being mounted, as well as excessive traction and over-elevation of the limb are considered predisposing factors for the onset of the disease. Rupture of the peroneus tertius muscle is unusual in production animals; therefore, the low occurrence of reports on this kind of rupture in the literature makes this case even more unique. The bilateral injury differs from cases described in the literature, in which the reported injuries were always unilateral. Our findings reinforce the hypothesis that the act of mounting was the triggering factor for the bilateral rupture of the animal peroneus tertius muscle. The breeding system also differs from the cases diagnosed by the same authors, since they describe the disease in bovines kept on intensive or semi-intensive breeding. In the present case, the cattle were kept on an extensive breeding system. The extension and flexion tests used in the clinical examination allowed for the diagnosis of rupture of the peroneus tertius muscle in both limbs, similarly to what has been reported by other authors. Anamnesis, clinical findings, and exclusion of different diagnoses were decisive for establishing the diagnosis. The treatment chosen was efficient, even though the case was severe, as the injury occurred in both hind limbs.

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Background: Hamstrings injuries are a major concern in football (soccer), affecting both recreational players and professional athletes. Although being a recognized issue within the football community, its incidence has been increasing over the last years and still poses a challenge to all practitioners involved. Study objectives and rationale: The goal of this narrative review is to outline hamstrings injuries epidemiology and mechanisms of injury, identify and discuss its risk factors, provide an approach to a proper early diagnosis, evaluate the efficacy of current treatment options and return to sports, and present the best strategies for hamstrings injury prevention. These guidelines will help the sports medicine staff team on how to better manage their players with or at risk of hamstrings injuries. Conclusion: Despite several breakthroughs in research of hamstrings injuries, there is still heterogeneity across studies and lack of consensus in regards to classification, diagnosis, treatment and prevention. Hamstrings injuries compromise the athlete's performance with time loss due to injury, shortens their highest-level career longevity with higher risk of reinjury rates, and is a defying problem for clubs to balance financial losses due to having their players off the pitch. Further research is warranted to keep moving forward with evidence on treating and preventing hamstrings injuries to mitigate its high incidence and keep the players safe.

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SUMMARY: Skeletal muscle injury is an acute inflammatory condition caused by an inflammatory response. To reduce inflammatory cell infiltration and relieve skeletal muscle injury, efficient treatment is urgently needed. Nitric oxide is a free radical molecule reported to have anti-inflammatory effects. In this study, we showed that NO could inhibit the inflammatory response of C2C12 cells in vitro and protect rat skeletal muscle injury from notexin in vivo. NO synthase inhibitor (L-NG-Nitroarginine Methyl Este?L-NAME) and NO donor (sodium nitroprusside dehydrate ?SNP) were used to explore the vital role of lipopolysaccharides (LPSs) in LPS-stimulated C2C12 myoblasts.The expression of IL-18 and IL-1b was upregulated by L-NAME and downregulated by SNP, as indicated by the ELISA results. NO can reduce ASC, Caspase-1, and NLRP3 mRNA and protein levels. Furthermore, NO was detected in the rat model. The results of immunohistochemical staining showed that the production of DMD decreased. We conducted qRT-PCR and western blotting to detect the expression of Jo-1, Mi-2, TLR2, and TLR4 on day 6 post injury following treatment with L-NAME and SNP. The expression of Jo-1, Mi-2, TLR2, and TLR4 was upregulated by L-NAME and significantly reversed by SNP. NO can alleviate C2C12 cell inflammatory responses and protect rat skeletal muscle injury from notexin.

RESUMEN: La lesión del músculo esquelético es una afección inflamatoria aguda causada por una respuesta inflamatoria. Para reducir la infiltración de células inflamatorias y aliviar la lesión del músculo esquelético es necesario un tratamiento eficaz. El óxido nítrico es una molécula de radicales libres que tiene efectos antiinflamatorios. En este estudio, demostramos que el ON podría inhibir la respuesta inflamatoria de las células C2C12 in vitro y proteger la lesión del músculo esquelético de rata de la notexina in vivo. El inhibidor de ON sintasa (L-NG-nitroarginina metil este, L-NAME) y el donante de ON (nitroprusiato de sodio deshidratado, SNP) se utilizaron para explorar el papel vital de los lipopolisacáridos (LPS) en los mioblastos C2C12 estimulados por LPS. La expresión de IL- 18 e IL-1b fue regulada positivamente por L-NAME y regulada negativamente por SNP, como indican los resultados de ELISA. El ON puede reducir los niveles de proteína y ARNm de ASC, Caspasa-1 y NLRP3. Además, se detectó ON en el modelo de rata. Los resultados de la tinción inmunohistoquímica mostraron que disminuyó la producción de DMD. Realizamos qRT-PCR y transferencia Western para detectar la expresión de Jo-1, Mi-2, TLR2 y TLR4 el día 6 después de la lesión después del tratamiento con L-NAME y SNP. La expresión de Jo-1, Mi-2, TLR2 y TLR4 fue regulada positivamente por L- NAME y significativamente revertida por SNP. El ON puede aliviar las respuestas inflamatorias de las células C2C12 en ratas, y proteger la lesión del músculo esquelético de la notexina.

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The intravascular or transcutaneous application of photobiomodulation (PBM) over blood vessels (vascular photobiomodulation, VPBM) has been used for the treatment of inflammatory and chronic conditions with promising systemic results. This study evaluated the VPBM effects on a model of muscle regeneration after acute injury and compared the outcomes of preventive and therapeutic VPBM. Transcutaneous VPBM was administered over the rat's main tail vein. Serum levels of creatine kinase (CK), aspartate aminotransferase (AST), and lactate were evaluated and muscles were processed for macroscopic and microscopic analysis. Preventive and therapeutic VPBM led to decreased inflammatory infiltrate, edema, and myonecrosis but with an increase in immature muscle fibers. CK, AST, and lactate levels were lower in the groups treated with VPBM (lowest concentrations in preventive VPBM application). Preventive and therapeutic VPBM were capable of exerting a positive effect on acute muscle injury repair, with more accentuated results when preventive VPBM was administered.

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The study aimed to verify how age, height, body mass and body mass index affects the eccentric knee flexor strength during the Nordic hamstring exercise (NHE) in male soccer players. Ten professional soccer clubs were included in this cross-sectional trial. Three hundred and eleven soccer players (192 from senior and 119 from under-20 teams) were assessed using a load-cell based device. Pearson's correlation tests were performed between peak force values (measured in Newtons) and age, height, body mass and body mass index. The individual-limb strength (n = 622 limbs) and the between-limb average strength (n = 322 players) presented no correlation with age (r = 0.12 for both) and height (r = 0.13; r = 0,15), and fair correlations with body mass (r = 0.37; r = 0,41) and body mass index (r = 0.40; r = 0,43). In conclusion, the male soccer players' eccentric knee flexor strength measured during the NHE execution is not affected by age or height. Body mass and body mass index play somewhat effect on strength, thus normalising absolute strength measures by body mass or body mass index can provide more accurate analysis in some contexts.

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Resumen La realidad virtual (RV) constituye una herramienta alternativa para la rehabilitación de distintas lesiones del cuerpo humano. Este artículo identifica los principales aportes de la RV en tratamientos de rehabilitación muscular reportados en la literatura. Según las investigaciones analizadas, se evidenció que, a diferencia de los tratamientos convencionales para la rehabilitación muscular, los realizados con RV incrementaron el nivel de motivación de los pacientes para culminar con éxito, gracias al ambiente interactivo que la RV ofrece. Así mismo, de acuerdo con los estudios revisados, los pacientes manifestaron disminución de dolor durante y después de las terapias.

Abstract Virtual reality (VR) is an alternative tool for the rehabilitation of various injuries of the human body. This paper identified the main contributions of RV in muscle rehabilitation treatments reported in the literature. According to the analyzed research, it was shown that, unlike conventional treatments for muscle rehabilitation, those performed with RV increased the level of motivation of patients to successfully complete them, thanks to the interactive environment that VR offers. Likewise, according to the reviewed studies, the patients manifested decreased pain during and after therapies.

Resumo Nos últimos anos, a realidade virtual (VR) se estabeleceu como uma ferramenta alternativa para a reabilitação das diferentes lesões que o corpo humano pode sofrer. O objetivo desta revisão sistemática é identificar as principais contribuições evidenciadas em pesquisas anteriores sobre o assunto, que serviram de base para a formulação deste artigo. Para avaliação da literatura, foi realizada uma consulta preliminar nas principais bases de dados, a partir da qual foram obtidos resultados que permitiram dimensionar a contribuição do VD na recuperação de lesões musculares. De acordo com a amostra, ficou evidente que, diferentemente dos tratamentos convencionais para reabilitação muscular, aqueles realizados com o VD aumentavam o nível de motivação dos pacientes para concluir com sucesso o tratamento, portanto a adesão a todas as terapias era mais alto, isso graças ao ambiente interativo que o RV consegue oferecer. Por outro lado, de acordo com os estudos revisados, os pacientes manifestaram diminuição da dor durante e após a realização de diferentes terapias implementadas em cada investigação.

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The objective of this study was to analyze the effectiveness of phonophoresis with copaiba oil gel, in comparison to therapeutic pulsed ultrasound alone or topical application of copaiba oil gel, on oxidative stress after a traumatic muscle injury. Forty male Wistar rats were divided into five groups: control, muscle injury, therapeutic pulsed ultrasound (TPU), copaiba oil gel (CO) and TPU plus CO. TPU and CO application occurred at 2, 12, 24, 48, 72 and 96 h after injury. The gastrocnemius muscle was injured by mechanical trauma. Malondialdehyde (a lipoperoxidation marker) and superoxide dismutase and catalase (antioxidant enzymes) were assessed 98 h after muscle injury. All were elevated in the muscle injury group. There was a significant difference among treatment groups favoring TPU plus CO for reducing malondialdehyde levels, but all treatments reduced superoxide dismutase and catalase activity, with no between-groups difference. In conclusion, phonophoresis-the application of TPU plus CO-was superior to TPU or CO alone for reducing lipoperoxidation. Phonophoresis, TPU alone and CO were all effective in decreasing antioxidant enzyme activity after a traumatic skeletal muscle injury.

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Skeletal muscle has remarkable regenerative ability after injury. Mesenchymal fibro-adipogenic progenitors (FAPs) are necessary, active participants during this repair process, but the molecular signatures of these cells and their functional relevance remain largely unexplored. Here, using a lineage tracing mouse model (Gli1-CreER Tomato), we demonstrate that Gli1 marks a small subset of muscle-resident FAPs with elevated Hedgehog (Hh) signaling. Upon notexin muscle injury, these cells preferentially and rapidly expanded within FAPs. Ablation of Gli1+ cells using a DTA mouse model drastically reduced fibroblastic colony-forming unit (CFU-F) colonies generated by muscle cells and impaired muscle repair at 28 days. Pharmacologic manipulation revealed that Gli1+ FAPs rely on Hh signaling to increase the size of regenerating myofiber. Sorted Gli1+ FAPs displayed superior clonogenicity and reduced adipogenic differentiation ability in culture compared to sorted Gli1- FAPs. In a glycerol injury model, Gli1+ FAPs were less likely to give rise to muscle adipocytes compared to other FAPs. Further cell ablation and Hh activator/inhibitor treatments demonstrated their dual actions in enhancing myogenesis and reducing adipogenesis after injury. Examining single-cell RNA-sequencing dataset of FAPs from normal mice indicated that Gli1+ FAPs with increased Hh signaling provide trophic signals to myogenic cells while restrict their own adipogenic differentiation. Collectively, our findings identified a subpopulation of FAPs that play an essential role in skeletal muscle repair. © 2021 American Society for Bone and Mineral Research (ASBMR).

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BACKGROUND: Given the severe economic and performance implications of hamstring injuries, there are different attempts to identify their risk factors for subsequently developing injury prevention strategies to reduce the risk of these injuries. One of the strategies reported in the scientific literature is the application of interventions with eccentric exercises. To verify the effectiveness of these interventions, different eccentric strength measurements have been used with low-cost devices as alternatives to the widespread used isokinetic dynamometers and the technically limited handheld dynamometers. Therefore, the purpose of the present systematic review was to summarize the findings of the scientific literature related to the evaluation of eccentric strength of hamstring muscles with these new technologies. METHODS: Systematic searches through the PubMed, Scopus, and Web of Science databases, from inception up to April 2020, were conducted for peer reviewed articles written in English, reporting eccentric strength of hamstrings assessed by devices, different to isokinetic and handheld dynamometers, in athletes. RESULTS: Seventeen studies were finally included in the review with 4 different devices used and 18 parameters identified. The pooled sample consisted of 2893 participants (97% male and 3% female: 22 ± 4 years). The parameters most used were peak force (highest and average), peak torque (average and highest), and between-limb imbalance (left-to-right limb ratio). There is inconsistency regarding the association between eccentric hamstrings strength and both injury risk and athletic performance. There is no standardized definition or standardization of the calculation of the used parameters. CONCLUSIONS: The current evidence is insufficient to recommend a practical guide for sports professionals to use these new technologies in their daily routine, due to the need for standardized definitions and calculations. Furthermore, more studies with female athletes are warranted. Despite these limitations, the eccentric strength of hamstring muscles assessed by different devices may be recommended for monitoring the neuromuscular status of athletes.

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Both injury history and eccentric knee flexor strength have been associated with risk of football players sustaining hamstring strain injury (HSI). However, it remains unclear whether football players who sustained HSIs in the prior season present persistent eccentric strength deficits. Therefore, the aim of the present study was to verify the eccentric knee flexor strength of professional male football players with and without history of HSI in the prior season. This case-control study assessed 210 professional male football players from 10 Brazilian clubs: 182 included in the control group and 28 in the previously injured group. Players from the injured group had suffered unilateral HSI in the prior season. We measured the knee flexors peak force during the Nordic hamstring exercise and calculated the between-limb asymmetry. Groups were similar for age, body mass and height (p > 0.05). Control group had similar strength values between left and right limbs (376.29 ± 61.77 N vs. 380.28 ± 61.77 N; p = 0.27; d = 0.06), while the previously injured limb was weaker than the contralateral uninjured limb in the injured group (350.87 ± 60.79 N vs. 385.75 ± 63.49 N; p < 0.01; d = 0.56). Thirty-seven percent of players in the control group and 50% in the injured group presented between-limb asymmetry >10%. This study demonstrates that players with history of HSI in the prior season present reduced eccentric knee flexor strength in the injured limb, but half of them have between-limb asymmetry within the most commonly adopted benchmark value of 10%.

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Cryotherapy is a therapeutic modality widely used for the treatment of muscle injuries to control pain and inflammatory processes. This study aimed to investigate the effects of cryotherapy on the inflammatory and oxidative stress parameters and mechanical properties of, and pain in, the skeletal muscles of rats with lacerative muscle injury. The rats were anesthetized with 4% isoflurane and subjected to gastrocnemius muscle laceration injury. After injury, all animals in the intervention groups received cryotherapy treatment for 20 minutes using plastic bags containing crushed ice. The protocol comprised three daily applications at 3-hour intervals on the day of injury, with reapplication 24 hours later. Seventy-two male Wistar rats were divided into three groups: sham, muscle injury (MI), and MI + cryotherapy (MI + cryo). Muscle mechanical properties were analyzed by mechanical tensile testing on day 7 after injury. The MI + cryo group showed reduced TNF-α, IFN-γ, and IL1ß levels; elevated IL4, IL6, and IL10 levels; reduced oxidant production and carbonyl levels; and elevated sulfhydryl contents. Animals that underwent tissue cooling showed superoxide dismutase activity and glutathione levels close to those of the animals in the sham group. The MI and MI + cryo groups showed reduced values of the evaluated mechanical properties and lower mechanical thresholds compared to those of the animals from the sham group. Our results demonstrated that the proposed cryotherapy protocol reduced the inflammatory process and controlled oxidative stress but did not reverse the changes in the mechanical properties of muscle tissues or provide analgesic effects within the time frame analyzed.

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Athletic dogs are more susceptible to musculoskeletal disorders, especially in the muscles or tendons surrounding the shoulder joint. In this report, we describe a case of partial bilateral rupture of the infraspinatus muscle, an unusual injury. Clinical signs included lameness of the left thoracic limb after training. On physical examination, there was discomfort on bilateral palpation in the infraspinatus fossa region. The main clinical suspicion was partial rupture or myositis of the infraspinatus muscle (IF). Ultrasound examination of the region revealed the presence of hypoechoic areas intermingling the muscle fibers in a deeper and distal region of the infraspinatus muscle, compatible with edema or bilateral intramuscular hematoma (left +++, right ++) and integrity of the fascia. The findings were characterized as a partial rupture of the musculature. A detailed physical examination associated with ultrasound examination is essential for early diagnosis and therapeutic management. Although no other reports of partial rupture of the IF have been found, partial or complete rupture of muscle fibers in sport dogs is frequent. Early diagnosis prevents the development of contractures due to the institution of therapy before the fibrous process is established and improves prognosis.

Os cães atléticos são mais suscetíveis a sofrer de distúrbios musculoesqueléticos, especialmente nos músculos ou tendões ao redor da articulação do ombro. Neste relato, é descrito um caso de ruptura parcial bilateral do músculo infraespinhal, uma lesão incomum. Os sinais clínicos incluíram claudicação no membro torácico esquerdo após o treinamento de corrida. Ao exame físico, havia desconforto à palpação bilateral em região da fossa infraespinhal. A principal suspeita clínica foi ruptura parcial ou miosite do músculo infraespinhal (IF). O exame ultrassonográfico da região revelou a presença de áreas hipoecóicas mesclando as fibras musculares em região mais profunda e distal do músculo infraespinhal, compatível com edema ou hematoma intramuscular bilateral (esquerdo +++, direito ++) e integridade da fáscia. Os achados foram caracterizados como ruptura parcial da musculatura. O exame físico detalhado associado ao exame de ultrassom foi essencial para o diagnóstico precoce e o manejo terapêutico. Embora nenhum outro relato de ruptura parcial do IF tenha sido encontrado, rupturas parciais ou totais das fibras musculares em cães esportivos são frequentes. O diagnóstico precoce evita o desenvolvimento de contraturas devido à instituição da terapia antes do estabelecimento do processo fibroso e melhora o prognóstico.

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SUMMARY: Severe muscle injuries are common in accidents and have a delayed recovery of muscle integrity. In these cases, muscle suture surgery is the standard treatment. However, Platelet Rich Plasma (PRP), has been widely used in orthopedic injuries due to its growth factors. Thus, the objective of the study will be to analyze the association of suture and PRP techniques in the collagen and tenacity of the injured muscle. Were used seventy rats, divided into five groups: control (C), injury control (CI), injury and suture (IS), injury and PRP (IP), injury, suture, and PRP (ISP). Were sectioned approximately 50 % of the width and 100 % of the thickness of the gastrocnemius muscle. The homologous PRP was applied 24h after the injury. On the 7th day after the injury, the animals were euthanized and their muscles subjected to mechanical testing to measure tenacity or collagen analysis to calculate the ratio between type I and III collagen. The results show a significant decrease (p <0.05) in the values of the relationship between collagens in all injured groups (CI, IS, IP, ISP) compared to group C. In injured groups, the tenacity was significantly (p <0.05) reduced compared to the control group, with no observed difference between treatments and injured groups. The amount of collagen in the injured area has increased, but it did not affect the tenacity of the muscles, which was reduced.

RESUMEN: Las lesiones musculares graves son comunes durante los accidentes y la integridad del músculo está sujeta a una larga recuperación. En esos casos la cirugía, para la sutura del músculo, es el tratamiento común, no obstante el plasma rico en plaquetas (PRP) ha sido utilizado recientemente en lesiones ortopédicas, debido a sus factores del crecimiento. El objetivo del estudio fue analizar la asociación de las técnicas de sutura y PRP en la histología y tenacidad de músculo lesionado. Fueron utilizadas 70 ratas distribuidas en cinco grupos: control (C), control lesión (CL), lesión y sutura (LS), lesión y PRP (LPRP), lesión, sutura y PRP (LSPRP). Aproximadamente en la lesión, el 50 % de la longitud y el 100 % del espesor del músculo gastrocnemio fueron seccionados. El PRP homólogo fue aplicado 24 horas después de la lesión. En el 7º día después de la lesión los animales fueron eutanasiados y las muestras fueran sometidas al ensayo mecánico para la medición de la tenacidad y análisis del colágeno, para realizar el cálculo de la relación entre los colágenos I y III. Los resultados demostraron una reducción significativa (p<0,05) en los valores de la relación entre los colágenos en todos los grupos lesionados en relación al grupo C. La tenacidad fue (p<0,05) reducida significativamente en los grupos lesionados en relación al grupo control, sin diferencia entre los tratados. En la lesión muscular hubo disminución de los valores de colágeno, aunque en los tratamientos se observó elevación de la cantidad de colágeno en la área lesionada, esta no tuvo efecto en la tenacidad de los músculos que fue disminuida en la lesión.

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The use of nanotechnology for administering drugs is a recent development that presents promising results. Therapeutic Pulsed Ultrasound (TPU) is one such therapeutic option and is widely used for treating soft tissue lesions. Thus, the objective of this study was to investigate the therapeutic effect of phonophoresis using diclofenac (DC) linked to gold nanoparticles (GNPs) in the skeletal muscle of rats used as a model of traumatic muscular injury. Wistar rats were divided into eight groups (N = 10): Sham, Muscle injury (MI), MI + TPU, MI + DC, MI + GNPs, MI + TPU + DC, MI + TPU + GNPs, and MI + TPU + DC-GNPs. The traumatic injury was performed in the gastrocnemius with a single direct traumatic impact via an injuring press. The animals received daily treatment for 5 consecutive days with TPU and gel with DC and/or GNPs. Two hours after the last treatment session, animals were euthanized and the gastrocnemius muscle surgically removed for histological and biochemical analysis. The groups exposed to some therapies (MI + TPU + DC, MI + TPU + GNPs and MI + TPU + DC-GNPs) showed reduced levels of pro-inflammatory cytokines, whereas an increase in anti-inflammatory cytokine levels was observed in the group exposed to all therapies combined (MI + TPU + DC-GNPs). Reactive species production and protein damage resulting from oxidative damage was lower for the group exposed to all tested therapies had lower production. Lower protein damage was also observed in the TPU + GNPs group. The group that underwent all tested therapies combined showed a significant increase in antioxidants compared to the MI group. During histological analysis, the MI group showed large amounts of cell infiltration and centralized nuclei, whereas the MI + TPU + DC-GNPs group showed structural improvements. Pain levels in the MI + TPU + DC-GNPs group were lower than those of the MI group. We believe that the association of TPU with DC linked to GNPs decreases the inflammation caused by traumatic muscle injury and accelerates tissue repair.

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BACKGROUND: Musculoskeletal injuries (MSK-I) are a serious problem in sports medicine. Modifiable and non-modifiable factors are associated with susceptibility to these injuries. Thus, the aim of this study was to describe the prevalence of and identify the factors associated with MSK-I, including tendinopathy and joint and muscle injuries, in athletes. METHODS: In this cross-sectional observational study, 627 athletes from rugby (n = 225), soccer (n = 172), combat sports (n = 86), handball (n = 82) and water polo (n = 62) were recruited at different sports training centres and competitions. Athlete profiles and the prevalence of MSK-I were assessed using a self-reported questionnaire. Only previous MSK-I with imaging confirmation and/or a positive physical exam by a specialized orthopaedist were considered. The association of the epidemiological, clinical and sports profiles of athletes with MSK-I was evaluated by a logistic regression model. RESULTS: The mean age was 25 ± 6 years, and 60% of the athletes were male. The epidemiological, clinical and sports profiles of the athletes were different for the five sport groups. The MSK-I prevalence among all athletes was 76%, with 55% of MSK-I occurring in a joint, 48% occurring in a muscle and 30% being tendinopathy, and 19% of athletes had three investigated injuries. The MSK-I prevalence and injury locations were significantly different among sport groups. There was a predominance of joint injury in combat sports athletes (77%), muscle injury in handball athletes (67%) and tendinopathy in water polo athletes (52%). Age (≥30 years) was positively associated with joint (OR = 5.2 and 95% CI = 2.6-10.7) and muscle (OR = 4.9 and 95% CI = 2.4-10.1) injuries and tendinopathy (OR = 4.1 and 95% CI = 1.9-9.3). CONCLUSION: There is a high prevalence of tendinopathy and joint and muscle injuries among rugby, soccer, combat sports, handball and water polo athletes. The analysis of associated factors (epidemiological, clinical and sports profiles) and the presence of MSK-I in athletes suggests an approximately 4-5-fold increased risk for athletes ≥30 years of age. The identification of modifiable and non-modifiable factors can contribute to implementing surveillance programmes for MSK-I prevention.

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