From muscle complaint to muscle strength

Muscles are responsible for movement in our body and can therefore shorten and lengthen for this reason. A muscle is composed of several muscle fibres that are controlled by nerve signals. These contractions provide strength and thus allow us to move. Muscles are attached to bone by tendons.

Tendons are firm connective tissue structures that anchor the muscle to the bone, so to speak. Besides thus fixing the muscle to the bone, they also play a role in transferring forces. The interplay between muscles and tendons is essential for fluid and controlled movements. Moreover, muscles and tendons adapt to varying forces exerted on the body in sport or in everyday life in order to injuries prevent.

Muscles and tendons themselves consist of several layers or parts. Below is a schematic overview:

Muscle tissue: 

Muscle belly is the central part of the muscle and consists of muscle fibres. This structure is well supplied with blood and in turn consists of smaller units within a muscle.

• Muscle fibres are the smallest units of a muscle. They consist of myofibrils, which in turn are composed of actin and myosin filaments. These contract to produce muscle strength.
• Endomysium is the connective tissue surrounding muscle fibres and is the deepest layer of the 3 connective tissue layers surrounding the muscle.
• Perimysium is the second connective tissue layer and includes groups of muscle fibres called fascicles.
• Epimysium is a layer of connective tissue that envelops the entire muscle and in this way distinguishes it from other muscles.

Tendon tissue:

In particular, tendons consist of collagen fibres that are strong and tensile. These fibres are meant to properly transfer forces from the muscles to the bone where the tendon attaches.

• Some tendons are surrounded by a tendon sheath, which contains a thin layer of mucous-like fluid to prevent friction and keep the tendon moving smoothly.
• Tendon tissue spills over into muscle tissue, or vice versa. It just depends on which side you look at it from.
• Endotenon is the deepest layer of tendon tissue. It allows some, but very little movement. This part is slightly perfused and also contains nerve tissue.
• Peritenon is the middle layer of tendon tissue and also contains multiple bundles of tendon fibres.
• Epitenon is the outer layer of the tendon that covers the entire tendon.

Generally, the recovery time of that muscle belly is the least and the recovery time of the tendon is the longest. On average, a muscle tear can recover within 6 weeks. We often see that the more the damage is in or around the tendon the longer the recovery time, with 3 months being the lower limit.

A quick correct diagnosis is very important for successful treatment, unfortunately this is still a missed. This is where ultrasound within physiotherapy can play an important role. Ultrasound is a valuable addition within physiotherapy to achieve a more objective and focused diagnosis and can reduce the need for costly additional examination. Performing ultrasound examinations more often gives us even more information about the actual damage in the muscle. In our experience, a one-off examination shows a less complete picture than when the same symptoms are followed up more frequently by ultrasound. One reason for this is that it can be difficult to fully expose the injury at an early stage because of swelling and other reactions of the body that take place shortly after the moment of occurrence.

48 hours after occurrence, we can make a statement about whether a muscle is damaged or not. Very briefly: tear or no tear.

After 7-10 days from the moment of onset, we can evaluate how the injury is recovering and whether adjustments may need to be made to the treatment plan. This moment is very important to be able to make a statement about the recovery time of the injury. Also to prevent worse by, for example, wanting to start sport again too soon.

Further examination after this initial phase depends on the type of injury and personal needs. Ultimately, the aim of these examinations is, of course, to get back to sport as soon as possible without taking unnecessary risks!

In short, a muscle tear can be challenging for avid athletes. Understanding the anatomy, as well as the importance of early diagnosis, is crucial for quick recovery. An early start to the rehabilitation process and proper monitoring of the injury is very important and reduces the risk of a recurrent injury. So listen carefully to your physiotherapist's advice and stick to the prescribed treatment plan. All this to get back to worry-free sports!