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C h e c k o u t A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 87 CLINICAL E XPLORATIONS this injury is often not chosen because the brachialis can do a great deal of the elbow flexion force generation. If the strain is severe, a defect in the continuity of the muscle fiber may be apparent either visually or with palpation. When visible, the defect looks like a divot or dent in the muscle. Some redness, which is indicative of an inflammatory reaction, may also be visible. The muscles most susceptible to strain injuries are multiarticulate muscles, which are those that cross more than one joint. The more joints crossed by a muscle, the greater their vulnerability to strain injury. The muscle cannot be fully stretched across all joints at the same time, so it is susceptible to tearing from excess tensile stress. Strains can develop in any part of the muscle but ordinarily occur at the musculotendinous junction. The junction of muscle and tendon places one tissue with higher pliability (muscle) directly adjacent to another with limited pliability and more tensile strength (tendon). As a consequence, the point of interface between the two tissues becomes a site of mechanical weakness where the strain occurs. CONTUSION A contusion results from a direct blow to the muscle that causes disruption in the fibers and/or their neurovascular supply. Bruising forms as the blood from damaged capillaries leaks into the muscle tissue and interstitial space. Muscle contusion healing depends on the severity of the impact trauma and the level of disruption of muscle fibers and neurovascular structures. In some cases, a severe contusion can develop into a condition known as myositis ossificans. During the healing process, ossification (bone tissue development) takes place within the muscle injured by the contusion. Awareness of this condition is important because deep pressure on an area with myositis ossificans can cause further muscle damage and be detrimental to the healing process. The anterior muscles of the body vulnerable to direct blows, such as the quadriceps group, biceps brachii, brachialis, and deltoid muscles, are most at risk. Because we focus so much on muscles with our treatment, it is valuable to have a good understanding of how muscles function in a healthy system, as well as common muscle pathologies that may affect them. A good understanding of these different muscle pathologies helps us choose treatment strategies that are most appropriate and will be most helpful for our clients. Notes 1. Jay P. Shah et al., "Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective," PM&R 7, no. 7 (February 2015): 746–61, https://doi.org/10.1016/j.pmrj.2015.01.024. 2. John L. Quintner, Geoffrey M. Bove, and Milton L. Cohen, "A Critical Evaluation of the Trigger Point Phenomenon," Rheumatology 54, no. 3 (March 2015): 392–99, https://doi.org/10.1093/rheumatology/keu471. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. Grades of Muscle Strain First Degree Few fibers torn Minor weakness Minor spasm Minimal loss of function Minor swelling Minor pain on MRT Pain on stretch No palpable defect Decreased ROM Second Degree About half of fibers torn Moderate to major weakness Moderate to major spasm Moderate to major function loss Moderate to major swelling Moderate to major pain on MRT Pain on stretch No palpable defect (usually) Decreased ROM Third Degree All fibers torn Moderate to major weakness Moderate spasm Major loss of function Moderate to major swelling Minor or no pain on MRT No pain on stretch (if muscle is only tissue injured) Palpable defect present Increased or decreased ROM