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86 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 2 0 movement is restricted due to pain or even fear of a movement being painful (kinesophobia). Disuse atrophy advances quickly, with the muscle losing strength and size in a relatively short period of time. Interestingly, it doesn't seem to affect all muscles equally. Disuse atrophy develops in the primary antigravity muscles more rapidly than other muscles, although the reason is not established. Antigravity muscles are those that are responsible for resisting the downward pull of gravity while in the normal upright position. For example, disuse atrophy affects the quadriceps more than the hamstring muscles because the quadriceps are antigravity muscles. The effects of disuse atrophy are more pronounced if the muscle is immobilized in a shortened position. Immobilization for knee injuries, for example, frequently requires the knee to be set in an extended position where the quadriceps are shortened and the hamstrings are lengthened, which accelerates the quadriceps atrophy. STRAIN A strain, sometimes referred to as a pulled muscle, is a muscle injury produced by excessive tensile stress that causes fibers within the muscle to tear. A muscle strain generally does not result from excess stretch alone but from a combination of tensile load and active muscle contraction. Due to muscle mechanics, strains are more likely when the muscle is in eccentric contraction than concentric or isometric. Remember that muscles are increasing in length during an eccentric contraction, so the increasing muscle length, along with the contraction force, contributes to the strain injury. Strains result from muscular fatigue, lack of proper conditioning, loss of flexibility, poor recovery after exercise, inadequate warm-up prior to vigorous activity, high-force loads, and repetitive overuse. Any muscle can experience a strain, but certain muscles are more susceptible. Those exposed to high-force loads while lengthening, such as the hamstrings or shoulder muscles, are commonly strained. Small muscles, like the intrinsic spinal muscles, are also susceptible to strains due to their small cross section and the repetitive postural loads that can cause the fibers to fatigue. When a muscle strain occurs, fibers of the muscle or tendon are torn along with the connective tissue, capillary beds, and nerve endings in the area. As a result, blood from the broken capillaries can leak into the interstitial space, causing a bruise. However, bruising is not always visible, so lack of visible bruising does not mean muscle damage has not occurred. Muscle strains are most often acute injuries. However, repetitive tensile forces on the muscle can cause small degrees of fiber tearing and produce a chronic strain. Strains, both acute and chronic, frequently develop in muscles that have previously experienced a strain. Scar tissue that repaired the original strain is a weak point in the muscle's continuity and is therefore vulnerable to re-injury. There are three grades of muscle strain: first degree or mild, second degree or moderate, and third degree or severe. Characteristics of these three grades of muscle strain are shown in Grades of Muscle Strain. In a first- degree strain, few muscle fibers are torn. While there may be some post-injury soreness, the individual usually returns to normal levels of activity quickly. With second- degree strains, more fibers are involved in the injury. There is a greater level of pain with this injury and a clear region of maximum tenderness in the muscle tissue. A complete rupture of the muscle-tendon unit occurs with a third-degree strain. Some strains are classified as third degree even though the muscle still has some fibers intact because the damage is so extensive. There is likely to be significant pain at the time of the injury. Pain can be significantly less sometime afterward in a complete rupture because the ends of the muscle are fully separated, and limb movement does not cause additional tensile stress to any remaining fibers. Third-degree strains generally require surgical repair. In some instances, surgery is not performed because the muscle does not play a critical role in that limb's movement, or the potential dangers of surgery outweigh the benefits. Ruptures to the rectus femoris are an example of this, because the other three quadriceps muscles make up for the strength deficit caused by the loss of the rectus femoris. Another example is a complete rupture of the long head of the biceps brachii, which causes the muscle to bunch up in the middle of the upper arm in what is called a "Popeye deformity." Surgery to repair ABMP members can take advantage of in-depth training with an exclusive discount on Whitney Lowe's 130-hour Orthopedic Massage online program. Normally $750, ABMP members pay only $650. Use this code when purchasing: ABMP PRO.

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