Konservative Therapie von Muskelverletzungen – Beurteilung aktueller Behandlungskonzepte

Zusammenfassung

Verletzungen der Skelettmuskulatur gehören in Anbetracht der Inzidenz zu den häufigsten Sportverletzungen. In der klinischen Diagnostik nehmen neben der sorgfältigen Anamneseerhebung und klinischen Untersuchung bildgebende Verfahren einen wichtigen Stellenwert ein. Eine exakte Diagnosestellung ist notwendig, um eine stadiengerechte Therapie einzuleiten und damit eine kurze Regenerationszeit und demzufolge die zeitnahe Re-Integration in den Sport zu gewährleisten. In der Regel können die meisten Muskelverletzungen konservativ versorgt werden und heilen folgenlos aus. Eine verzögerte Diagnosestellung, eine inadäquate Therapie oder eine zu frühe sportliche Belastung können jedoch zu komplizierten und frustranen Heilungsverläufen führen. Therapeutisch stellen die initiale Akuttherapie am Spielfeldrand, adjuvante Therapieverfahren in Form von Infiltrationen und die Anwendung von Physiotherapie wichtige Therapiebausteine dar. Obgleich Verletzungen der Muskulatur in Anbetracht der Inzidenz weit verbreitet sind, ist die wissenschaftliche Grundlage der angewandten Therapieverfahren limitiert. Die vorliegende Arbeit soll eine aktuelle Übersicht über Klassifikation und diagnostische Verfahren geben und dem Leser aktuelle Behandlungsempfehlungen und deren Evidenzlage liefern.

Abstract

Muscle injuries frequently occur during sport and are one of the commonest injuries. The diagnosis and treatment of muscle injuries impose high demands on medical treatment, in order to ensure successful regeneration and a rapid return to sport. Most of the injuries can be treated conservatively, as skeletal muscles have a high endogenous capacity for repair and regeneration. Conservative treatment includes initial on-field therapy. This is known as the “RICE” principle and is common and recommended for initial treatment for most sports injuries. The primary therapy target is to reduce pain, swelling and bleeding and thus to limit the initial inflammatory process and prevent further damage. During the first days after injury, brief immobilization helps to reduce the re-injury rate and accelerates the formation of granulation tissue. There are many possible additional treatments, including intramuscular injections, manipulation of the sacroiliac joint or rehabilitation programs, including stretching and strengthening. If the acute treatment phase is complete after 3 to 5 days, more active treatment, including trunk stabilisation, stretching and strengthening, can be started gradually. Despite their high prevalence, there have only been a few studies on the treatment and management of these injuries. The aim of this manuscript is to review the literature on the classification, pathobiology and treatment strategies for muscle injuries.

Schlüsselwörter

Muskelverletzungen - Muskelfaserriss - Regeneration - Infiltrationstherapie - PECH-Prinzip

Key words

skeletal muscle injuries - muscle strain - regeneration - immobilization - RICE principle

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