How To Treat a Long-Term Injury

A long-term injury is a very stressful situation for athletes mainly if they have competitions during the year.

I have been treating many long-term injuries during my career and most of them came from a multifactorial cause and not just a single issue.

Most of these injuries are caused by postural imbalances or musculoskeletal issues and not just by a single muscle issue where is focused the pain.

In order to cure a recurrent injury, we have to treat not only the symptoms but the causes that have led to It.


Now I am going to explain to you the most common causes of long-term injury and right approach to treating and curing them.

We can summarize the most common causes of recurrent injury into 6 categories:

1. Muscles Imbalances between right and left-hand side.

For example, muscles imbalances between the two legs produce an unequal forces distribution during their movement or exercise.

Generally, the weaker leg is not able to support the same load as the stronger leg, and for this reason, It can build new tension up faster.

If this excessive tension continues for a long time It can produce an inflammation process or leads you to an injury such as muscle strain, muscle tear, or tendon tear.

Most of the time the stronger leg is the tightest one and with a lack of muscle and joint flexibility. So, in this case, It is very important do not to treat only the leg affected by the issue ( generally the weaker one ) but the opposite leg too to ease the bigger tension and create a better balance.

Strengthening exercises for the weaker leg are important but only when there is no inflammation process and there is no pain.

Sports therapy such as Sports Massage is one of the best treatments to reduce muscles tension and speed up the anti-inflammatory process and recovery time in general.

For a clinical assessment of muscles imbalances, we can use a simple body tape measure that allows us to get the body part circumferences measurements such as quad and calf.

For a more accurate assessment of muscles biomechanics, we advise you to get a Gait Analysis that will provide you with dozens of analytical data about the forces acting on your body and its interaction with the ground.

2. Stiffness of the Antagonist Muscles.

The muscle or group of muscles that contract to move a joint are called the First Motors or Agonists while the muscles relaxing or lengthening in the opposite direction of the same joint are called Antagonists.

The antagonistic muscles during the movement of the joint have to relax or lengthen in order to facilitate the movement produced by the agonist’s muscles. Antagonistic Muscles exert a braking control on the movement and therefore if they are tense and contracted they oppose a great resistance to the work of the agonists reducing both their power and the range of motion of the related joint.

The picture below illustrates the Agonist and Antagonist system of the arm in which the Biceps Brachii muscle and the Triceps Brachii muscle work simultaneously but in opposite ways.

Antagonist-Agonist Muscles

So in order to reduce the mechanical opposition of the Antagonists to their Agonists muscles we have to ease as much as possible Antagonists’ tension and stiffness.

For example, if we have a hamstring or back leg injury, It is fundamental to treat and check always their antagonists represented by the quadriceps muscles.

The most effective treatments to reduce muscle tension and stiffness are:

Another important thing that all athletes should do in order to reduce muscle tension and improve muscles flexibility, is Stretching.

3. Previous sports injuries not properly healed or cured.

Very often a previous sports injury not properly healed or cured can lead to another injury in the same area or opposite body area due to a postural cross-compensation.

The most common injuries that can initiate this vicious circle of re-injury are:

For example, plantar fasciitis or knee inflammation not properly healed, with the presence always of mild symptoms, can lead to a mechanism of body cross compensation of the opposite body side, like opposite knee or ankle, that can produce a new injury for an excessive load of these musculoskeletal structures.

4. Scar tissue from a previous muscle strain or tear.

Most of the time, a muscle injury, like muscle strain or tear, if not cured or treated properly can lead to the formation of excessive scar tissue around the injured area.

For example, scar tissue represents a point of rigidity of the muscle’s structure as It is not elastic tissue anymore. In fact, the scar tissue is formed by Collagen Tissue that has substituted the muscle fibers. Collagen tissue is mainly an anelastic tissue that will represent the weak point of the muscle with a possible mew muscle tear around that area.

The image below shows how the scar tissue forms in muscles for different conditions.

How Scar Tissue Forms in Muscles

5. Adhesions and Calcifications formed following a previous surgery or muscle/tendon injury.

Adhesions are bands of scar tissue that bind two parts of tissues that are not normally joined together.

The adhesion develops when the body’s repair mechanisms respond to any tissue disturbance such as surgery, traumas, or radiation resulting in inflammation.

Repair cells within the body can not tell the differences between one organ or tissue and another. For example, If a tissue undergoes repair ( like a tendon ) and comes into contact with another part of itself, or another tissue, scar tissue may form to connect the two surfaces.

Tendons Adhesion-Mr Salus Sporting Lab

So we need to avoid as much as possible any chronic inflammation condition It increases the chances to get adhesion formation.

Calcification is a condition caused by calcified fibroblasts. Calcium build-up is most often a result of micro-tears or other trauma to a tendon or other tissues.

Both adhesions and calcification can create more friction between different tissues such as tendons and their sheaths, muscles and their fascias, muscles and closer tendons, and reduce their range of motion too.

Calcifications and adhesion can be treated with good results through an Instrument Assisted Sports Massage with the aim to reduce the frictions between the different tissues, increase the range of motion of the joints, reduce the friction between tendons and their sheath as well as the muscles and their sheaths.

Shockwave Therapy can give good results too with calcifications as acoustic waves generated by the shockwave machine breaks up the existing calcification, starting the biochemical decalcification of the calcium build-up of a toothpaste-like consistency.

6. Postural Imbalances due to the structural issue of the body.

 There are many body structural issues that can produce postural imbalances and lead to recurrent injury.

The most common musculoskeletal disorders are:

  • Scoliosis
  • Kyphosis
  • Flat Back
  • Pelvic Tilt
  • Pronated Foot
  • Supinated Foot
  • Valgus knee

All these different conditions can create an imbalance with the overloading of a particular body’s part or group of muscles. This daily overloading could be the main cause of muscle tension, muscle pain, muscle strain, muscle tear, tendon tear, or a condition of chronic inflammation.

You could assess your body’s structural issue with a good clinical assessment by your trusted doctor or sports therapist.

In order to get more precise information about your musculoskeletal system, you can try to get a High-Tech Postural Assessment through a Gait analysis System that will provide you with dozens of analytical data that your trusted therapist can utilize to work on.

Another good diagnostic is an X-ray of your spine or pelvis to check its structure if you did not already get it in the past.

So in order to cure a long-term sports injury, you need to take into consideration all the possible causes discussed above.

If you have a recurrent injury we highly recommend seeking the consultation of your trusted doctor or sports therapist and avoiding self-treatments.


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