Patient that attends to the clinic with a pain in a spot in the lower vertex of the medial gastrocnemius. The pain appeared suddenly while running. It is described as a blow with a stone. There is no hematoma, but there is pain when touching the painful point and when doing efforts and stretching.
It is decided to make an ultrasound. The following images are found.
This image has been taken longitudinally.
The rupture in this spot tipically appears in the vertex of the medial gastrocnemius, where both fascias (gastrocnemius and soleus) join.
This pain is not usually identified as a muscle injury and many of them evolve to a more severe injury. The ultrasound image allows me to locate the injury and treat it in the same moment, being able to reduce the recovery terms.
Patient 28 years old that attends to the clinic to ask about a pain and a lump in the Rectus abdominis muscle. The pain started during a Padel game, in an toss.
There is no difference between both halves of the abdomen in the visual inspection. In the palpatory examination I can feel the lump. This leads me to think about an abdominal hernia. There is a pain of 4 out of 10 in the V. A. S.
The ultrasound image (ecography) shows the swollen muscle belly and also shows that there is no breakage of the deep abdominal fascia, what means that there is not an hernia.
The treatment consists in putting needles into the muscle rupture and applying a current.
In this case the use of ultrasound image (ecography) is compulsory due to the risk of drilling the deep abdominal fascia.
After one single session the patient feels a remarkable improvement and a reduction in the lump. More sessions are needed though.
Patient 29 years old that comes up to consultation due to a focused pain of 6 out of 10 in the Visual Analogue Scale. The pain started 3 months ago during the refurbishment of the house. It has been increasing since then. His pain appears when palpation in the spot, not in different spots arround though. Ultrasound image does not show inflammation or degenerative changes in the tendon or in the bone cortex.
It is decided to use puncture due to the fact that the patient does not ameliorate after treating muscles involved.
Patient: Male, 28 years old. Football player. Comes up to consultation due to an acute pain on his knee, mostly when shooting the ball, that started about 1 month ago and has increased since then. He locates the pain in the Pens aserinus.
There is no inflammation or bruise in the visual exploration.
His pain appears when palpation in the spot, not in different spots arround though. There is a pain of 8 out of 10 in the visual analogue scale both when shooting the ball and pressing the spot.
Tests used to assess the state of the knee do not show a lack of stability or an increased pain (Lachman test, MCL, LCL, PCL and Apley test for meniscus).
Ultrasound image shows the inflammation and degenerative changes in the anserin tendon, probably in the gracilis section. The inflammation seen in the ultrasound image coincides with the painful spot.
Picture 1: Swollen spot in the Pens anserinus
It is decided to treat the tendon with needles and electrical current in order to achieve a quick heeling.
Access to the injured section of the tendon is made both from above and below the spot. Needles used are 0'32 x 40 mm size. The patient feels an increase of the pain when the needle touches the swollen spot, thereby it is confirmed that this the point to be treated.
6 cycles of 8 seconds of electrical current are applied in the swollen spot. Microwave is used afterwards in order to stimulate tendon's metabolism.
One week later the patient has improved and he feels a pain of 4 out of 10 in the V.A.S. both when shooting the ball and pressing the painful spot.
My intention here is to share the most important and innovative part of my work as a sports physiotherapist.
For 3 years I have been studyng ultrasound image and anatomy in order to enforce innovative invasive treatments that accelerate the recovery of injuries and guarantee a suitable tissues regeneration.
