How Long will a 50% quad tear take to heal

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Paperclip
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Re: How Long will a 50% quad tear take to heal

Post by Paperclip » Mon Jul 18, 2011 9:17 am

Muscle or tendon tears, can they repair themselves without surgery?


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Re: How Long will a 50% quad tear take to heal

Post by stuward » Mon Jul 18, 2011 9:34 am

Paperclip wrote:Muscle or tendon tears, can they repair themselves without surgery?
You know I'm not a medical person but, sometimes but they may not attach themselves in the same place. Of course a muscle that has been completely detached needs to be surgically repaired or it can't reattech. I think in Leanmuscle's case, the muscle reattached at the wrong spot so now he has the gap and is meak in leg lifts. Severe pulled hamstrings are often carreer enders for proffessional atheletes, especially sprinters, since they are never strong enough again. A previously strained muscle is always more prone to reinjury.

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Re: How Long will a 50% quad tear take to heal

Post by leanmuscle13 » Mon Jul 18, 2011 9:38 am

As far as I know, surgery is the only way that an injury like this can be repaired completely and correctly. I have seen information where physical therapists perform some sort of massage to manipulate the injured area, but I don't know if that is done to repair it or what.

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Re: How Long will a 50% quad tear take to heal

Post by leanmuscle13 » Mon Jul 18, 2011 9:43 am

Sorry Steward, I didn't realize you had posted before I put my post up. But your assessment sounds very true. I really cannot squat alot at all ( 225lbs in peak condition) and tend to focus on leg extensions and hamstring curls. I do this to strengthen the supporting quadriceps muscles as I will need them as I get older. As I stated I'm still active (just ran a 5k two months ago) but I don't see any awe inspiring moments in my future with these injuries.

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Re: How Long will a 50% quad tear take to heal

Post by Jungledoc » Mon Jul 18, 2011 4:56 pm

We're confusing two different but related kinds of injuries, tendon tears and muscles tears. There are really 4 scenarios here:

A tendon tear may be partial or complete. Leanmuscle13 had a partial on one side and a complete on the other. When the tendon is completely torn, the muscle retracts, and the part of the tendon that is attached to the muscle is pulled far from the part that is attached to the bone. The muscle can no longer do it's function, because it is not attached to the bone that it was intended to pull on. Scar tissue may form around the torn ends of the tendon, but this doesn't help. The ends just become attached to something that is non-functional. Because the muscle retracts, the area where it is supposed to be has a space at the far end, and bunched-up muscle at the other end, so there will be a big lump of muscle away from the tear, and a dent closer to the tear. How the person is effected by this injury depends on whether there are other muscles that are involved in the same movement. In leanmuscle's case, since there are other hip flexors, he can still flex his hip. His strength in this movement just depends on how strong the other muscles are.

A partial tendon tear is quite a bit different. Because there is still some tendon tissue attaching the muscle to the bone, the muscle doesn't retract. If there isn't any further injury (i.e., you don't go and start squatting the next week) there can be a lot of healing, and return of function. Scar tissue forms in the torn area, strengthening the torn area. Remember that scar tissue is not as strong as the original tissue, but it's a lot stronger than dead space! Because the muscle is still basically in it's normal place, you won't see the dent and bump.

Surgical repair involves sewing the torn ends of the tendon together, or possible grafting a piece of tendon from some other part of the body. The thread or wire that is used in the repair adds some strength, and the sewn pieces scar together and eventually achieve some part of the original strength. The decision to have surgery or not is not straight-forward. It depends on what muscle is involved, and the health of the patient. For me, if I had a complete tear of the tendon of a major muscle, I'd definitely have surgery. Partial tear, it would depend on the degree of the tear, and a lot of other things.

In muscle tears, the muscle itself is torn. Again, you can have partial or complete tears. In complete tears the two parts of the muscle each retract, leaving a gap in between. There can be some scaring and reattachment. In treating an acute (new) tear, usually a splint is used to hold the involved joint in the position that minimizes tension on the involved muscle, and moves the fragments closer together. So for a torn quad muscle, the knee would be splinted in extension to minimize the pull on the muscle, and allow the scarring to occur over as small a distance as possible. After enough time for scarring to occur, movement would be started gradually. With a complete tear there is usually a dent between the torn parts.

In a partial tear it is similar, but a little easier. Since some of the muscle fibers are still attached, the torn parts are closer, and can scar together better. In treating, the joint is still splinted in the position that shortens the muscle, and return to function is gradual to prevent further injury. There may or may not be a visible dent where the muscle is torn. If there is, it's usually a small one that is within the body of the muscle.

Surgery is not as useful in muscle tears. For one thing, muscle doesn't hold sutures well. Because the structure of muscle is a big bundle of fibers, the thread tends slip between the fibers and pull through. Think of sewing two brushes together, end-to-end. The thread has to go around some fibers, and then to the other side. This tends to squeeze the fibers that it goes around, and they can die. So a lot of sewing can do more damage than it's worth. Sometimes the fascia, the connective-tissue covering of the muscle, can be sewn. It holds sutures well, and can help to direct the scarring of the muscle fibers.

In my work in PNG I often have to repair muscle injuries, but these are usually from machete wounds, where the muscle is cut cleanly. (Sadly, we have a lot of violence here, and the "bush knife" is the usual weapon of choice.) I usually try to sew the fascia, then protect the muscle from further injury until it can heal. If they start moving it too soon the repair may not work well. If they wait too long to start using it they can develop contractures, excess scarring, and poor ROM. It's sometimes hard to know the right time to start moving it again. Of course, this is often complicated by the other structures (bone, tendons, blood vessels, nerves) that are injured at the same time!


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Re: How Long will a 50% quad tear take to heal

Post by leanmuscle13 » Mon Jul 18, 2011 7:29 pm

Jungle Doc, I've got a question. It has been 8+ years since my injury and although I still lead an active lifestyle, my biggest fear is when I become old. Do you think this injury is possibly debilitating? If so is the surgery possible now 8 years later? I was 25 when it occurred and I was overseas in Kuwait, part cocky, but also fearful as I didn't want to be cut on in a field hospital unless absolutely necessary. There's more to the story, but I'm not trying to write my memoirs! :)

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Re: How Long will a 50% quad tear take to heal

Post by Paperclip » Mon Jul 18, 2011 9:57 pm

Doc, that was a very informative reply!
stuward wrote:A previously strained muscle is always more prone to reinjury.
I have to keep this in mind.

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Re: How Long will a 50% quad tear take to heal

Post by carlito » Tue Jul 19, 2011 3:47 am

I happened to tear my quad about 8 months ago, but I didn't have it splinted or anything, left it to heal/couldn't move on it for about a month, and even after that I kept tweaking it. Seems to be fine now though, as I'm squatting on it among other things. I guess I would have recovered much better if I'd had it splinted?

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Re: How Long will a 50% quad tear take to heal

Post by Jungledoc » Wed Jul 20, 2011 2:48 am

leanmuscle13 wrote:Jungle Doc, I've got a question. It has been 8+ years since my injury and although I still lead an active lifestyle, my biggest fear is when I become old. Do you think this injury is possibly debilitating? If so is the surgery possible now 8 years later? I was 25 when it occurred and I was overseas in Kuwait, part cocky, but also fearful as I didn't want to be cut on in a field hospital unless absolutely necessary. There's more to the story, but I'm not trying to write my memoirs! :)
I doubt that it will have a bigger effect on you then than it does now. I'd think that the benefits of surgery after this long would be minimal, and the surgery would be much harder to do. The unused part of the muscles is very atrophied by now, so it probably wouldn't add much function anyway.


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