Nonoperative treatment of muscle injuries - recommendations from the GOTS expert meeting

Abstract

BackgroundMuscle injuries are some of the most common injuries in sports; they have a high recurrence rate and can result in the loss of ability to participate in training or competition. In clinical practice, a wide variety of treatment strategies are commonly applied. However, a limited amount of evidence-based data exists, and most therapeutic approaches are solely based on “best practice”. Thus, there is a need for consensus to provide strategies and recommendations for the treatment of muscle injuries.MethodsThe 2016 GOTS Expert Meeting, initiated by the German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), focused on the topic of muscle and tendon injuries and was held in Spreewald/Berlin, Germany. The committee was composed of twenty-two medical specialists. Nine of them were delegated to a subcommittee focusing on the nonoperative treatment of muscle injuries. The recommendations and statements that were developed were reviewed by the entire consensus committee and voted on by the members.ResultsThe committee reached a consensus on the utility and effectiveness of the management of muscle injuries. Main results: the “PRICE” principle to target the first inflammatory response is one of the most relevant steps in the treatment of muscle injuries. Haematoma aspiration may be considered in the early stages after injury. There is presently no clear evidence that intramuscular injections are of use in the treatment of muscle injuries. The ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) should be regarded critically because there is currently no hard evidence to support their use, although they are appropriate in exceptional cases.ConclusionsThe present work provides a structured overview of the various nonoperative treatment strategies of muscle injuries and evaluates their effectiveness with respect to the existing scientific evidence and clinical expertise in the context of basic science on the healing process of muscle injuries. The committee agreed that there is a compelling need for further studies, including high-quality randomized investigations to completely evaluate the effectiveness of the existing therapeutic approaches. The given recommendations may be updated and adjusted as further evidence will be generated.

Calf Blood Compound (CFC) and Homeopathic Drug Induce Differentiation of Primary Human Skeletal Muscle Cells

“…According to Reurink et al [6], there is strong to moderate evidence that intramuscularly injected local anesthetics and NSAIDs are myotoxic, and there is conflicting evidence of the myotoxicity of PRP. Limited evidence exists that single corticosteroid injections are not myotoxic but demonstrate a synergistic myotoxic effect when used together with local anesthetics [4]. Therefore, the authors conclude that the combination of local anesthetics with NSAID injections should not be recommended for the treatment of muscle injuries in athletes.…”

“…The persistent aim of therapy remains to enhance muscle healing and to limit scar formation. Recently, several new injection methods were reported to shorten the recovery time after muscle strain injuries [4][5][6][7][8][9][10]. The injection of local anesthetics, Calf Blood Copmpound (CFC) and Homeo pathic Drug (Tr14), or platelet-rich plasma (PRP), was reported most frequently.…”

Advances in Delayed-Onset Muscle Soreness (DOMS) – Part II: Treatment and Prevention

“…The use of non-steroidal anti-inflammatory drugs (NSAIDs), e. g. diclofenac, is widely used by many sports physicians in the routine treatment of various types of muscle injuries and, of course, in DOMS as well [4,25]. The ingestion of NSAIDs in DOMS has been considered to offer both pain relief and to limit the inflammatory responses.…”

Intramuscular Injection of Combined Calf Blood Compound (CFC) and Homeopathic Drug Tr14 Accelerates Muscle Regeneration In Vivo

“…It inhibits the secretion of pro-inflammatory cytokines, such as IL-1β, TNF-α, and IL-8, by immunocytes [18]. The oral application of Tr14 has been demonstrated to have beneficial effects on epicondylitis and different musculoskeletal disorders [19,20]. Although numerous biochemical and cellular pathways seem to be modulated by its ingredients, the precise mechanism of action of Tr14 has never been explored in detail.…”

“…Although athletes are reported to be successfully treated in practice [19,21,22], only limited scientific evidence exists to support the general use of the above-mentioned agents in the treatment of skeletal muscle injuries in athletes. In a previous study conducted in our laboratory, we could prove in vitro that neither CFC nor Tr14 is myotoxic and that both could modulate the biological function of primary human skeletal muscle cells [23].…”