【下腿三頭筋肉離れのガイドライン!?】スポーツ現場エキスパートの定性的研究

“I have seen players that have ‘one week lesions’ on a scan miss six. And I have had other players who have, you know, what looks like a three or four-week injury on imaging play…I think it comes back to those internal factors, the ones that can play with them are strong, good athletically, minimal soft tissue injuries, young. Whereas if you get a smaller lesion in an older player, with no strength, poor training age in the gym—they can’t cope if they don’t have the architecture to support that lesion. And taking a holistic approach, and really knowing them inside out. Knowing their training background and their injury history,” (Expert 1).

“What trumps MRI is the clinical progression: the recovery of strength, the recovery of range of motion, the ability to progress through clinical milestones, decreased swelling, decreased pain, muscle activation, resolving strength. Those to me are a lot more important,” (Expert 10). Early focuses for experts were the rate of resolution of pain free walking (“players saying ‘I felt a big rip, a big pop,’ and you’ve got someone who can’t walk pain free until after day 10: that’s a 6 to 8 week calf before you scan it,” (Expert 15)), palpation tenderness, stretch tolerance, single leg calf raise strength and plyometric function.

MRIに勝るものは臨床経過です：筋力や可動域の回復程度や、腫脹、痛みの軽減、筋出力の増加、筋実質の回復程度が重要な指標になります(エキスパート10)

エキスパートにとって、最初にフォーカスを当てるのは痛みなしで歩けるかということ(選手が、肉離れした感じや音が鳴ったといって10日以降も歩けない場合、MRI検査する前に6~8週程度かかると考えます(エキスパート15))と、触診、圧痛、伸張痛、片足ヒールレイズの筋力とプライオメトリクス機能です

Experts also refrained from routinely reimaging prior to RTP to “confirm healing” as a perceived safeguard against recurrence: “If we accept that clinical findings are actually better for us prognostically than MRI, sometimes the MRI can overly cloud your judgement, and I think that applies to calf injuries more than it does for hamstrings and quads, and other things,” (Expert 16).

専門家は競技復帰前に筋損傷の治癒を確認するための再発予防を目的としたMRI再検査を習慣的に行うことを控えます

もし、臨床初見の方が予後の判断がMRIよりも優れていると認められれば、MRIの結果が判断を曇らせる場合があるからです

そして、この傾向はハムストリングスや大腿四頭筋など他部位の損傷よりも下腿三頭筋で当てはまると思われます(エキスパート16)

Experts acknowledged criteria for running after CMSI is more stringent relative to other types of muscle strains, because running is a high-load scenario for the calf even at the slow speeds prescribed initially .

ランニングは初期に低速で始めても下腿三頭筋にとって高負荷であるため、エキスパートは下腿三頭筋損傷後のランニング開始基準は他の筋損傷よりも厳しいと認識していました

Most experts accepted a slightly delayed return to running in order to reduce the likelihood of early recurrence .

早期再発のリスクを減らすために、ほとんどのエキスパートはランニング開始がやや遅れることを受け入れています

Six ‘rules of thumb’ were identified from information provided by experts to guide running rehabilitation after CMSI: (1) initially run on alternate days, (2) avoid “plodding” early, (3) do not progress volume and intensity on consecutive days, (4) schedule off-field exercises (e.g. loaded strengthening) after running, (5) shape running progressions to meet the demands of the sport— don’t overshoot with excessive volume, (6) avoid sudden changes in conditions, such as the surface and footwear. Learning from past mistakes, experts preferred to avoid prolonged, slow continuous running (i.e. “plodding”, “go and jog 5 laps,” Expert 4) during early running rehabilitation because it had been found to predispose to recurrence for CMSI involving soleus.

特にヒラメ筋損傷をしている場合は、負荷量の調整をする必要があると述べられています

Experts also advocated taking additional care when building volume for athletes that are rehabilitating a soleus injury in order to mitigate the risk of fatigue- related recurrence, especially if they are returning to a sport involving large running workloads (e.g. soccer, Australian Football, distance runners)

リハビリ期間の正確な長さと再発リスクには関連がないことが示されており

Total volume was highlighted for offsetting the risk of gradual-onset CMSI involving soleus, which were attributed to cumulative overload, whereas gastrocnemius injuries were perceived to be more sensitive to high-intensity activities such as jumping.

蓄積していく過負荷によって受傷するとされるヒラメ筋が関与する下腿三頭筋損傷のリスクを減らすためには総負荷量に着目する必要があります。一方で腓腹筋の損傷はジャンプなど高強度活動で生じるとされていると考えられています