**3. RICE protocol**

The first treatment of a muscle lesion, as with any other injured soft tissue, normally consists of the RICE protocol (Rice, Ice, Compression and Elevation). The rationale behind this

treatment is mainly to reduce hemorrhage. However, there are no randomized control trials (RCTs) which have proven the effectiveness of using RICE for soft tissue injury. However there is evidence on the effectiveness of the single components of the RICE regime [3,5].

One research study showed that Diclofenac taken priorto a strenuous exercise program produced lower levels of histological muscle damage in athletes compared with athletes who received placebo medication [17]. In addition, Naproxene has been demonstrated to decrease muscle pain post strenuous exercise [18], while ibuprofen proved to be less ef‐

Medical Treatment of Muscle Lesion http://dx.doi.org/10.5772/56329 159

However, generally, in patients with acute hamstring muscle injury who were undergoing physiotherapy, the administration of NSAIDs had little effect on pain assessment or muscle

It can be concluded that the short-term use of NSAIDs in muscle injury reduces pain and the time to return to full activity. Conversely, the few studies that have followed the repair process over a longer period of time suggest that any apparent benefit of NSAID treatment in the short term is not maintained in the long term and may result in a higher incidence of GI and CV

An alternative to NSAIDs for analgesia is acetaminophen, which can be considered as effective

The prophylactic use of NSAIDs to prevent inflammation and pain that may accompany normal training and activity currently lacks scientific evidence and its use may create harmful

However, it is also worth considering that from a purely clinical viewpoint, the use of NSAIDs' for muscle lesions may possibly predispose to injury recurrence as a result of pain masking.

Finally on a biological level, a number of basic science studies showed that NSAIDs may inhibit muscle regeneration in the first stages of healing, which relies on the inflammatory process.

Many injection protocols have been proposed for the treatment of muscle lesions. Cortico‐ steroid injections, Muller-Wolfart protocol, prolotherapy, classic mesotherapy, mesothera‐ py with omeophatic products and others have been suggested. However, no protocol has strong scientific evidence, as there are no RCTs supporting their use. Although anecdotal clinical data and expert opinion can be found on each technique and their use in athletes [21], unfortunately, currently there is insufficient scientific evidence to support the use of

Further research is required to assess the efficacy of these injection therapies preferably with

The use of corticosteroids in the treatment of muscle injuries is controversial. There are concerns due to the risk of incomplete healing or rupture of the healing tissue. Moreover,

the integration of various techniques in order to obtain a holistic approach.

as NSAIDs for pain reduction after musculoskeletal injury [20].

fective [19].

performance.

adverse effects (ref).

collateral effects.

**5. Injective therapy**

such protocols..

**5.1. Corticosteroids**

#### **3.1. Rest**

Rest prevents an increase in the lesion gap which can occur as a consequence of the fibrotic tissue that forms with healing of the muscle lesion [4,6]. Rest also reduces the hemorrhage associated with the lesion.

#### **3.2. Ice**

There is evidence that ice utilization in the early stages of soft tissue injury is associated with a reduced haematoma and inflammatory process and therefore a quicker regenera‐ tive process [7,8].

#### **3.3. Compression**

Despite the fact that compression it has been demonstrated to reduce the blood flow in the injured area, its effectiveness is still controversial. In fact, there is no evidence,, that compres‐ sion may accelerate the healing process in a muscle strain.

However, the clinical recommendations are usually to perform a combination of icing and compression for a period of 15-20 minutes, repeated in 30-60 minute intervals. This protocol has been demonstrated to reduce the intramuscular temperature to between 3° and 7° C, thus decreasing the blood flow by approximately 50% [9,10].

#### **3.4. Elevation**

It is advised to elevate the injured body part in order to decrease the hydrostatic pressure and therefore the interstitial fluid within the lesion itself.
