Player characteristics:

Age: 28 years
Height: 194 cm
Body weight: 86 kg
Position: receiver

Injury description:

The injury occurred during a Plus League match, the player was accepting an uncomfortable serve from an opponent (changing the direction of the ball after being knocked over the net). He performed a rapid side-to-side lunge combined with a dynamic rotation and trunk extension in the opposite direction. The player felt a sharp pain in the front of his pelvis. In the next action, he tried to go on the attack and was unable to perform a jump. He reported the injury and left the field assisted by a physiotherapist.

Diagnosis and functional examination

Functional examination revealed severe limitation of hip flexor muscle strength (pain) and limited, painful extension. During palpation examination, there was tenderness in the left groin area and inferior anterior iliac spine.

The X-ray taken at the hospital excluded a fracture in the hip area and asymmetries of the pubic symphysis. The extended diagnosis with an ultrasound examination showed an injury (a 10 x 5 mm tear) to the attachment of the rectus thigh muscle on the left side.

x-ray of tendon tear

Rehabilitation

The treatment and rehabilitation process was spread over 4 weeks. The following treatment procedures were applied:

1st – 3rd day of recovery

local cryotherapy
compresses with STADIOPASTY (algae extract)
relief of the left lower limb
magnetotherapy
isometric exercises of the healthy lower limb

4th – 8th day of recovery

medical visit and administration of PRP in the area of the muscle injury
local cryotherapy
isometric exercises of the gluteal muscles, adductors and posterior muscle band
active exercises of the healthy lower limb in different planes of motion

9th – 14th day of recovery

magnetotherapy
ASTAR POLARIS HP S high-energy laser (analgesic, anti-inflammatory effect)
IMPACTIS M+ shock wave (1st treatment 10 days after injury)
manual therapy, transverse massage
inner range left quads (IRQ) exercise
isometric exercises of the gluteal muscles, adductors and posterior muscle band
active exercises of the healthy lower limb in different planes of motion

15th – 21th day of recovery

ASTAR POLARIS HP S high-energy laser (anti-inflammatory, biostimulative effect)
IMPACTIS M+ shock wave (II treatment and III treatment every 5 days as appropriate)
manual therapy, transverse massage, FDM
muscle strengthening exercises for the thigh muscles (excluding the flexors of the left thigh), adductors, gluteal muscles and the posterior limb band

22nd – 28th day of recovery

ASTAR POLARIS HP S high-energy laser every 2 days (biostimulative effect)
IMPACTIS M+ shock wave (IV treatment)
manual therapy, transverse massage, FDM
muscle strengthening exercises for the thigh, gluteal, adductor muscles, posterior limb band
introduction to jumping exercises

Magnetotherapy (PhysioGO 701 C)

with a mobile CPEP applicator in the area of the proximal attachment of the rectus thigh muscle on the left side

Day	Induction [mT]	Frequency [Hz]	Field shape	Treatment time [min]
2	3	10	sinusoid	10
3	3	10	sinusoid	10
4	3	10	sinusoid	10
5	5	10	sinusoid	15
6	5	10	rectangular	15
7	5	10	rectangular	15
8	5	10	rectangular	15
9	10	20	rectangular	30
10	10	20	rectangular	30
11	10	20	rectangular	30
12	10	20	rectangular	30
13	10	20	rectangular	30

High energy laser (POLARIS HPS)

Applied around the proximal attachment of the rectus thigh muscle on the left side.

Day	Irradiation dose: 808 nm / 980 nm [J/cm²]	Output power: 808 nm / 980 nm [W]	Operation mode: 808 nm / 980 nm	Frequency: 808 nm/ 980 nm[Hz]	Duty factor: 808 nm/ 980 nm [%]	Treatment area: 808 nm/ 980 nm [cm²]
9	20 / 20	3 / 3	Impulse / impulse	2800 / 2800	30 / 30	30
10	20 / 20	3 / 3	Impulse / impulse	80 /80	30 / 30	30
11	20 / 20	3 / 3	Impulse / impulse	2800 / 2800	30 / 30	30
12	20 / 20	3 / 4	Impulse / impulse	80 / 80	30 / 30	30
13	30 / 30	3 / 4	Impulse / impulse	2500 / 2500	30 / 40	30
14	30 / 30	3 / 4	Impulse / impulse	80 / 80	30 / 40	30
15	30 / 30	4 / 4	Impulse / impulse	2500 / 2500	40 / 40	30
16	30 / 30	4 / 4	Impulse / impulse	700 / 700	40 / 40	30
17	30 / 30	4 / 4	Impulse / impulse	700 / 700	40 / 40	30
18	30 / 30	4 / 4	Impulse / impulse	700 / 700	40 / 40	30
19	30 / 30	4 / 4	Impulse / impulse	700 / 700	40 / 40	30
20	30 / 30	4 / 4	Impulse / impulse	500 / 500	40 / 50	30
21	30 / 30	4 / 5	Impulse / impulse	500 / 500	50 / 50	30
23	30 / 40	4 / 5	Impulse / impulse	500 / 500	50 / 50	30
25	30 / 40	4 / 5	Impulse / impulse	500 / 500	50 / 50	30
27	30 / 40	4 / 5	Impulse / impulse	500 / 500	50 / 50	30

Impactis M+

Shock wave treatments in the area of rectus thigh muscle injury.

Treatment	Operation mode	Frequency: [Hz]	Pressure, [bar]	Number of impulses
I	set frequency	8 – for the muscle area	3	2000
I	set frequency	18 – for the tendon area	2,5	500
II	set frequency	8 – for the muscle area	3	2000
II	set frequency	18 – for the tendon area	2,8	500
III	set frequency	8 – for the muscle area	3,5	2000
III	set frequency	14 – for the tendon area	2,8	800
IV	set frequency	8 – for the muscle area	3,5	2000
IV	set frequency	14 – for the tendon area	3	800

Conclusion

The injury sustained by the player required more focus on the recovery process. The tendon attachment injury of the muscle takes longer to heal (build up) than an injury on the course of the belly. The rehabilitation process required good cooperation with the player, so as to intensively support the healing process, but without the time pressure of returning to sports training. Having completed 4 weeks of rehabilitation, the player was gradually prepared for training loads and supported with an appropriate preventive program.

Case study – treatment of left rectus femoris muscle tendon tear injury in BBTS player