Muscles are generally composed of many fibers bundled together; the bigger, more frequently used muscles have more fibers than the smaller, lesser-used ones. The muscle fibers are made up of smaller muscle-type cells. Among the muscles are voluntary and involuntary muscles. Voluntary, or skeletal muscles, are those that we move by choice (for instance, the muscles in your arms and legs).
Involuntary muscles, or smooth muscles, are the ones that move on their own. The muscles in your heart are called involuntary cardiac muscles. Skeletal muscles are attached to bones both by tendons at either end of the bone. The muscle is also attached directly to the outside lining of the bone itself, which is called the periosteum. Myositis ossificans (MO) is a small bone growth within the muscle, which occurs as a complication of a severe contusion.
A contusion is an injury to muscle caused by direct impact or trauma. Impact on the muscle crushes it against bone, also causing damage to the periosteum (sheath) surrounding the bone. If it is neglected then your body mistakenly sends new bone cells to repair the damage. As a result, a small part of the muscle calcifies and turns the bone.
Anatomically, myositis ossificans occurs in the skeletal muscles of the body, and most often in the large muscles of the upper and lower extremities, such as the biceps of the upper arm or the quadriceps muscle of the thigh, but it can occur in any of the skeletal muscles.
Causes & Symptoms of Myositis Ossificans
Myositis ossificans can be divided into two main types…the first common type of myositis ossificans is termed myositis ossificans traumatica or traumatic MO. In this type of MO, there are times when an exact injury or trauma actually cannot be identified and repeated micro-trauma may be suspected.
The second type of myositis ossificans is called MO progressiva, which is an inherited condition and is different from that which occurs in the process of myositis ossificans traumatica. In cases of traumatic MO, results in what is also termed heterotrophic ossification.
Heterotrophic ossification means that bone has formed in a part of the anatomy where it usually does not form, such as soft tissue. This type of ossificans can occur for a number of reasons. Therefore, myositis ossificans is listed as a type of heterotrophic ossification in which the abnormal bone forms within the muscle.
Myositis ossificans has been theorized to occur as a result of an injury to the muscle, which may also affect the outside of the bone that the muscle is attached to. This trauma either allows bone cells from the periosteum to enter the muscle and begin to grow where they should not or causes basic cells within the muscle to turn into bone-forming cells.
Although the exact type of bone formation remains unknown, studies have shown that there are a few risk factors that may increase the likelihood of myositis ossificans forming. These include:
- Severe loss of range of motion
- Experiencing a severe injury
- Massaging the injury aggressively
- Re-injury while recovering
Most contusion, strains, and hematomas will begin to improve within a few days or weeks if you treat them on time with a set of conservative treatments.
However, some patients with myositis ossificans development will notice that their pain worsens, and the range of movement reduces. Other symptoms linked to MO may include:
- Palpable lump in the muscle
- Limited range of motion
- Weakness of the muscle
- Ongoing pain
One of the most common signs of myositis ossificans is a large lump beneath your skin. In some cases, the bump forms in your arm or leg muscle. The lump may show certain signs, such as:
- Painful sensation
- Swelling
- Tenderness
- Warmth to the touch
- Fast-growth
As the lump grows larger, it may reduce your range of motion. You’re more likely to have a reduced range of motion if the growth is near a joint. Other symptoms of myositis ossificans present initially as the typical symptoms of a muscle injury, include pain, weakness, and bruising in the area or down the limb.
Also, patients with myositis ossificans may develop significant pain after using the muscle or may have pain during the night or upon waking up. Most patients experience normal initial rehabilitation and show improvement in their symptoms early on in their recovery but then this improvement either halts or deteriorates as the bone forms.
Who gets Myositis Ossificans?
Certain risk factors that are associated with myositis ossificans include the following:
- Lack of resting the muscle after a bruise or muscle strain, thus causing repetitive injury to the affected muscle.
- Not taking any measures to help reduce inflammation and swelling in the injured muscle, including not icing, or applying compression.
- Being older than 50 years old – this is due to decreased muscle mass.
- Intensive stretching, therapy, or massage after an injury are thought to increase bleeding into the muscle and inhibit healing.
- Having weaker muscles. Many people tend to bruise very easily because of having weaker muscles; one person can withstand a direct blow with a minor bruise while the other has a much higher chance of a grade 2 muscle contusion due to weaker muscle.
How Does Myositis Ossificans Affect You? How Serious is it?
Suffering through myositis ossificans can be severe that surgery will be required to excise the boney tissue that has formed. These cases include those that have not responded to physical or occupational therapy treatment and remain painful and have poor range of motion and strength.
Other cases include those where the boney tissue is near a joint and is restricting its motion or cases where it is close to a nerve and causes irritation to that nerve. Therefore, when surgical bone excision is required, it is necessary that the bone tissue has fully matured before it is excised, otherwise, it could reoccur.
Complications that may occur during a surgical bone excision include:
- Nerve / blood vessel damage – During surgery, there is a slight chance that the nerves, veins, or tissue around your injured area can be damaged. Damaged nerves or blood vessels can cause numbness, pain, or lower blood flow around the joint.
- Persistent pain – Some patients tend to continue to have persistent pain after surgery.
- Long-term stiffness – Long-term stiffness is usually caused by excessive scar tissue. Oftentimes, lack of use or exercise can cause scar tissue to build up in the soft tissue around the joint.
Recommended Treatment & Rehabilitation for Myositis Ossificans
During a diagnosis of myositis ossificans, a complete medical history of your injury may be good enough for your doctor to suspect the condition. However, myositis ossificans cannot be confirmed as a diagnosis until the calcified bone is seen on a diagnostic test such as an:
- X-ray
- Ultrasound
- Computed Tomography (CT) scan
- Magnetic Resonance Imaging (MRI) scan
In most cases, only an X-ray is required alongside a muscle biopsy may be used to confirm a diagnosis or when further testing is required.
After a diagnosis has been completed, physiotherapy may be further advised. A physiotherapist will be able to work with you to develop a specific treatment plan to achieve your recovery goals. These treatment plans may include:
Patient education
Your physiotherapist will work with you to help identify and change any external factors causing your pain. The type and amount of exercises you perform, your athletic activities, or your footwear may be discussed. Next, your physiotherapist will recommend improvements to your daily activities and design a personalized exercise program to help ensure a pain-free return to your desired activity level.
Range-of-motion exercises
Your physiotherapist may teach you range-of-motion techniques to restore normal motion in your muscles that are affected by myositis ossificans or muscle contusion in general.
Pain management
Your physiotherapist will develop a treatment plan to address ice in the affected area. They may use ultrasound, electrical stimulation, and/or other methods to help control your pain. Your physiotherapist may recommend decreasing some activities that cause pain.
Manual therapy
Your physiotherapist may provide hands-on treatments to gently move your muscles and joints. These techniques help improve motion and strength. They often address areas that are difficult to treat on your own.
Functional training
Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities. To reduce pain in your muscle, you will need to learn safe, controlled movements. Therefore, your physiotherapist will create a series of activities based on your unique condition to teach you how to move correctly and safely.
Muscle-strengthening
Muscle weaknesses or imbalances can contribute to muscle strain. They can also be a result of your injury. Based on your condition, your physiotherapist will design a safe muscle strengthening program for your muscle strain recovery.
Stretching is important for keeping muscles flexible and preventing further complications due to myositis ossificans. The specific stretches will depend on the injured area. Therefore, here are some examples that you can try at home:
Hip flexor stretch
Lie flat on the back and pull the right knee to the chest. Hold it there for 10 to 15 seconds before straightening the leg out again. Repeat with the left leg, feeling a stretch in the upper thigh and hips.
Neck stretches
For a strained neck muscle, lean the head forward to try to touch the chin to the chest. Next, lean the head first to the left and then to the right, trying to touch the ear to the shoulder.
Hamstring stretch
Stand with the feet hip-width apart, and bend at the waist to lean forward. There should be a mild stretch along the back of the legs.
Alternative & Homeopathic Treatment for Myositis Ossificans
Most mild cases of myositis ossificans can be successfully treated homeopathically. The following home remedies include:
Massage
Therapeutic massage helps loosen injured muscles and increases blood flow to help heal damaged tissues. Applying pressure to the injured muscle tissue also helps remove excess fluid and cellular waste products. Studies have shown that performing a massage immediately following an injury may even speed bruised muscle healing.
Pain medication
You can relieve pain with over-the-counter medications like aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), which may also help reduce swelling.
Rest
Avoid using your injured muscle for a few days, especially if movement causes an increase in pain. However, too much rest can cause muscles to become weak.
Cold therapy
When you experience a bruise contusion in a muscle, the fibers in the tissue are damaged. This may cause immediate pain, inflammation in the muscle tissue, and swelling in the affected area. You can help combat these symptoms by applying a cold pack to the injury. Continue applying cold several times a day for 20 to 30 minutes at a time. You can try to use gel packs, cold therapy systems, or cold-water baths for a rapid recovery.
Heat therapy
Heat therapy may help relieve pain after the initial swelling has subsided. You can apply therapeutic heat with electric hot pads, warm baths or hot tubs, hot cloths, and hot water bottles. Heat also increases blood flow, which may promote healing. You can alternate hot and cold therapy to help reduce the pain and swelling.