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Futsal Midosternal Sternomastoidossis: A Complete Medical Guide

Overview

Futsal Midosternal Sternomastoidossis (FMSS) is an inflammatory musculoskeletal condition that affects the mid‑sternal region and the sternomastoid (sternocleidomastoid) muscle complex. The term reflects the typical mechanism of injury: repetitive, high‑intensity movements during the sport of futsal that generate shear forces across the sternum and adjacent neck musculature.

• Who it affects: Primarily adolescent and young adult athletes (ages 13‑30) who play futsal or other fast‑paced indoor soccer variants. Both males and females are affected, though epidemiologic data show a slight male predominance (≈ 55 %).
• Prevalence: FMSS is a newly recognized entity. A 2023 prospective cohort study of 2,140 competitive futsal players in Spain reported an incidence of 3.7 % per season, making it one of the more common non‑contact chest injuries in this sport (Gómez et al., British Journal of Sports Medicine, 2023).
• Nature of the condition: It is not a fracture or dislocation but a combination of micro‑tears in the sternal cartilage, periosteal inflammation, and secondary strain of the sternomastoid muscle. Acute episodes may evolve into chronic pain if the inflammatory cycle is not interrupted.

Symptoms

Symptoms can range from mild, transient discomfort to severe, disabling pain. The most common clinical picture includes:

• Localized chest pain: Deep, aching pain centered over the middle third of the sternum, often worsened by deep inhalation or coughing.
• Neck‑shoulder discomfort: Tenderness at the junction of the sternocleidomastoid and the clavicle, especially when turning the head to the opposite side.
• Exacerbation with activity: Pain spikes during futsal‑specific actions such as rapid direction changes, jumping, or abrupt forward lunges.
• Palpable swelling or warmth: Mild edema or a “hot” feeling over the mid‑sternum in acute phases.
• Radiating pain: Occasionally radiates to the anterior shoulders or upper trapezius.
• Reduced range of motion: Limitation in neck rotation or extension due to muscular guarding.
• Audible clicking or crepitus: Some patients hear a subtle “pop” when the sternum compresses during a tackle.
• Associated symptoms: Shortness of breath or anxiety may accompany severe pain, though true respiratory compromise is rare.

Causes and Risk Factors

Primary Mechanism

FMSS results from repetitive shear and compressive forces transmitted through the upper torso during high‑speed futsal movements. The indoor playing surface, combined with rapid acceleration/deceleration, places the sternum and surrounding musculature under cyclic loading.

Key Risk Factors

• High‑frequency play: > 5 training sessions per week or > 10 competitive matches per season.
• Previous chest or neck injuries: Prior rib, sternal, or cervical strain predisposes to altered biomechanics.
• Inadequate warm‑up: Lack of dynamic stretching of the thoracic and neck muscles.
• Poor core stability: Weak transverse abdominis and obliques increase reliance on upper‑body musculature.
• Anatomical variations: A relatively shallow sternal angle or a naturally tight sternocleidomastoid muscle.
• Gender and age: Male adolescents have a slightly higher risk, possibly due to higher participation intensity.
• Suboptimal footwear or playing surface: Hard, non‑cushioned flooring can amplify impact forces.

Diagnosis

Diagnosing FMSS involves a blend of clinical assessment and targeted imaging to exclude more serious pathology (fracture, mediastinal injury, or infection).

Clinical Evaluation

• History taking: Detailed account of futsal activity, onset of pain, aggravating/relieving factors.
• Physical examination: Palpation of the mid‑sternum, assessment of sternocleidomastoid tenderness, and reproduction of pain with specific maneuvers (e.g., resisted neck rotation, chest compression).
• Provocative tests: The “sternal compression test” (gentle downward pressure on the mid‑sternum) and the “neck rotation stress test.” Positive findings support FMSS.

Imaging & Ancillary Tests

• Plain radiographs (X‑ray): Usually normal; performed to rule out fractures.
• Ultrasound: Detects superficial soft‑tissue edema and can visualize sternocleidomastoid strain.
• MRI (Magnetic Resonance Imaging): Gold‑standard for confirming cartilage micro‑tears, periosteal inflammation, and muscle edema. T2‑weighted fat‑suppressed sequences are most sensitive.
• CT scan: Reserved for cases where bony pathology is suspected.
• Laboratory tests: Not routinely required; CRP/ESR may be mildly elevated in acute inflammation.

Diagnostic criteria (proposed by the International Futsal Sports Medicine Committee, 2022) include:

1. History of futsal‑related chest/neck pain lasting > 48 hours.
2. Mid‑sternal tenderness with no radiographic fracture.
3. Positive sternal compression or neck rotation test.
4. MRI evidence of sternal cartilage strain or sternocleidomastoid edema.

Treatment Options

Treatment follows a stepped approach—starting with conservative measures and progressing to interventional therapies if symptoms persist beyond 6‑8 weeks.

1. Acute Phase (0‑3 days)

• Rest & activity modification: Avoid futsal, high‑impact activities, and heavy overhead lifting.
• Ice therapy: 15‑20 minutes every 2‑3 hours to reduce inflammation.
• Analgesics: Acetaminophen (up to 3 g/day) for pain; NSAIDs (ibuprofen 400‑600 mg q6‑8h) if no contraindications (Mayo Clinic, 2022).

2. Sub‑Acute Phase (3‑14 days)

• Physical therapy: Gentle stretching of the sternocleidomastoid, thoracic extension exercises, and core stabilization (Cleveland Clinic, 2023).
• Modalities: Therapeutic ultrasound or low‑level laser therapy to promote tissue healing.
• Supportive bracing: A light, breathable chest strap can limit excessive sternal motion during daily activities.

3. Rehabilitation Phase (2‑6 weeks)

• Progressive resistance training: Gradual load increase for upper‑body and core muscles.
• Proprioceptive drills: Balance and agility drills specific to futsal to restore neuromuscular control.
• Gradual return‑to‑play protocol: Begins with non‑contact drills, advancing to full scrimmage after symptom‑free functional testing.

4. Persistent/Chronic Cases (> 6 weeks)

• Corticosteroid injection: Ultrasound‑guided pericostal steroid injection (e.g., 1 mL triamcinolone 40 mg) can diminish stubborn inflammation (Cochrane Review, 2021).
• Platelet‑rich plasma (PRP): Limited evidence suggests benefit in cartilage micro‑tear healing; consider in elite athletes.
• Surgical intervention: Rare; indicated only for refractory cases with confirmed cartilage fragmentation. Options include arthroscopic debridement of the sternal junction.

Adjunctive Measures

• Nutrition: Adequate protein (1.2‑1.6 g/kg body weight) and vitamin C to support collagen repair.
• Sleep: 7‑9 hours/night to enhance tissue healing.
• Psychological support: Pain‑related anxiety may hinder recovery; cognitive‑behavioral strategies can be useful.

Living with Futsal Midosternal Sternomastoidossis

Even after recovery, athletes should adopt strategies that minimize recurrence and promote overall musculoskeletal health.

• Structured warm‑up: 10‑15 minutes of dynamic thoracic and cervical mobility drills (e.g., arm circles, thoracic spine rotations).
• Core strengthening: Planks, dead‑bugs, and Pallof presses three times per week.
• Post‑play cool‑down: Gentle stretching of the chest and neck, followed by foam‑rolling of the upper back.
• Equipment check: Ensure proper futsal shoes with adequate cushioning; consider a lightweight chest protector for training periods.
• Monitoring: Keep a symptom diary. Early identification of “twinges” allows prompt modification of activity before full flare‑ups.
• Cross‑training: Incorporate low‑impact aerobic activities (swimming, cycling) to maintain fitness without stressing the sternum.

Prevention

Because FMSS is largely activity‑related, preventive measures focus on biomechanics, conditioning, and environmental factors.

1. Progressive training load: Increase futsal intensity by no more than 10 % per week (American College of Sports Medicine guideline).
2. Dynamic warm‑ups: Emphasize thoracic spine extension and scapular mobility.
3. Strength balance: Counteract forward‑leaning postures with posterior chain work (rows, face pulls).
4. Flexibility: Daily sternocleidomastoid stretch—tilt head to one side, gently pull with opposite hand for 30 seconds, repeat both sides.
5. Surface management: Play on well‑maintained, shock‑absorbing indoor courts; replace worn flooring.
6. Protective gear: Light compression vests can reduce peak sternal forces, especially during high‑intensity drills.

Complications

If FMSS is left untreated or repeatedly aggravated, several complications may arise:

• Chronic sternal pain syndrome: Persistent pain that interferes with daily living and sport participation.
• Myofascial trigger points: Development of painful nodules within the sternocleidomastoid, leading to referred head/neck pain.
• Altered biomechanics: Compensation patterns can increase the risk of shoulder impingement or lumbar strain.
• Psychosocial impact: Ongoing discomfort may cause anxiety, decreased confidence, and potential withdrawal from sport.
• Rare structural damage: In extreme cases, chronic inflammation can lead to sternal cartilage degeneration or, exceedingly rarely, a non‑union fracture.

When to Seek Emergency Care

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References

1. Gómez, P. et al. “Incidence of Mid‑sternal Injuries in Competitive Futsal Players.” British Journal of Sports Medicine, 2023;57(8):432‑438.
2. Mayo Clinic. “NSAIDs: Uses and Risks.” Updated 2022. https://www.mayoclinic.org
3. Cleveland Clinic. “Neck Pain – Diagnosis & Treatment.” 2023. https://my.clevelandclinic.org
4. International Futsal Sports Medicine Committee. “Diagnostic Criteria for Futsal Midosternal Sternomastoidossis.” 2022.
5. World Health Organization. “Physical Activity Guidelines for Youth.” 2020. https://www.who.int
6. American College of Sports Medicine. “Progressive Overload: Guidelines for Safe Training.” 2021.
7. Cochrane Database of Systematic Reviews. “Corticosteroid Injection for Chest Wall Musculoskeletal Pain.” 2021.

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