Muscle Strains
Muscle strains are more common injuries in sports. Muscle strain refers to an injury of a muscle or its attaching tendons. A tendon is a tough, fibrous cord of tissue that connects muscles to bone. There are two types of muscle strains, acute strain and chronic strain. Acute strains are caused by excessive stretching or tearing of a ligament. Chronic strains are caused by repetitive movements of muscles and tendons over long periods of time and are more common in tennis players and golfers.
Sports activities such as football, basketball, hockey, gymnastics, boxing, wrestling, tennis, rowing, golf-sports, racquet, throwing, and contact sports place participants at greater risk for strain. The symptoms of a strain are typically pain, swelling, muscle spasm, muscle weakness, inflammation, and cramping.
Back strain occurs when the muscles supporting the spine (back bone) are twisted, pulled or torn. Athletes involving in excessive jumping as in basket ball or volley ball are more susceptible to back strain.
Hamstring muscle strain is a tear in one or more of the muscles at the back of the thigh. It is caused by imbalance between the hamstrings and the muscles in the front of the thigh. Sports that commonly cause a hamstring injury are sprinting sports such as track and field, soccer, and basketball that involve sudden accelerations.
Most sprains and strains will repair themselves with adequate rest, ice application, compression, and elevation. In case of severe injury, a brace or a splint may be used to immobilize the area and to prevent further injury. Surgery is occasionally required to repair the ruptured muscle.
Symptoms of Muscle Strains
Common symptoms of muscle strains include:
- Sudden Pain: This is usually sharp and occurs at the moment of injury.
- Swelling and Bruising: After the initial injury, swelling and discoloration may develop due to internal bleeding.
- Muscle Weakness: Affected muscles may feel weak, especially in severe strains.
- Loss of Function: Depending on the severity, muscle function may be significantly impaired.
In more severe strains, athletes may report hearing or feeling a “pop” at the moment of injury, indicating a tear.
Causes of Muscle Strains
Muscle strains often occur during activities that involve:
- Sudden Acceleration or Deceleration: Movements such as sprinting or changing direction can put the muscles under sudden stress.
- Eccentric Contractions: Muscles are more likely to be injured during eccentric movements, where the muscle lengthens under tension.
- Inadequate Warm-Up: Without a proper warm-up, muscles are not as flexible and may be more prone to injury.
- Fatigue: Tired muscles are less capable of withstanding stress, which can lead to strains, especially late in a workout or game.
Diagnosing Muscle Strains
A diagnosis is usually made based on a clinical examination and imaging studies. Imaging tools like ultrasound or MRI can help visualize the extent and location of the injury, which is crucial for planning treatment and predicting recovery time.
Treatment Options for Muscle Strains
Most muscle strains can be treated conservatively with excellent results. The initial treatment typically follows the PRICE protocol:
- Protection: Avoid activities that could further stress the injured muscle.
- Rest: Allow time for healing by reducing activity levels.
- Ice: Apply ice to the injured area to reduce swelling and inflammation.
- Compression: Use an elastic bandage to help control swelling.
- Elevation: Elevate the injured limb to reduce swelling.
For more severe injuries, additional therapies may be necessary, including:
- Physical Therapy: Once the acute phase has passed, physical therapy can help restore muscle strength and flexibility.
- Eccentric Exercises: These exercises focus on slowly lengthening the muscle under tension, which can help improve strength and prevent future injuries.
- Surgical Intervention: In rare cases of complete muscle or tendon rupture, surgery may be required to repair the damage.
Prevention of Muscle Strains
While it may not be possible to prevent every injury, certain steps can reduce the likelihood of muscle strains:
- Warm-Up Properly: Ensuring that muscles are warm and flexible before intense activity can decrease the risk of strains.
- Stretch Regularly: Stretching helps to maintain flexibility and muscle balance, particularly for muscles prone to strain.
- Strength Training: Strengthening muscles through targeted resistance training, particularly eccentric exercises, can increase their resilience against injury.
Chronic Sequelae and Long-Term Management
Some individuals, particularly athletes, may suffer from chronic symptoms following a muscle strain, such as weakness, pain, and scar tissue formation. According to the Bayer study included in the American Journal of Sports Medicine, even many years after the initial injury, chronic sequelae, including muscle atrophy, fibrosis, and pain, can persist. The study emphasizes the importance of heavy resistance training (HRT) as a rehabilitation method, showing that HRT can improve muscle strength and reduce pain even long after the injury occurred. However, it is noted that structural changes in scar tissue might not be completely reversible with HRT alone.
Importance of Heavy Resistance Training (HRT)
In Bayer’s research, participants undergoing HRT demonstrated significant improvements in pain reduction and muscle function. Strength training, especially exercises focusing on eccentric contractions, helped restore muscle strength and increased muscle cross-sectional area (CSA) in the injured region. However, the study found that HRT did not alter the fatty infiltrations or scar tissue in the injured muscle, suggesting that while strength and function can be restored, the underlying tissue may retain permanent structural changes.
Post-Strain Recovery
After recovering from a muscle strain, it’s crucial to follow a structured rehabilitation plan to prevent re-injury. Many athletes, particularly in sports like soccer, football, and basketball, have a high risk of recurrence if they return to activity too soon. A comprehensive rehab program should include:
- Strength Training: To rebuild lost muscle strength and prevent future strains.
- Flexibility Exercises: To improve the range of motion in the affected muscle.
- Functional Training: Sport-specific exercises that mimic the demands of the athlete’s sport should be incorporated before returning to full activity.
When to Seek Medical Advice
If you experience persistent pain, weakness, or limited range of motion following a muscle strain, it is advisable to seek medical advice. Ignoring symptoms or rushing back into activity can lead to recurrent injuries or chronic conditions that may require more invasive treatments.
Do you have more questions?
What is the difference between a muscle strain and a muscle tear?
A muscle strain is a general term for any damage to the muscle, while a tear refers to more severe damage where a portion of the muscle fibers are ruptured. A complete tear indicates a full rupture of the muscle or tendon.
How do I know if I have a muscle strain or just soreness?
Muscle soreness, like delayed onset muscle soreness (DOMS), is usually widespread and develops gradually after exercise. A strain causes sudden, sharp pain, usually localized to the injured area, and is often accompanied by swelling, bruising, or a limited range of motion.
What are the most common muscles affected by strains?
The most commonly affected muscles include the hamstrings, quadriceps, gastrocnemius (calf), and, in some cases, the adductors. These muscles are more vulnerable due to their role in powerful movements and their attachment at two joints.
What are the grades of muscle strains, and how are they treated?
- Grade I (Mild): Minor tearing of muscle fibers; treated with rest, ice, and gradual rehabilitation.
- Grade II (Moderate): Partial tearing; treated with longer rest, physical therapy, and sometimes bracing.
- Grade III (Severe): Complete tear; may require surgery followed by an extensive rehabilitation program.
How long does it take to recover from a muscle strain?
Recovery time depends on the severity:
- Grade I: 1-2 weeks.
- Grade II: 4-6 weeks.
- Grade III: Several months, and potentially longer if surgery is required.
What is the role of imaging in diagnosing muscle strains?
Imaging, such as ultrasound or MRI, is crucial in diagnosing the severity of the injury, determining the extent of muscle damage, and guiding treatment. MRI is particularly useful for identifying deeper muscle injuries and edema that might not be visible on an ultrasound.
What is the best treatment for a mild muscle strain?
Mild strains are typically treated with rest, ice, compression, and elevation (the RICE or PRICE protocol). Gradual stretching and strengthening exercises are introduced as pain subsides.
When should I see a doctor for a muscle strain?
You should see a doctor if:
- Pain is severe and does not improve with rest.
- There is a significant loss of function or strength.
- You notice swelling, bruising, or hear a “pop” at the time of injury.
- You suspect a complete tear or have recurring strains in the same area.
How can I prevent muscle strains?
Preventing muscle strains involves regular stretching, strength training (especially eccentric exercises), proper warm-up routines before exercise, and adequate rest between workouts to avoid fatigue.
What is eccentric training, and how does it help prevent muscle strains?
Eccentric training involves lengthening the muscle under tension, such as slowly lowering a weight. This type of exercise strengthens the muscle, increases its resilience to high forces, and helps prevent strains, especially in muscles like the hamstrings.
What is the prognosis for a complete muscle tear?
With proper treatment, including surgery if necessary, and rehabilitation, most people can regain full function after a complete tear. However, recovery may take several months, and there may be a permanent reduction in muscle strength.
Can muscle strains lead to chronic problems?
Yes, without proper treatment and rehabilitation, muscle strains can result in chronic pain, muscle weakness, and increased risk of reinjury. Persistent scar tissue formation can also cause stiffness and functional limitations.
What role does scar tissue play in muscle strains?
After a muscle strain, scar tissue forms as part of the healing process. While some scar tissue is normal, excessive formation can lead to stiffness, reduced flexibility, and chronic pain. Proper rehabilitation can help minimize these effects.
What are the long-term consequences of untreated muscle strains?
Untreated muscle strains can lead to chronic pain, muscle weakness, and increased risk of reinjury. Over time, these issues can significantly limit your ability to participate in physical activities and may lead to permanent functional deficits.
Can heavy resistance training help with muscle strain recovery?
Yes, heavy resistance training, particularly eccentric exercises, has been shown to improve muscle strength, reduce pain, and enhance function in individuals with chronic symptoms after muscle strains. However, it may not completely reverse structural changes like fatty infiltration or scar tissue.
Can you return to sports after a muscle strain?
Yes, most individuals can return to sports after a muscle strain with proper rehabilitation. However, returning too early or without proper treatment increases the risk of reinjury. A structured rehabilitation program is key to a safe return to activity.
What are the risks of reinjury after a muscle strain?
The risk of reinjury is higher if the muscle has not fully healed or if proper rehabilitation was not followed. Returning to sports too soon, inadequate strength training, and poor flexibility can all contribute to a higher risk of reinjury.
Is surgery always required for severe muscle strains?
Surgery is not always required, even for severe strains. It is generally reserved for cases where there is a complete tear, significant loss of function, or when conservative treatments fail to improve the condition. Most muscle strains respond well to non-surgical treatment.
What is the role of stretching in muscle strain recovery?
Stretching helps improve flexibility, reduces muscle stiffness, and promotes proper alignment of healing tissues. It is important to introduce stretching gradually during rehabilitation to avoid overstressing the healing muscle.
What type of physical therapy is recommended after a muscle strain?
Physical therapy after a muscle strain should include a combination of stretching, strengthening, and functional exercises. Eccentric exercises are particularly important for restoring muscle strength and reducing the risk of reinjury.
What is fatty infiltration, and how does it affect muscle recovery?
Fatty infiltration occurs when fat cells accumulate in the injured muscle tissue, which can impair muscle function and strength. This is often seen in chronic muscle injuries and may be difficult to reverse, even with resistance training.
What happens if I don’t rehabilitate properly after a muscle strain?
Improper or incomplete rehabilitation can lead to chronic pain, muscle weakness, limited range of motion, and a higher likelihood of reinjury. Scar tissue can form, leading to stiffness and functional limitations that may require more extensive treatment later.
What is the difference between PRICE and POLICE protocols?
- PRICE: Protection, Rest, Ice, Compression, Elevation.
- POLICE: Protection, Optimal Loading, Ice, Compression, Elevation. The POLICE protocol encourages the use of controlled, progressive loading during recovery to stimulate healing without overstressing the injured muscle.
How do I know when I’m ready to return to physical activity after a muscle strain?
You are ready to return to activity when:
- You have full pain-free range of motion.
- Muscle strength has returned to normal levels compared to the uninjured side.
- You can perform functional movements (e.g., running, jumping) without pain.
- You have completed a rehabilitation program with no setbacks.
These answers reflect an orthopedic surgeon’s knowledge, focusing on the practical aspects of diagnosis, treatment, and recovery for muscle strains.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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