A muscle strain is a stretch or tear in the muscle or tendon caused by over-stretching or over contracting of muscle tissue. The muscles in the legs and lower back are most commonly affected.
 
About muscle strain
Symptoms of muscle strain
Causes of muscle strain
Diagnosis of muscle strain
Treatment of muscle strain
Prevention of muscle strain
 

About muscle strain

Muscle strain (also called pulled muscles) occurs when a muscle or the tendon (the tough tissue that attaches it to the bone) is overstretched or torn. Often, muscle strain happens during exercise or sports activities. It can also happen when lifting heavy objects.
 
Muscle strain often occurs in the legs and lower back. Muscles most likely to be injured include the following.

  • Calf muscles – a calf strain is a tear in the muscles at the back of your lower legs. The function of the calf muscles is to help raise the heel.
  • Quadriceps muscles – a quadriceps strain is a tear in the muscles at the front of your thigh. The main function of the quadriceps is to help straighten your knee.
  • Hamstring muscles – a hamstring strain is a tear in the muscles at the back of your thigh. The main function of the hamstrings is to help bend the knee.
  • Paraspinal muscles – a low back strain or lumber strain is a tear in the muscles in your lower back. The main function of the paraspinal muscles is to support your spine as well as the weight of your upper body.

Types of muscle strain

Depending on how severe the injury is, muscle strain may be classed as:

  • grade 1 – there is very minor damage to the muscle fibres
  • grade 2 – there is a partial tear of the muscle fibres
  • grade 3 – there is a complete tear of the muscle fibres

 

Symptoms of muscle strain

If you have a mild (grade 1) muscle strain, the area may feel tender and the muscle tight. With minor strain, you may be able to carry on with your activity.
 
More serious muscle strain (grades 2 and 3) will cause considerable pain. The muscle will feel stiff and you will have swelling around the injured area. The pain is worse with movement so it will stop you from doing your activities. You may even have some bruising around the injured area.
 
If you have a grade 3 muscle strain, you will have severe pain, significant swelling and no muscle function. If you have torn your muscle significantly, there might be an unusual lump or dent that was not previously present over the injured area.

Causes of muscle strain

A muscle strain occurs when the muscle contracts when it is stretched. This can happen when running, jumping or kicking.
 
You’re more likely to have a muscle strain if your:

  • warm-up is too short
  • recovery time between training sessions isn’t long enough
  • muscles are already tight or stiff
  • muscles are tired or overused
  • muscles are weak

Diagnosis of muscle strain

Your doctor or a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) can help diagnose a muscle strain. He or she will determine exactly which muscle tissues are damaged, the extent of the damage and estimate how long the injury will take to heal.
 

Treatment of muscle strain

Self-help
Minor muscle strains can be treated quickly and simply at home using the PRICE method.
 

  • Protect your injury from further harm.
  • Rest your injury for the first 48 to 72 hours; then re-introduce movement so you don’t lose too much muscle strength.
  • Ice packs or a bag of frozen peas wrapped in a towel should be applied to the injured area to reduce swelling and bruising. Don’t apply ice directly to your skin as it can give you an ‘ice burn’ – place a cloth between the ice and skin.
  • Compress the area by bandaging it to support the injury and help reduce swelling.
  • Elevate the injured area above the level of your heart to control swelling. Keep the area supported. Try to keep it elevated as much as possible until the swelling goes down.

 
Get medical advice if your injury is very painful and the swelling doesn’t improve.

Medicines

Over-the-counter pain relief medicines, such as paracetamol or ibuprofen can help ease mild and moderate pain. Your GP may prescribe stronger painkillers if your pain is severe. As well as easing your pain, painkillers may help to reduce inflammation and swelling. Always read the patient information that comes with your medicine and if you have questions, ask your pharmacist or doctor for advice.

Surgery

If your injury is severe, you may need surgery to repair the torn muscle or ligament and then a long period of rest and recovery.

Physiotherapy

If your injury is severe or you find that it keeps re-occurring, physiotherapy may help to strengthen the damaged muscle or ligament.
 
Your GP may refer you to a physiotherapist or you can choose to see a physiotherapist privately. He or she will develop a programme of rehabilitation exercises to gradually strengthen and stretch your muscles. These exercises will vary depending on the kind of injury you have and how severe it is. Your physiotherapist may also use various techniques to help speed up the healing of your injury.

The muscle should be allowed to heal fully before you start exercising again.

 

Prevention of muscle strain

You can reduce your risk of muscle strain by doing a thorough warm-up and cool down before and after exercise. The reason for a warm-up is to allow time for your body to prepare mentally and physically for the exercise that you intend to do. It should include cardiovascular exercise followed by stretching.

What is the best way to warm-up before starting running?
I have muscle strain – should I see the doctor?
I have muscle strain – what should I do to speed up my recovery?

 

What is the best way to warm-up before starting running?

A gentle warm-up before running may include some brisk walking, gentle jogging or skipping, followed by a series of stretches and exercises, such as lunges and squats, which mimic running movements.

Explanation
Warming up before exercise prepares you both physically and mentally for the activity you intend to do. The benefit of stretching before or after exercise is unproven. However, warming up before you start exercising helps:

  • increase blood flow and oxygen to your muscles
  • increase flexibility (if you stretch)
  • increase relaxation and concentration
  • reduce risk of injury

No matter what physical activity you plan to undertake, a good warm-up should include cardiovascular exercise, stretches and sports-specific exercises. Therefore, a warm-up for running will be very different from a warm-up for swimming.
A warm-up for running may include some brisk walking, gentle jogging or skipping, followed by a series of stretches and exercises, such as lunges and squats, which mimic running movements.

With stretches you should feel a stretch sensation rather than pain and should try to hold your stretches for at least 30 seconds. Avoid bouncing as you stretch as this may cause injury.

There’s no rule about how long your warm-up should be, but as a general guide you should start to sweat but not feel tired. Stretching is usually done for 15 minutes before you exercise.

Listen to your body to help you create a warm-up that works well for you.

 

I have muscle strain – should I see the doctor?

If your injury is very painful and you have a lot of swelling then it’s important that you get medical advice.

Explanation
You can treat most muscle strains quickly and simply at home by following the PRICE method. PRICE means protection, rest, ice, compression and elevation (see the muscle strain factsheet for more information). If your symptoms don’t improve or any pain or swelling gets worse, you need to speak to your doctor.
 
More serious muscle strains need immediate medical attention. For example, if the affected muscle is very painful, feels hot to touch and there is significant swelling, you should visit your local accident and emergency department.

 

I have muscle strain – what should I do to speed up my recovery?

You need to take it easy, rest the injury and allow time to heal before returning to your usual activities.

Explanation
The most important way to help your injury to heal is to follow the PRICE method immediately after the injury. PRICE means protection, rest, ice, compression and elevation (see the muscle strain factsheet for more information).
There are certain things you should not do in the first three days after your injury to avoid doing further damage to your muscle or tendon. These can be remembered as HARM.

  • Heat – this includes having a hot bath or using a heat pack.
  • Alcohol – drinking alcohol can increase bleeding and swelling in the affected area.
  • Running or other forms of exercise.
  • Massaging the injured muscle – this can cause more swelling or bleeding.

Physiotherapy can help speed up the healing of your injury. A physiotherapist is a health professional who specialises in movement and mobility. Your GP can refer you to a physiotherapist or you can choose to see one privately. He or she will develop a programme of rehabilitation exercises to gradually strengthen and stretch your muscles. These exercises will vary depending on the kind of injury you have and how severe it is. Your physiotherapist may also use various techniques to help speed up the healing of your injury.

Depending on the type of injury you have, a complete recovery can take up to eight weeks.

Further information

The Chartered Society of Physiotherapy
020 7306 6666
www.csp.org.uk
 

Sources

  • John Orchard. Conference Proceedings: The biomechanics of muscle strain injury. NZJSM 2002; 30(4):92–98
  • St John Ambulance. First aid manual. 9th ed. London. Dorling Kindersley Ltd. 2009: 241
  • Sprains and strains. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 10 February 2010
  • Starting to exercise. Bandolier. www.medicine.ox.ac.uk/bandolier, accessed 10 February 2010
  • Herbert RD, de Noronha M. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews, 2007, Número 4. DOI: 10.1002/14651858.CD004577.pub2
  • Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sport Med 2009; 43:247–52

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