Muscle strains can occur in many muscle groups, however the most commonly affected during work and exercise are the Lower Back, Hamstrings, Quadriceps, Hip Flexors, Groins and Calf muscles. Each one of these muscle strains can range from a slight overstretch or pulled muscle to full-thickness ruptures.
Thorough muscle strain treatment protocols and a full rehabilitation program is to be completed in order to restore the appropriate strength and mobility required to return. Muscle strains can become a frustrating injury to deal with as many people return to sport or work too early, re-injuring the pulled muscle by overloading it before it was ready!
Severity of Muscle Strains – Grading System
In sports medicine, muscle strains are graded as either level I, II or III depending on the severity of injury and amount of damage to the muscle fibres. This means there are varying levels of physical therapy and rehabilitation required as well as a large range in return to sport and/or activity time frames.
Grade I Muscle Strain
In a grade I muscle strain, the muscle or tendon is overstretched. Small tears to the muscle fibres may or may not occur. You may have mild pain with or without swelling. Usually use of the muscle will be sore but most if not all the strength of that muscle still remains.
Grade II Muscle Strain
A grade II muscle strain occurs when the muscle or its’ tendon is overstretched with a large proportion of muscle fibres torn. Symptoms may include significant pain, bruising and swelling. The area of injury can be very tender. Movement may be difficult due to pain and there is normally a loss of strength output as well..
Grade III Muscle Strain
Grade III muscle strains are the most serious among the three grades of muscle strains. Most, if not all (complete ruptures) of the muscle fibres are torn. Pain, swelling, tenderness and bruising are all present and quite significant. Movement is usually difficult with a substantial loss of strength and mobility.
Muscle Strain Treatment and Rehabilitation
There is no specific time frames for when to progress from each stage of muscle strain treatment to the next. Your rehabilitation of the injured muscle will be determined by many factors during your Physio Fit clinical assessment. You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
It is also important to note that each progression must be carefully monitored as attempting to progress an acute muscle strain too soon to the next level can lead to re-injury and the frustration of a delay in your recovery.
Phase 1 – Injury Protection, Pain Relief & Relative Rest
As with most acute muscle (or soft tissue) injuries the initial treatment is POLICE – Protect, Optimal Loading, Ice, Compression and Elevation.
Protection: First course of any muscle strain treatment should always be to prevent further injury. For example, an injured leg or foot may be protected by limiting or avoiding weight-bearing through the use of crutches. Partially immobilising the injured area by using a sling, splint, or brace may also be a means of protection.
Optimal Loading: In the early phases you may not be able to use the injured muscle group very well. Your first aim is actively rest from pain-provoking postures and movements but still load it where you can. This means that you should stop doing the movement or activity that provokes muscle pain but if able to, continue gentle movements or walking as it may actually be beneficial if there’s minimal pain.
Ice: This is a simple and effective modality to reduce your pain and potentially limit the amount of swelling. Apply for 20 minutes each 2 to 4 hours during the initial phase of injury (normally the first 48 hours).
Compression: A compression bandage (tubigrip compression stocking) will help to both support the injured soft tissue and help to reduce excessive swelling through improving lymphatic drainage.
Elevation: Elevating the injured area above your heart will assist with circulation and reducing overall swelling.
Additional to these initial recovery techniques, your physiotherapist will utilise a range of helpful tricks including pain relieving techniques, joint mobilisations, massage and strapping to assist you during this painful phase.
NOTE: Anti-inflammatory Medication: It is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may actually encourage additional bleeding.
Phase 2: Regain Full Range of Motion
During this period, the aim is to regain your full range of motion pain free. This may mean that you have some gentle exercises to complete and need to modify some tasks while the injury heals. During this time, your Physiotherapist will guide you and prescribe the exercises that are best suited to your needs.
Phase 3: Restore Muscle Strength, Endurance & Power
Your injured muscles will require strengthening after any strain. It is important to regain normal muscle strength and endurance to provide normal dynamic control and function. Your strength and power should be gradually progressed from body weight exercises to resistance exercises. You may also require strengthening for your other limb or side of the body depending on assessment findings.
Proprioceptive and endurance training are also introduced during this stage of rehabilitation. Exercises that challenge balance, body awareness and stability are commonly prescribed to assist with returning back to your specific goal/activity.
Phase 4: Return to Activity
Depending on the demands of what you are planning on getting back to, you may require work or sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your desired activity. Your Physiotherapist will work with you to help you towards your goals, guiding you through time frames and training schedules to optimise you for a complete and safe return. The perfect outcome will have you performing at full function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.
Following most muscle strains, most athletes return to their previous level of competition. While each case is individual, the process to return to sport will be based heavily on the athlete returning to symmetry (as close as possible) in all aspects of range of motion, strength, balance, biomechanics and function. In the early stages, milestones centre around returning athletes to baseline performance values that, if available, would have been tested in the pre or off-season. Later stage milestones prior to return to sport will involve at least 2 weeks of pain free trainings at full contact and intensity before being cleared to return to sport.
Mechanism of Injury
A muscle strain is any physical trauma to a muscle caused by force applied along the length of the muscle. When a ‘load’, applied to a tissue outweighs it capacity of the tissue, break down occurs. Patients often coin their strain has a “pulled muscle” or “muscle tear”.
While there are many forms of muscle strains, typically they will involve a high speed contraction (sprinting), high speed deceleration (kicking or change of direction) and sometimes a physical blunt trauma (tackling).
Other forms of muscle strains may be over longer periods of time where micro-trauma begin to build up. Fatigue related muscle strains for example occur with poor sustained postures. But likewise overuse of a tissue can lead to break down such a repetitive strain injury (RSI)
The symptoms of a muscular strain may include:
- Pain – especially when using or when pressure is applied to the affected muscle
- Swelling – across the affected area
- Stiffness – over the joint that the muscle crosses
- Reduced function – the limb becomes difficult to move because of pain and swelling
Can Muscle Strains Be Prevented?
Not all muscle strains can be prevented, however there are always things you can do to help minimise the risk of them occurring. Follow these steps to keep your muscles strong and ready to go at all times!
- Warm ups before and cool downs after any exercise or physical activity to ensure muscles are prepared as well as recovering appropriately
- Working on muscle strength and endurance to ensure there are no imbalances between sides
- Having good recovery habits such as stretching, foam rolling, good nutrition and adequate sleep.
Many athletes will suffer a muscle strain of some degree. Despite their high incidence, advances in sports medicine and clinical diagnostic criteria and imaging, the optimal management and rehabilitation strategies are still debated in literature.
Furthermore, re-injury rates of muscle strains are high after a muscle lesion, and an improper treatment or an early return to sports can increase the rate of re-injury and complications. Most muscle injuries are managed conservatively with excellent results, and surgery is normally advocated only for larger tears.
