A muscle is surrounded by an outer sheath that allows it to move smoothly over the surrounding tissues as it contracts. Inside the outer sheath are bundles of muscle fibers known as fascicles, which are further made of myofibrils. These myofibrils are composed of millions of microscopic units called sarcomeres that are responsible for muscle contraction. In the sarcomere, muscle proteins called myosins pull against thin ropes of a protein called actin when they are stimulated by nerves. When this occurs, the sarcomeres shorten, resulting in a contraction. When the myosin proteins relax, the sarcomeres lengthen back to their original position and so does the muscle. Overall, the combination of muscle contraction and relaxation is coordinated through the nervous system. This is what allows athletes to run, kick, throw, and even walk and breathe.
A muscle strain is the stretching or tearing of muscle fibers. Most muscle strains occur for one of two reasons, which are either the muscle has been stretched beyond its limits, or it has been forced to contract too strongly. In mild cases, only a few muscle fibers are stretched or torn, and the muscle remains intact and strong. However, in most severe cases, the strained muscle may be torn and unable to function properly. To better understand the severity of a muscle strain, doctors commonly classify muscle strains into three separate grades, depending on the severity of muscle fiber damage; the grades are as follows:
- Grade 1 muscle strain – In this mild strain, only a few muscle fibers are stretched or torn. Although the injured muscle is tender and painful, it has normal strength.
- Grade 2 muscle strain – This is a moderate strain, with a greater number of injured fibers and more severe muscle pain and tenderness. There is also mild swelling, noticeable loss of strength, and sometimes a bruise.
- Grade 3 muscle strain – This strain tears the muscle all the way through, sometimes causing a popping sensation as the muscle rips into two separate pieces or shears away from its tendon. Grade 3 strains are serious injuries that cause complete loss of muscle function, as well as considerable pain, swelling, tenderness, and discoloration. Because grade 3 strains typically cause a sharp break in the normal outline of the muscle, there may be an obvious dent or gap under the skin where the ripped pieces of muscle have come apart.
Causes & Symptoms
A muscle strain occurs when you overstretch, stress, twist, or tear the muscle. This damage can be acute or chronic and these two scenarios have different causes.
Chronic muscle strains develop gradually over time. They are repetitive strain injures (which is the result of prolonged, repetitive overuse of the muscle or muscle group). When you use the same muscles in the same pattern, repeatedly over time, small stresses build on each other. This eventually causes wear and tear on the muscle leading to a strain. Some examples of chronic muscle strain causes include the following below:
- Improper fitting shoes and other sports equipment.
- Improper body mechanics, such as lifting with your back instead of your legs.
- Poor posture, which stresses muscles that normally do not support posture.
- Lack of diversity in activities.
- Poor sports technique, such as gripping a golf club too tightly.
Acute muscle strains happen suddenly when you load a muscle beyond its capacity. A few examples of acute strains are:
- Direct blow to the muscle.
- Excessive contraction of the muscle.
The most common symptoms of a muscle strain are a sudden pain that worsens while contracting the muscle, swelling, bruising, loss of strength, and loss of range of motion. People often report the sensation of pain as the feeling of being stabbed. When a muscle is initially injured, significant inflammation and swelling may occur. After inflammation, the muscle begins to heal by regenerating muscle fibers from stem cells that live around the area of injury. However, a significant amount of scar tissue also forms where the muscle was injured. Over time, this scar tissue remodels, but the muscle tissue never fully regenerates. It is thought that this makes a strained muscle prone to future injury.
Generally, how long a strain lasts depends on the location and severity of the injury. Symptoms of a mild back muscle strain typically improve within 1 to 2 weeks and are gone within 4 to 6 weeks. In the legs, mild or moderate strains may take up to 8 to 10 weeks or more to heal. Symptoms of a severe strain may persist until the torn muscle is repaired surgically.
Who gets Muscle Strains?
Muscle strains occur frequently in athletes. Most strains respond well to non-surgical treatments, however, some strains can result in partial or complete tears. Other risk factors associated with muscle strains include the following:
- Muscle fatigue, which makes muscles more susceptible to injury.
- Old age or adolescence.
- Poor conditioning – weak muscles are less able to cope with stress.
- Muscle tightness.
- Muscle imbalance, which can occur during high-speed activities.
Additionally, athletes who participate in football, soccer, basketball, running, sprinting, and dancing are especially at risk of muscle strains. Certain parts of the body are more susceptible to strains during participation in certain sports. A few examples include:
- Hands – Gripping sports, such as gymnastics or golf, can increase your risk of muscle strains located in your hands.
- Elbows – Elbow strains are often caused by throwing sports such as baseball and football.
- Legs and ankles – Sports that feature quick starts and jumping, such as hurdling and basketball, can be particularly tough on the Achilles tendon in your ankle.
How Does it Affect You? How Serious is it?
Normally, treating a muscle strain is necessary if you want to boost your recovery process whether you’re dealing with a mild or moderate strain. However, if you have experienced a severe muscle strain, this can require surgical repair, and sometimes recovery is incomplete even after many months or substantial rehabilitation. Surgical repair of a torn muscle carries certain risks. These risks can include:
- Slowed healing time
- Blood clots
- Intense pain
Recommended Treatment & Rehabilitation
During a diagnosis of muscle strains, your doctor will begin by asking questions about what type of activity triggered your muscle pain and whether there was a pop in the muscle at the time of injury. The doctor will then ask about your symptoms, especially any decrease in muscle strength or any difficulty moving. Afterward, he or she will want to know whether you have had a recent fever, weight loss, leg numbness, urinary or bladder problems, or other symptoms that may point to a more severe medical problem.
After noting your symptoms and past medical history, your doctor will examine you, checking for muscle tenderness, spasms, weakness, and decreased muscle movement. If this exam points to a mild or moderate muscle strain, you may not need any additional testing. However, if the diagnosis suspects a muscle strain, X-rays or Magnetic Resonance Imaging (MRI) scans may be helpful. If you have back pain, your doctor may order additional tests to check for a urinary tract infection or a problem involving the vertebrae (or backbones), vertebral disks, spinal canal, or spinal cord.
After finishing a diagnosis of muscle strains, 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 strain may be causing increased tension in your muscle. Your physiotherapist may teach you range-of-motion techniques to restore normal motion in your muscles.
- Pain management – Your physiotherapist will develop a treatment plan to address ice to 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 tension on 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 strains. 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
Most muscle strains can be successfully treated homeopathically. The following treatments include:
- Massage – Therapeutic massage helps loosen tight 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 strained 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 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 strain 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 have 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 caused by a muscle strain.
- Compression – Compression helps reduce swelling inflammation, which may intensify pain and slow healing. You can use static compression with an elastic bandage to apply consistent pressure and help prevent additional swelling.