We have all heard the term muscle strain, and most of us have experienced at least one in their lifetime. This post will discuss in detail what muscle strains are, how they occur, and how they are diagnosed. Muscles make up over half of the weight of a human body and they are required to make even the smallest of movements such as nodding your head or tapping your toe. If too much stretch is put through one of your muscles you may end up with a painful muscle strain. If the similar type of injury occurred to one of the ligaments in your body, it is termed a sprain.
What parts of the body are involved?
Muscles are composed of many fibers bundled together; the bigger, more frequently used muscles have more fibers than the smaller, lesser-used ones. Among the muscles are voluntary and involuntary muscles. Voluntary, or striated muscles, are those that we move by choice (for example, the muscles in your arms and legs). Involuntary muscles, or smooth muscles, are the ones that move on their own (for example, the muscles that control your diaphragm and help you breathe). The muscles in your heart are called involuntary cardiac muscles. Voluntary muscles are attached to bones by tendons, a sinewy type of tissue. The area where the muscle attaches to the tendon is called the musculotendinous junction.
What causes a muscle strain?
A muscle strain, or a muscle pull occurs when a muscle in your body is overstretched or overworked. Even if the injury from overstretching or overworking occurs more to the attaching tendon it can also be classified under the term muscle strain. A muscle strain can occur in any of your voluntary muscles (or tendons which attach to the muscle), but they are most common in the low back, the calves, the front and back of the thighs, the pectoral muscles, and the muscles of the neck and the shoulder. Muscle strains occur more often in muscles that cross two joints (such as the thigh or calf muscles) and often occur when the muscles are working eccentrically (working while under a stretch). Most often a strain occurs at the musculotendinous junction but can occur anywhere along the muscle.
A muscle strain can occur due to a one-time over-stretching or overworking of a muscle (acute injury) or can occur from repetitive use of a muscle over time (overuse injury).
The initial approach to rehabilitation of your muscle strain will depend on how long after your injury that you seek treatment. The immediate line of defence straight after a muscle strain should be the application of ice and compression, followed by rest and elevation for the affected muscle. Recent research on the benefits of applying ice immediately after an injury are beginning to be questioned, but the general consensus is still to apply ice. The importance of applying compression initially as a line of first defence (generally done by wrapping the affected area) is becoming more evident.
The initial aim of treatment for acute strains at Health Bound Health Network is to manage the secondary inflammation and pain in the area. Some initial inflammation is actually required to start the healing process, but a large inflammatory response can also lead to secondary inflammation and secondary cell injury, which affects tissues that were not directly related to the initial insult. Ice and compression can greatly assist in decreasing this detrimental secondary tissue injury.
In cases where it is not an acute strain heat may be more useful in decreasing pain. Your physiotherapist can advise you whether it is best to use ice or heat at your stage of healing. Your therapist may also use electrical modalities, as shown in the photo, such as ultrasound or a laser current to help decrease the pain and control the amount of inflammation. Massage of the injured area or the tissues surrounding the area may also be helpful. Depending on the severity of the strain and the time that has elapsed since the injury, massage directly over the torn area can slow the healing process and may lead to other muscle complications so be sure to let your physiotherapist determine whether or not this is something you should be doing on your own.
Once the initial pain and inflammation has calmed down, your physiotherapist will focus on improving the flexibility and strength of the involved muscle. Static stretches to increase the flexibility of the muscle will be prescribed by your physiotherapist early on in your treatment as these types of stretches encourage the healing tissues to withstand stretch and they ensure that you do not lose any range of motion overall. As your range of motion improves, more aggressive stretches will be added, however stretching should be limited such that it never causes pain. Feeling a gentle stretch at the end of the range of motion should be the limit otherwise further damage could occur to the muscle. As the muscle nears the end of its healing, dynamic stretching (rapid motions that stretch the tissues quickly) will also be taught and will be incorporated into your rehabilitation exercise routine in order to prepare your muscle to return to more taxing movements such as those involved in normal everyday activity or sport. Dynamic stretches are used to prepare the tissues for activity whereas static stretches focus more on gaining flexibility.
Rest is also an important part of your physiotherapy treatment. ‘Relative rest’ is a term used to describe a scale of resting compared to the normal activity you would be doing. If you are experiencing pain while doing nothing at all it means the injury is more severe and your physiotherapist may advise a period of complete rest where you do either no activity, or very little activity such as a few gentle stretches. As your pain improves then the rest to activity balance will swing the other way such that you will still require more rest for the muscle than usual but there will also be a gradual increase in activity including more aggressive stretches along with strengthening so long as there is no return in symptoms.
Along with stretching exercises, your physiotherapist will also prescribe strengthening exercises in order to get your strained muscle back in top shape. Initially your therapist may suggest that you only do isometric contractions of your muscle, which means that you tighten the affected muscle without actually moving the associated joints. An example of this type of contraction occurs when people are asked to flex their biceps muscle, and they tighten the muscle fibers of the upper arm in place, without bending the elbow or moving the shoulder. This type of contraction is an effective way to begin strengthening an injured muscle. As the muscle continues to heal, more aggressive strengthening will be prescribed where you are moving your limb and using the weight of your body to provide resistance. When appropriate your therapist will prescribe strengthening exercises with free weights, elastic bands or tubing, weight machines, etc. These types of exercises are necessary as part of your rehabilitation program in order to prepare the strained muscle for the return to normal everyday activity and sport. Quite often it is an eccentric contraction of the muscle that has caused the strain in the first place, so training the muscle to withstand this type of force when the time is right is crucial to ensuring it won’t be re-injured.
In addition to stretching and strengthening the muscle, taping or wrapping the affected muscle with an elastic bandage may be done by your physiotherapist in order to assist initial swelling, and to provide support to the muscle as you rehabilitate it. They may even teach you how to tape or wrap your own muscle so you can do it on your own.
If your muscle strain is in the lower part of your body, your therapist may prescribe a specific type of strengthening called plyometrics. Plyometrics is a form of power strengthening that is a particularly important part of the end stage of your rehabilitation for any of your power muscles in your legs such as your quads, hamstrings, and calves, especially if you are involved in sport. Plyometrics involves repetitive jumping which forces your muscles to engage in force as they repetitively shorten and lengthen. This type of training maximally loads the lower extremity muscles and prepares them to take the high stress load involved with activity such as sport or daily activities such as running across the street.
A critical part of our treatment for a muscle strain at Health Bound Health Network includes advice from your physiotherapist on the acceptable level of activity at each stage of your rehabilitation process will be invaluable, and will assist you in returning to your activities as quickly but as safely as possible. If you experience a muscle strain, let the expert physiotherapists at Health Bound Health Network assist you in determining the severity of your strain as well as help get you back to your everyday activity or sport by guiding you through the appropriate rehabilitation program.