Muscle Strain

Muscle strain is an injury to the muscle as a result of strenuous activity

Muscle strain is an injury to the muscle as a result of strenuous activity. Almost anyone can put undue tension on muscles during the course of normal daily activities, with sudden, quick heavy lifting, during sports, or while performing work tasks.

Muscle strain is sometimes referred to as muscle pull. A severe muscle strain can result in a muscle tear. The tearing of the muscle can also damage small blood vessels, causing local bleeding (with or without bruising) and pain (caused by irritation of the nerve endings in the area).

Of note, a sprain, in contrast to a strain, is an injury to ligaments and/or joints that cause pain and swelling but not dislocation.

Muscle strains can happen to anyone. They occur in the course of normal activities of the day or as a result of sudden use of a muscle with activity. Activities that can increase the risk of muscle strain include:

• athletic activity in sports with sudden acceleration or deceleration,
• throwing,
• quick and/or heavy lifting,
• sudden coughing, or
• injury of muscle while performing irregular work tasks.

It is possible to strain any muscle that moves bones. Commonly strained muscles include the:

• lumbar muscles,
• hamstring muscles of the posterior thigh,
• abdominal muscles,
• biceps muscles,
• triceps muscles,
• adductor muscles,
• quadriceps muscles of the thigh,
• triceps muscles, calf muscles,
• upper back muscles including trapezius and rhomboid muscles,
• neck muscles, and
• the intercostal muscles and oblique muscles of the chest.

Symptoms of a muscle strain may include:

• Swelling, bruising or redness, or open cuts as a consequence of the injury
• Pain in the affected muscle at rest
• Pain when the specific muscle or the joint in relation to that muscle is used
• Weakness sensation of the associated muscle or tendons (a sprain, in contrast, is an injury to a joint and its ligaments.)
• Inability to use the affected muscle at all

Ultimately, the symptoms depend on the muscle affected and the severity of the injury. Here is a listing of various muscles with the corresponding location and other corresponding symptoms:

• Intercostal muscle: pain between the ribs; pain with throwing or chopping motion
• Abdominal muscle: pain with sit-up or "crunch" motion of belly
• Calf muscle: pain in the back of the lower leg with walking or running; limping
• Lumbar back muscle: pain with bending over and returning to an erect position
• Rhomboid muscle: pain with a rowing motion
• Neck muscle: pain with movement of the head in direction of strained muscle or twisting the neck
• Trapezius muscle: pain with pulling down from an overhead position
• Adductor muscle: pain when squeezing knees together
• Quadriceps muscle: pain when extending the knee from a flexed position
• Hip flexor muscles: pain when flexing the thigh into the body at the hip
• Gluteal muscle: pain when walking or running up hills or stairs
• Hamstring muscle: pain when accelerating during sprinting
• Bicep muscle: pain when curling (lifting) against resistance at the elbow

If one has a significant muscle injury (or if the home care methods bring no relief in 24 hours), call a doctor.

If someone hears a "popping" sound with the injury, cannot walk, or there is significant swelling, pain, fever, or open cuts, he or she should be examined in a hospital's emergency department.

Muscle strains are commonly treated by primary care providers, including family medicine doctors, internists, and general practitioners.

Other doctors who can be involved in caring for patients with muscle strains include emergency physicians, physiatrists, orthopedists, sports-medicine doctors, and rheumatologists.

Ancillary caregivers who can be involved in caring for muscle strain injuries include physical therapists, massage therapists, and chiropractors.

The doctor will take a medical history and perform a physical exam. The examination is generally all that is needed for diagnosis and can help to establish whether the muscle is partially or completely torn. A higher degree or grade of strain (grades 1-3) can involve longer healing, possible surgery, and more complicated recovery.

X-rays or laboratory tests are often not necessary unless there was a history of trauma or evidence of infection. Infrequently, the physician may order a CT or MRI to better assess the diagnosis of the injury.

Grade I muscle strain: This is the most minor of muscle strains, affecting only a minimal percentage of the muscle fibers of the affected muscle. Complete recovery is expected within weeks.

Grade II muscle strain: This is a partial tear of a significant percentage of the muscle fibers of the affected muscle. Complete recovery can occur but can take months and require rehabilitation.

Grade III muscle strain: This is a complete tear, or rupture, of the affected muscle. This can require surgical repair, and sometimes recovery is incomplete, even after many months of substantial rehabilitation.

Muscle strain typically involves varying degrees of injury to tiny blood vessels. The effects of swelling or local bleeding into the muscle can best be managed early on by applying ice packs to close the blood vessels and maintaining the strained muscle in a relaxed, stretched position. Heat can be applied to further relax the muscle when the swelling has lessened (in general, about 12-24 hours after the initial strain). However, the early application of heat can increase swelling and pain.

Note: Ice or heat should not be applied to bare skin. Always use a protective covering such as a towel between the ice or heat and the skin.

• Take nonsteroidal anti-inflammatory agents (NSAIDs) such as aspirin (Bufferin, Ecotrin) and ibuprofen (Advil) to reduce the pain and improve one's ability to move around. However, do not use aspirin in children with muscle strains.
• Protection, rest, ice, compression, and elevation (known as the PRICE formula) can help the affected muscle. Here's how: First, remove all constrictive clothing, including jewelry, in the area of muscle strain.
  • Protect the strained muscle from further injury.
  • Rest the strained muscle. Avoid the activities that caused the strain and any activities that are painful.
  • Ice the muscle area (20 minutes every hour while awake). Ice is a very effective anti-inflammatory and pain-relieving agent. Small ice packs, such as packages of frozen vegetables or water frozen in foam coffee cups, applied to the area may help decrease inflammation.
  • Compression can be gently applied with an Ace or other elastic bandage, which can provide both support and decrease swelling. Do not wrap tightly.
  • Elevate the injured area to decrease swelling. Prop up a strained leg muscle while sitting, for example.
• Activities that increase muscle pain or work the affected body part are not recommended until the pain has significantly gone away.

Medical treatment is similar to the treatment at home. The doctor, however, also can determine the extent of muscle and tendon injury and if crutches or a brace is necessary for healing. The doctor can also determine if a patient needs to restrict his or her activity, take days off work, and if rehabilitation exercises are required to help in recovery.

Not all muscle strains can be prevented, but the chance for them to develop may be reduced by the following:

• Avoid injury by daily stretching.
• Stretch every time before exercise.
• Establish a warm-up routine prior to engaging in strenuous exercise.
• Start an exercise program in consultation with a doctor.

Usually, with proper treatment, most people recover completely from muscle strain. More complicated situations are handled on an individual basis by the doctor.