Your Guide to Muscle Strains
Many athletes will suffer a muscular strain of some degree. Despite their high incidence, advances in clinical diagnostic criteria and imaging, their optimal management and rehabilitation strategies are still debated in literature.
Furthermore, re-injury rate is 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.
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)
Symptoms of a muscular strain
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
Grades a muscular strains
Acute soft tissue injuries are graded according to their severity and include:
Grade I – some fibres are torn and the site is moderately painful and swollen, but function and strength are mostly unaffected
Grade II – many fibres are torn and the site is painful and swollen, with some loss of function and strength
Grade III – the soft tissue is totally torn, with considerable loss of function and strength. Grade III injuries often need surgical repair.
Muscle strains respond well to conservative management. Typically categorised in phases, management of a muscle strain can be straightforward with goals defining each phase.
The first-line treatment for a muscular strain in the acute phase include five steps commonly known as P.O.L.I.C.E.
(P) Protection: Apply soft padding to minimise impact and further trauma
(O.L) Optimal Load: Injured muscles require rest, but a balanced and progressive program should gradually reintroduce controlled stress to reduce muscle contracture, neural tension and increase flexibility
(I) Ice: Apply ice to induce vasoconstriction, which will reduce blood flow to the site of injury. Never ice for more than 20 minutes at a time.
Compression: Wrap the strained area with a soft-wrapped bandage to promote lymphatic drainage.
Elevation: Keep the strained area as close to the level of the heart as is possible in order to promote venous blood return to the systemic circulation.
In the initial phase, treatment will usually involve the use of NSAIDs and cold compression (icing). Cold compression therapy acts to reduce swelling and pain by reducing inflammatory cells into the injured area.
A new treatment for acute strains is the use of platelet rich plasma (PRP) injections. Blood is drawn from the client, which is then put through a process of centrifuge in order to concentrate the platelets which are then injected into the site of the injury. These platelets contain several growth factors that may stimulate healing and muscle regeneration, and limit the amount of scar tissue that forms. There continues to be an increasing body of research in this field so watch this space!
In the sub acute phase, mobilisation must begin as soon as possible but gradually and within the limits of pain. Tissue mobilisation is completed with the goal of facilitating muscle movement, promote blood circulation and tissue regeneration.
Low impact cardio is encouraged as soon as possible. Since core stability programmes have been shown to improve results in terms of lower re-injury rates and enhanced return to play, they are introduced as soon as possible in this phase.
Proprioceptive and endurance training are used in the advanced stages of rehabilitation. Exercises that challenge balance, body awareness and stability are commonly prescribed. Goals in this phase look to regain the remaining range of motion, return to full strength and begin to participate in sport specific exercises and trainings.
Return to sport
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 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 2-3 pain free full trainings before being cleared to return to sport.
Key take home messages!
You can expect a full recovery from a muscular strain
Early mobilisation is recommended to reduce muscle contracture, neural tension, and increase flexibility
Muscle and performance imbalances are key indicators for return to sport