By: Daniel P. Bouvier, MD
What is a Muscle Strain?
A strain is an injury to a muscle or tendon, which occurs when the muscle is stretched or torn. This differs from a sprain, which is a term used to describe a stretching or tearing of ligaments. Ligaments connect bones to other bones, whereas tendons connect muscles to bones. Muscle strain often occurs in the low back and the hamstrings.
A “pop” may be felt and there will be some discomfort. There may be more pain when attempting to move the affected area. Swelling may occur. Depending on the strain’s severity, bruising may develop – sometimes days later – and not necessarily at the original painful area.
An acute muscle strain results from a rapid movement of a limb or from a fall. Lifting with improper body mechanics can also result in a strain. Chronic muscle injuries occur from “micro” trauma from repetitive activity in sports like tennis, gymnastics, golf, and ballet.
Deconditioning: The “Weekend Warrior” syndrome can lead to acute injury. If you are participating in an activity you don’t do regularly or don’t keep in shape to do, you are setting yourself up for a muscle strain.
Uncontrollable elements: Weather or other factors may result in slippery field conditions.
Equipment: Faulty, worn, or improper footwear, ski equipment, or other sporting gear.
Fatigue: If you can feel your muscles reaching a fatigue point, your normal protective mechanics will be disrupted and sudden injury may result.
Improper Warm Up: Improper warm up can lead to injury. Doing a light to moderate period of jogging or cardio activity can warm the muscles for proper stretching prior to your activity.
The history and a good physical exam is usually enough to diagnose a muscle strain. A screening X-ray is often used to rule out a bone avulsion, or fracture of the bone at the attachment point of the muscle, which is more commonly seen in children. In severe cases an MRI can be useful, but isn’t always necessary.
When to See a Specialist
If a loud pop is heard during an injury, followed by severe pain, inability to move the limb, and/or an inability to bear weight on the extremity, orthopaedic evaluation is usually necessary. Severe bruising is another reason to seek out specialty care.
Treatment may range from basic home remedies all the way to surgery, depending on the severity of the injury.
RICE: Rest, Ice, Compression, Elevation is usually the first step in muscle strain treatment. Over the counter medications to control pain may be useful, but only on an as needed basis. Rest doesn’t necessarily mean to do nothing. One can cross train and do activities such as a bike or using the pool, that won’t aggravate or worsen symptoms. Proper elevation means to elevate the injured area above the level of the heart. Icing should be done for 15-20 minutes at a time 4-5 times daily, taking care to place a layer between the skin and the ice so as not to cause a frostbite injury to the skin. After a few days of RICE, it is usually safe and recommended to begin to move the limb as your symptoms will allow.
Physical Therapy: Many strains and sprains are very amenable to physical therapy. A good physical therapist can be instrumental in speeding your recovery by helping to reduce swelling, reactivate muscles and keep other joints moving.
Surgery: In the most severe cases in certain parts of the body, surgery may be warranted or offered as an option to reattach or repair a disrupted muscle/tendon unit.