Muscle Strain

GENERAL INFORMATION:

What is a muscle strain? A muscle strain is a twist, pull, or tear of a muscle or tendon. A tendon is a strong elastic tissue that connects a muscle to a bone. You may have a muscle strain in the thigh, lower leg, arm, abdomen (stomach), or back. Muscle strains most often occur in people who do sports.

What causes a muscle strain? Overstretching or tightening a muscle too much may cause a muscle strain. A strain may also happen when a muscle is used too much or too often without rest. Leg muscle strains are more common in people who play sports such as football, running, jumping, dancing, and water-skiing. Strains in the muscles of the abdomen may happen while playing volleyball, tennis, golf, baseball, and diving. Low back muscle strains may occur while lifting heavy objects, or when you are wrestling or doing gymnastics.

What are the types of muscle strains?

• Mild: This is also called a first-degree tear. It is a tear of a few muscle fibers with little swelling. You may have very little or no loss of muscle strength.
  
  
• Moderate: This is a second-degree tear. There is more damage to your muscle and it is weaker than it was before the injury.
  
  
• Severe: This is also called a third-degree tear. This tear goes along the whole length of the muscle, and you are unable to use the muscle at all. The muscle may not be able to contract or move.

What increases my risk of having a muscle strain?

• Older age.
  
  
• Muscle fatigue (tiredness).
  
  
• Not getting ready for exercise by moving around long enough to get your muscles warm.
  
  
• Past muscle injury, or going back to your usual activity before your injury has healed well.
  
  
• Stiff, tight, and weak muscles. In athletes who compete only part of the year, such as baseball players, this can happen if they do not train enough before the game season starts.
  
  
• Training longer or farther than your usual time or distance.
  
  
• Unequal leg length, or foot problems such as when you have an inward twisting of your foot.

What are the signs and symptoms of a muscle strain? The signs and symptoms of a muscle strain depend on how badly your muscle is injured. These may or may not show up right away when the injury happens. You may have one or more of the following:

• Bruised skin (bleeding under the skin) on the area of your injured muscle.
  
  
• Little or stiff muscle movement, or loss of muscle strength.
  
  
• Muscle soreness, cramps, or spasms.
  
  
• Muscle pain that gets worse with activity, or pain that moves or spreads to another body area.
  
  
• Crepitus (crackling or grating feeling or sound under the skin) when moving your muscle.
  
  
• Swelling in the area of the injury.

How is a muscle strain diagnosed? Your caregiver will ask about diseases or injuries you have had in the past. He may touch and press parts of your muscle. He may bend, stretch, or move your joint certain ways. You may also have any of the following tests:

• Computed tomography scan: This is also called CT scan. A special x-ray machine uses a computer to take pictures of your limbs, back, or abdomen. It is used to check for muscle injuries. It may also be used to look for broken bones and damaged blood vessels.
  
  
• Magnetic resonance imaging: This test is also called MRI. During the MRI, pictures of your muscles are taken. An MRI may be used to check for tears or other muscle injuries. It may also be used to look at your joints, bones, or blood vessels. Before taking the pictures, you may be given dye through your vein. This helps parts inside your body show up better. Tell your caregiver if you are allergic to shellfish (lobster, crab, or shrimp) as you may also be allergic to some dyes.
  
  
• Ultrasound: An ultrasound is a test that looks inside your body. Sound waves are used to show pictures of your muscles and tissues on a TV-like screen.
  
  
• X-ray: This is a picture of the bones and tissues in your body. X-rays may be done to make sure that none of your bones were broken when your muscle strain happened.

What can I do if I have a muscle strain? The goals of treatment are to help your muscle work as it did before the strain, and prevent scar tissue from forming. Treatment may prevent another muscle strain, and help you go back to your activity as soon as possible. It will also help your muscle work as well as it can within the shortest possible time. You may do any of the following depending on the time after your injury:

• Phase one: This is also known as the acute phase. It may last from 3 to 7 days after an injury happens. The most used treatment for a muscle strain in its early stage is Rest, Ice, Compression, and Elevation (RICE). Doing this may help stop bleeding (bruising), and decrease pain and swelling.
  
  
  • Rest: Rest your muscle to allow your injury to heal. When the pain decreases, begin normal, slow movements. For mild and moderate muscle strains, you should rest your muscles for about two days. However, if you have a severe muscle strain, rest should be for 10 to 14 days. If your muscle strain is in your legs or lower body, you may need to use crutches to walk.
    
    
  • Ice: Put an ice pack on the injured area. Do not put the ice pack directly on your skin. Put a towel between the ice pack and your skin. A package of frozen peas or other small vegetables in a thin towel can be used instead of an ice pack.
    
    
  • Compression: You may need to wrap an elastic bandage around the area to decrease swelling. It should be tight enough for you to feel support. Do not wrap it too tightly.
    
    
  • Elevation: Keep the injured muscle raised above your heart if possible. For example if you have a strain of your lower leg muscle, lie down and prop your leg up on pillows. Doing this helps decrease pain and swelling.
    
    
  • Medicines: You may also want to use medicine to decrease pain and swelling.
    
    
    • Pain medicine: You may use medicine to take away or decrease pain, such as a non-steroidal anti-inflammatory drugs (NSAIDs). Some pain medicines may also help decrease swelling. These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Before using this medicine, tell caregivers if you have liver or kidney disease, a history of bleeding in your stomach, or any other medical problems. Also tell your caregiver about any allergies you have to medicines. Your caregiver will tell you if you should use this medicine. If you do use this medicine, it should only be used for 3 to 7 days after the injury happened.
      
      
    • Muscle relaxers: This is medicine to help your muscles relax. When your muscles relax, you may move more easily and have less pain.
  
  
• Phase two: This is also known as the subacute phase. It may last from 3 to 21 days after the injury. During this time, there is less swelling, redness and pain. Your strained muscle should be moved and used, as this will help it begin healing. Start to slowly and regularly exercise your muscle. If you feel pain, decrease how hard you are exercising.
  
  
• Phase three: This is also known as the remodeling phase. This may last from 1 to 6 weeks after the injury. Stretch the injured muscle. Stretch the muscle for about 30 seconds. Do this four times a day. You may stretch the muscle until you feel a slight pulling, but no pain. Stop stretching the muscle if you feel pain.
  
  
• Phase four: This phase is also known as the functional phase. It may last from 2 weeks to 6 months after the injury. The goal of this phase is to return to the activity you were doing before the injury happened without hurting the muscle again. For example, if you have felt no pain for two weeks, you may cross-train. You could try other sports such as bicycling, swimming, or pool jogging, and then begin running again.
  
  
• Phase five: This is the last phase of the healing process. It may last from 3 weeks to 6 months after the injury. Keep stretching and strengthening your muscles to avoid getting hurt again. You may do core (stomach and back) strengthening exercises such as sit-ups. Slowly increase the time and distance that you exercise. You may do many things to help your muscle strain heal, but still have signs and symptoms of it six months after the injury. In this case, caregivers may talk to you about having surgery on the muscle.

How can my caregiver help me? Your caregiver may do any of the following depending on the severity of your muscle strain:

• Injected medicine (shots): You may get a shot of medicine given into the strained muscle. The medicine used for this is usually local anesthetic. This type of medicine causes the area to be numb (lose feeling) for a short time. This medicine is often given when you have a muscle strain in your back. Steroid medicine may also be used. This medicine may decrease swelling and pain in the area, but there are risks of using this medicine. Pain is a sign of an injury. If the medicine makes your pain go away, you may start using the muscle before it has time to heal. This places you at a higher risk of injuring your muscle again.
  
  
• Surgery: Caregivers may talk to you about having surgery if your muscle strain does not heal after six months of treatments. Surgery may be done to drain blood that has pooled in your muscle. If your tendon was completely torn off of the bone, it may be put back with surgery.
  
  
• Physical therapy: Your caregiver may want you to go to physical therapy. A physical therapist will help you with special exercises. These exercises help make your bones and muscles stronger.

How can a muscle strain be prevented?

• Always use proper footwear when playing sports. Replace your old running shoes with new ones often if you are a runner. Use special shoe inserts or arch supports to correct leg or foot problems. Ask your caregiver for more information on shoe supports.
  
  
• Do warm up and cool down exercises. You may do stretching exercises before working out or doing sports activities. These exercises will help loosen and decrease stress on your muscles. Cool down and stretch after your workout. Do not stop and rest very quickly after a workout. Cool down exercises help your muscles prepare to rest.
  
  
• Drink plenty of liquids during and after exercise. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). People who play sports may need to drink more than this.
  
  
• Eat high carbohydrate foods. Eat foods that are high in carbohydrates such as corn, bread or rice before exercising. This will give your muscles the energy they need to avoid fatigue.
  
  
• Keep your muscles strong by doing strength training exercises. Having strong muscles can help prevent another injury. Exercises such as weight lifting, and stretching exercises may help keep your muscles flexible and strong. Ask a caregiver to teach you how to do strength training exercises correctly.
  
  
• Slowly start your exercise or sports training program as directed by your caregiver. Slowly increase time, distance, and how often you train. Sudden increases in how often you train may cause you to injure your muscle again. If you injured your leg area, you may walk before running and slowly increase the time or distance.

When should I call my caregiver? Call your caregiver if:

• The area of your injured muscle becomes very swollen and feels tight inside.
  
  
• Your pain and swelling worsen or do not go away.
  
  
• You have questions or concerns about your muscle strain or treatment.

When should I seek immediate help? Seek care immediately or call 911 if:

• You suddenly cannot feel or move your injured muscle.
  
  

Where can I find more information?

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont, IL 600184262
  Phone: 1-847-8237186
  Web Address: http://www.aaos.org/
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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