Muscle Strain

This article contains self-care information for the selected condition. If you have questions or need more comprehensive treatment advice, please consult a medical professional.

A strain is an injury to either a muscle or tendon (fibrous cords of tissue that connect muscle to bone) and is a common musculoskeletal condition. 1 Strains can be caused by twisting or pulling these tissues.

Muscle strains can be acute, sudden and severe in the beginning, or chronic, persisting for a long time or constantly recurring. Typical forms of musculoskeletal strains are:

• Back strain
• Hip strain
• Wrist strain
• Ankle strain
• Calf muscle strain

The most common form is muscle strain in the back. Symptoms may include pain, swelling, muscle spasms, and reduced ability to move a muscle. 2

Treatment of strains includes conservative measures at the initial phase; this consists of resting the injured area and applying ice and compression with a bandage. Treatment with medication is also possible. 1 2.

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Muscle strains most commonly occur in the setting of increased eccentric muscle load on the body. Eccentric force is when muscles contract while elongating, resulting in excessive force and damage. 3

Injuries to the muscle or tendon can present in 2 forms, either suddenly or developing over time. A strain injury can result from twisting or pulling a muscle or tendon. An acute strain is associated with recent trauma or injury. It also can occur after lifting heavy objects or over-stressing the muscles.

Chronic strains are caused mainly by muscle overuse due to too much physical activity, inadequate warming up before physical activity or poor flexibility. 1 Repetitive movement of the muscles and tendons can lead to a prolonged injury.

The most common sites are back and hamstring muscles. Many people get strains from playing sports. 2

Participating in team sports and court games can increase the chance of developing a strain. Other risk factors can include: 3 4 5

• Age
• Previous history of strain injury
• Anatomical variation of muscle and tendons
• Eccentric exercise
• Individuals who are starting physical activity for the first time
• Not warming up before commencing physical activity.

The symptoms of musculoskeletal strains can differ depending on the anatomic location and severity of the injury. These can include: 1 2 3:

• Sudden pain when contracting the muscle
• Swelling
• Bruising
• Loss of strength
• Impaired range of motion in the affected area.

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The severity of a strain may be assessed by a medical professional. 6 7

1. First-degree strains (mildest form)

• not much tissue tearing
• mild tenderness
• pain with a full range of motion.

1. Second-degree strains

• torn muscle or tendon tissues
• painful, limited motion
• possibly some swelling or depression at the spot of the injury.

1. Third-degree strains (most severe)

• limited or no movement
• pain will be severe at first but possibly painless after the initial injury.

Diagnosis of muscle strains relies on the history of the mechanism of injury and clinical examination. Imaging investigations can also be used as a tool to confirm the diagnosis. 3 4 8

Diagnosis of strains begins with a consultation with a doctor, where they may ask questions regarding the history of the injury. These may include: 3

• What is the symptom
• When did the symptom begin, and how did it occur
• Any additional symptoms that you are currently experiencing
• Previous history of injury, how it was managed and what were the outcomes.

• UltrasoundNon-invasive and fast to perform, which allows staging of almost all muscle lesions, assessing their evolution and complications. 4 8
• X-RayAn x-ray may be ordered by a doctor if there's a suspicion of a fracture requiring specific treatment or excluding other causes.
• MRICan easily assess deeper tissues, perform an early evaluation, and detect smaller lesions. 8 It can be requested in cases where ultrasound is insufficient.

Most muscle strains in clinical practice do not require surgery; a full recovery can almost always be expected. The initial approach to treating musculoskeletal strains is conservative methods that can be combined with medical therapy.

The first step in treating strains is to initiate PRICE protocol within the first couple of days of injury. This consists of: 9 10

• Protection of the affected area
• Rest
• Ice (application of an ice pack around the injury up to 20 minutes every 2-3 hours)
• Compression of the injury with a bandage
• Elevation (keeping the affected area raised).

Drug therapy may not be necessary but can be used to control symptoms of pain and inflammation. It's important to always consult your doctor before starting any medication.

Paracetamol is a common painkiller that is used to reduce pain symptoms. It can be purchased over the counter and used within the first days of injury. The recommended dose for adults is one to two 500mg tablets, four times a day. 11

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can reduce pain and limit inflammation in the affected area. You can acquire NSAIDs over the counter in topical gel and tablet forms. The effectiveness of topical NSAIDs is questionable; however, there are fewer side effects. It's important to note that excessive use may delay the natural healing process. 9 10 12

Like all medications, NSAIDs do have side effects. These are more common if you're taking high doses for a long time or are elderly or in poor general health. 12 Possible side effects include:

• Indigestion
• Stomach ulcer
• Headaches
• Drowsiness
• Dizziness
• Allergic reactions

In rare cases, liver, kidney, heart or blood circulation problems can arise, such as heart failure, heart attack and strokes. If you are experiencing any side effects, it's recommended that you stop taking any medication and consult with your doctor.

Musculoskeletal strain injury can happen to everyone. However, some preventive methods can reduce the risk of injury: 13

• Use protective gear in contact sports
• Maintain flexibility and strength of muscles
• Warming up thoroughly before starting any physical activity
• Wearing appropriate shoes for the specific physical activity.

The outcome of musculoskeletal strains depends on the grade of injury [14].

• Grade I strains: heal with conservative treatment, with minimal long-term complications.
• Grade II strains: high risk of extending the tear in the muscle or tendon in the first 4-6 weeks.
• Grade III strains: can have significant complications, including pain and chronic instability.

Guidelines for Americans](https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf). Accessed February 7, 2022.