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Muscle Strains

A strain is an injury to muscle with damage that is caused by over-stretching of muscle tissue.

A sprain is an injury to ligaments that is caused by being stretched beyond their normal capacity and possibly torn.

Muscle Strains

Symptoms

Stiffness, tenderness and pain.  Worse with movement, especially after resting. After warming up the pain and stiffness usually lessens, but pain will return once the muscle tires again. This will very depending on the level of damage the muscle or associated tendon has sustained and the amount of work you then ask it to do.

Muscle strains can be very painful although often the main symptom is stiffness.  Sometimes there is not much pain until the muscle is pressed when it will feel tender.  If there is an acute strain, pain will be felt immediately but often in less severe strains the pain is not felt until the following morning after injury.

About a quarter of all injuries involve muscle strains. Muscles and their tendon attachments combine to form what are known as musculo-tendinous units. These musculo-tendinous units provide the force which is necessary for movement.

What is a muscle strain?

A muscle strain is damage caused by over-stretching of muscle tissue.

In back muscle strains, this occurs most often when lifting is carried out without co-ordinating the back and abdominal muscles correctly.

The muscle tissue becomes overloaded and reaches a breaking point where a tear or partial tear occurs.

The person will experience pain that will persist if he or she attempts to stretch or contract the muscle.

Depending on their severity, muscle strains are categorised into Grades 1, 2 or 3.


Grade 1 Strain:

There is damage to individual muscle fibres (less than 5% of fibres). This is a mild strain which requires 2 to 3 weeks rest.

Grade 2 Strain:

There is more extensive damage with visible bruising, with more muscle fibres involved, but the muscle is not completely ruptured. The rest period required is usually between 3 and 6 weeks.

Grade 3 Strain:

This is a complete rupture of a muscle. In a sports person this will usually require surgery to repair the muscle. The rehabilitation time is around 3 months.

All muscle strains should be rested and allowed to heal. If the patient continues to repeat the causative action, the condition may worsen. If ignored, a grade one strain has the potential to become a grade two strain or even a complete rupture.

How is Muscle Structured?

In order to understand how muscles are injured it is helpful to know how the muscle is made up. The muscle is surrounded by an outer sheath or covering. Inside this outer sheath are bundles of muscle fibres which are known as fasicles and are themselves surrounded by another inner sheath. If you looked at the bundles very closely you would just be able to see the individual muscle fibres. (The muscle fibres are made up of even smaller parts but a microscope is required to see them).

A muscle contracts when two of these microscopic parts link together and slide together (causing the muscle to shorten) or slide apart (causing the muscle to lengthen). If the muscle shortens, the result is movement of a joint in one direction; if it lengthens, it causes movement of a joint in the other direction. The co-ordination of this muscle activity by the brain allows us to perform complex movements such as kicking a football or running.

How does a damaged muscle heal?

The healing process of a muscle strain begins with an inflammatory response which can last for three to five days. This is a crucial time during which rest and protection of the injured part is vital in order to prevent any further damage. During the inflammatory reaction the body produces chemicals and cells which remove dead muscle fibres and start the repair process. The repair process consists of three stages:

REGENERATION: New muscle fibres grow from special cells within the muscle.

FORMATION OF SCAR TISSUE: There is bleeding in the gap between the torn muscle ends, and from this blood matrix, or scaffold, is formed to anchor the two ends together.

MATURATION OF THE SCAR TISSUE: The collagen fibres which make up the scar tissue become aligned along lines of external stress and are able to withstand more force.

Treatment

Acute muscle strain: Follow P.R.I.C.E protocol:  Protect from Injury, Rest, Ice, Compression, Elevation.

Stop the activity, rest in a comfortable position, preferably lying down and apply ice or a cold pack for 10 minutes every hour for 6 hours to reduce internal bruising to the muscle.

The muscle may tend to spasm for the first two or three days after injury.  Warm compresses can help to ease the spasms. Avoid over-working the muscles for several days but do try to continue with as near to normal activities particularly walking to keep the muscle actively healing.

Massage will help to clear the inflammation from the muscle and ease the tenderness but care must be taken not to further bruise the muscle.

It is important to keep the region warm to relieve pain and muscle spasm, but preferably using clothing, a pad or pillow avoiding hot water bottles or similar as these tend to cause congestion of the area. Bandaging with elastic cohesive bandages or using a muscle support can help relieve pain and protect the muscle to allow more normal activity to continue.

Rest and, if needed, non-steroidal anti-inflammatory (NSAIDs) drugs e.g. paracetamol, aspirin or ibuprofen should help settle the problem in a week or two.

Mild to moderate muscle strain: This is usually noticed the next day when there may be significant pain and stiffness on getting up in the morning. A warm shower or bath, especially with Epsom salts will help to ease the stiffness. See the Hydrotherapy page. Again refrain from the offending activity but do keep on the move.

The rehabilitation after this period involves gradually stretching the muscle to elongate the scar tissue and progressively increasing the muscle strength. Your osteopath will use massage and neuro-muscular techniques to improve drainage, blood flow and reduce spasm as well as addressing any causative factors such as local or remote stiffness or dysfunction using mobilisation and remedial exercises.

Protection and Prevention of Muscle Strains

The following measures may have the effect of reducing the chances of sustaining a muscle strain:

Warming up is thought to decrease muscle stretch injuries because the muscle is more extensible when the tissue temperature has been increased by one or two degrees. A good warm up should last several minutes - starting gently and finishing at full pace activity. Simply starting with lighter activities and building up gradually whether it be housework, gardening, moving building blocks, preparing for playing golf, dancing or practising match activities such as sprinting and passing for rugby. Do not stretch before exercising unless specifically instructed to do so.  There is a lot of recent evidence to show that stretching slightly irritates the muscle and therefore leaves it more vulnerable to injury during exercise.

Recovery after training sessions and matches can be enhanced by performing a cool down, which is thought to help muscles get rid of waste products.

Careful stretching of muscles after use or exercise is important to re-order the muscle fibres and return the muscle to its normal length. Tired muscles tend to retain a memory of the repeated contractions they have undergone as part of the exercise or activity and stretching helps to correct this contraction. Tight muscles are also associated with increased risk of strains, and stretching is therefore practised to maintain muscle strength and prevent injury.

Do not overstretch the muscles (remember pain means damage!) - just take the stretch to the point of where you just feel it. Very slight discomfort only, not pain.  Active stretches are helpful if the muscle is very tight.  For these you hold the stretch and slightly contract the muscle at the same time.  Ask your osteopath or physio to teach you.

Maintaining good muscle strength and flexibility may help prevent muscle strains. Muscle strength allows you to carry out activities in a controlled manner and decreases the unco-ordinated movements which can lead to injury. Diet can have an effect on muscle injuries. For instance, it has been found that if a player’s diet is high in carbohydrate in the 48 hours before a match, there will be an adequate supply of the energy which is necessary for muscle contractions. However, if the muscles become short of fuel, fatigue can set in during training or matches. This fatigue can predispose a player to injury. Carbohydrate and fluids can be replenished during training and matches by taking regular sips of a sports drink. This applies to any physical activity.

Common Muscle Injuries

Back muscles - these are injured when lifting incorrectly. The large back muscles (Erector Spinae) cause pain down the middle of the back and at the very base of the spine where their tendons attach. Small stabilising back muscles (Multifidii) may be injured by simply leaning over a table due to poor muscle balance and control. They cause acute low back pain. Side muscles, including the Obliques, Transversalis and Latissimus Dorsi are injured during twisting, swinging or pulling movements; also the opposite side may be injured when throwing.

Neck muscles - are usually injured due to poor muscle balance and control during a sudden movement, often after rest, or when they are cold.

Arm muscles including the Biceps and Triceps - usually injured when carrying or pulling too heavy a weight (or being jerked by a dog or pony!). Forearm muscles are commonly strained using hand tools eg. screwdrivers, hammers or even lifting heavy saucepans “Le Creuset Syndrome”.

Leg muscles - Adductor and Hip Flexor (psoas, tensor fasciae latae/TFL) are commonly injured during football. Adductor muscles are put under a great deal of stress during turning activities. They are also very active during side foot passing. Hip flexors are the kicking muscles at the front of the hip which are very active during shooting and striking a ball. Quadriceps and Hamstring muscles are powerful muscles of the thigh are most active during running, kicking, jumping and sprinting.