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Muscle Strain

(Pulled Muscle; Strain, Muscle)

Definition

A muscle strain is an injury that damages the internal structure of the muscle. It may be small, or severe enough to cause internal bleeding and lengthening of muscle fibers. If the damaged parts of the muscle pull away from each other, it is called a muscle rupture.

Muscles of the Back

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Causes    TOP

A muscle strain is caused by tension or stress applied to the muscle that it cannot withstand. There are several ways that this can happen:

  • Muscle may not be ready for sudden stress
  • Tension may be too much for the muscle to bear, such as lifting a weight that is too heavy for you
  • Muscle is used too much on a certain day

Certain areas have muscles that are more likely to be strained than others, including:

Muscles that cross 2 joints are at the greatest risk.

Risk Factors    TOP

Factors that increase your chances of getting a muscle strain include:

  • Athletic activities, especially those with running, lifting, and jumping
  • Tight muscles
  • Fatigue
  • Overexertion
  • Cold weather

Symptoms    TOP

Symptoms depend on how you strained the muscle.

Strain While Performing an Athletic or Physical Activity

You feel immediate soreness or pain in the affected muscle. If you try to use that muscle, it hurts even more. The area becomes tender and swollen. In the most severe cases, there may be a skin bruise because of bleeding underneath. Moving the nearby joints causes pain. Running and lifting are common activities that cause this type of muscle strain.

Strain from a Build Up of Stress

When you do an activity that your body is not used to doing, the muscles are not in shape for that kind of activity. You may not feel pain during the activity, but the next day a muscle or set of muscles may be very sore. The muscle will be tender, and using it causes pain or discomfort.

Diagnosis    TOP

You will be asked about your symptoms, your recent physical activity, and how the injury occurred. The injured area will be examined for:

  • Tenderness directly over the muscle
  • Pain when contracting the muscle, particularly against resistance
  • Pain when stretching the affected muscle

Images may be taken of structures inside your body. This can be done with:

Treatment    TOP

Treatment depends on the severity of the strain and the muscle involved.

Acute Care

Rest

The muscle will need time to heal. Avoid activities that place extra stress on the affected area. In general:

  • Avoid activities that cause pain.
  • Walk using a shorter stride.
  • Avoid playing sports.

Cold

Ice may help decrease swelling and pain in the first few days after the injury.

Pain Relief Medications

Pain medications may be advised. These may include:

  • Over-the-counter medication, such as aspirin, ibuprofen, or acetaminophen
  • Topical pain medication—creams or patches that are applied to the skin
  • Prescription pain relievers

Compression

Compression can help prevent more swelling. This can be done by wrapping an elastic compression bandage around the affected muscle.

Elevation

Keeping the affected muscle higher than the heart can help reduce swelling.

Recovery Steps

Rehabilitation with a physical therapist may be required.

Heat

When returning to physical activity, heat may be used before stretching or getting ready to play sports to help loosen the muscle.

Stretching

Begin stretching exercises for your muscles as recommended.

Prevention    TOP

To reduce your chance of straining a muscle:

  • Keep your muscles strong so they can absorb the energy of sudden stressful activities.
  • After a short warm-up period, stretch out tight muscles, especially previously injured ones.
  • Learn the proper technique for athletic activities to decrease muscle stress.
  • Stop when you are tired. Tired muscles do not function well. They do not react properly to sudden stress.

RESOURCES:

American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org
Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES:

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References:

Counsel P, Breidahl W. Muscle injuries of the lower leg. Semin Musculoskelet Radiol. 2010 Jun;14(2):162-175.
Muscle strain. Johns Hopkins Medicine website. Available at:
...(Click grey area to select URL)
Accessed May 11, 2016.
Orchard J, Best TM, et al. Return to play following muscle strains. Clinical Journal of Sport Medicine. 2005 Nov;15(6):436-41.
Sprains, strains, and other soft-tissue injuries. Ortho Info—American Academy of Orthopaedics website. Available at:
...(Click grey area to select URL)
Updated July 2015. Accessed May 11, 2016.
1/4/2011 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.
Last reviewed May 2016 by Warren A. Bodine, DO, CAQSM
Last Updated: 5/13/2014

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