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Muscle strain

A muscle strain is a stretch or tear in your muscle caused by over-stretching or over-tightening of muscle tissue. The muscles in your legs are most commonly affected.

Muscle strain (also called pulled muscles) happens when one of your muscles is over-stretched or torn. Your muscles are a band of fibres, which relax and tighten to make you move. Muscle strain can happen when you’re exercising or playing sport, or during accidents. Strains can also happen when you’re lifting heavy objects.

The muscles that are most commonly strained are those in your legs. The main muscles affected are listed below.

  • The calf muscles at the back of your lower legs. These muscles help you to raise your heel.
  • The quadriceps muscles at the front of your thigh. These muscles help you to straighten your knee.
  • The hamstring muscles at the back of your thigh. These muscles help you to bend your knee.

Muscles sprains of the lower part of your back, called your lumbar spine, are also common.

Muscles strains can be graded, depending on how severe they are. A grade one strain is minor damage to your muscle fibres, with some pain and swelling. A grade two strain is a partial tear of your muscle, with moderate pain and swelling and a grade three strain is a full tear of your muscle. This grading can help your doctor to choose the right treatment for you.

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Details

  • Symptoms Symptoms of muscle strain

    The main symptoms of muscles strain are pain and tenderness when you touch the affected muscle.

    If you have a mild (grade one) muscle strain, the area may feel tender, but you should still be able to move normally and carry on with your activities.

    With a grade two muscle strain, your pain is likely to be more severe. You may also have a bruise and some swelling over the affected area. You’re likely to lose some strength in the affected muscle, which may mean you can’t carry on with your usual activities.

    A grade three strain causes severe pain and you may feel a popping sensation as the injury happens. This type of strain can cause you to lose any strength in the affected muscle. This means you won’t be able to carry on with your usual activities. 

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  • Diagnosis Diagnosis of muscle strain

    Your GP or physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will ask you about your symptoms and examine you. He or she may also ask you about your medical history and how your injury happened.

    Your GP or physiotherapist will usually be able to diagnose a muscle strain by examining you. However, you may also be asked to have an ultrasound or an MRI scan if the injury is severe, or if you play sport to a high level. An ultrasound uses sound waves to produce an image of the inside of your body, or part of your body. An MRI scan uses magnets and radiowaves to produce images of the inside of the body.

  • Treatment Treatment of muscle strain

    The aim of treatment for muscle strain is to reduce your pain and any swelling, make sure the movement and strength of your muscle is maintained and to get you back to your usual activities as soon as possible. The type of treatment you need will depend on how severe your injury is. Many grade one and two strains can be managed by you at home. More severe strains may need treatment in hospital.

    Self-help

    It’s important to help your injury heal and to protect it from further damage by taking certain steps as soon as you can. Many minor strains will respond to the PRICE procedure.

    • Protect your injury from further harm.
    • Rest your injury for the first two to three days, and then re-introduce movement so you don’t lose too much muscle strength.
    • Ice the injured area using an ice pack or ice wrapped in a towel to reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage your skin.
    • Compress the area by bandaging it to support the injury and help reduce swelling. The bandage should fit snugly but not be too tight, and you should remove it before going to sleep.
    • Elevate the injured area above the level of your heart to control swelling. Keep the area supported and try to keep it elevated as much as possible until the swelling goes down.

    For the first 72 hours after an injury there are certain things you shouldn’t do to ensure you don’t make the injury worse. See our frequently asked question for more information.

    If your injury doesn't improve, it's important to seek advice from your GP or physiotherapist. As soon as you feel able to, you can start to move around gently, building up your activity slowly.

    Medicines

    If you need pain relief, you can take over-the-counter painkillers, such as paracetamol. This will help to ease mild pain and discomfort. If you have more severe pain, you can take a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen. You can take these as tablets, or as a cream or gel rubbed gently onto your skin where the injury is. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    Surgery

    If you have a grade three strain and your muscle has completely torn, you may need an operation to repair it. You’re likely to have surgery within the first week after your injury.

    Physiotherapy

    If your injury is severe or you find that it keeps re-occurring, physiotherapy may help you to strengthen the damaged muscle and return to your usual activities.

    Your GP may refer you to a physiotherapist or you can choose to see a physiotherapist privately. He or she will develop a programme of exercises to gradually strengthen and stretch your muscles. These exercises will vary depending on the kind of injury you have and how severe it is. Your physiotherapist may also use various techniques to help speed up the healing of your injury.

    It’s important to make sure your injury has fully healed before you start exercising again. If you return to exercise too soon, you’re more likely to have another muscle strain injury.

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  • Causes Causes of muscle strain

    A muscle strain can occur when you over-stretch a muscle, or if your muscle is forced to contract against a force that is too strong for it. This can happen when you’re active, playing sport or exercising, or when you’re lifting something.

    You're more likely to develop a muscle strain in certain situations. Some of the main ones are listed below.

    • If you don’t warm up your muscles properly before exercise.
    • Your recovery time between training sessions isn't long enough.
    • Your muscles are already tight or stiff.
    • You have previously injured your muscles.
    • Your muscles are tired or overused.
    • You have weak muscles.
  • Prevention Prevention of muscle strain

    You can reduce your risk of muscle strain by doing a thorough warm-up before exercise. It’s also important that you make sure your muscles are strong enough and you’re fit enough for the activity you’re doing.

  • FAQs FAQs

    I have muscle strain – should I see my GP?

    Answer

    Most muscles strains can be treated by you at home and you won’t need to see your GP. However, if you have a severe injury, pain or swelling, or if you can’t move the affected muscle you should get medical help straightaway.

    Explanation

    You can treat most mild and moderate muscle strains quickly and simply at home and usually won’t need to see your GP. However, you should see your GP if:

    • your symptoms get worse – you develop more swelling and pain
    • movement doesn’t get better, for example if you have a muscle strain in your leg and you have difficulty walking
    • you’re worried that the injury is worse than you first thought

    If you have a severe muscle strain and your muscle has completely torn, you should get immediate medical help. If you have a severe strain you may have felt a popping or tearing sensation as your muscle was torn. You may also have severe pain and swelling and be unable to move the affected muscle.

    I have muscle strain – what can I do to help it heal well?

    Answer

    A strained muscle will heal well if it’s protected from further injury, rested and treated quickly.

    Explanation

    The most important way to help your injury to heal is to follow the PRICE method immediately after the injury. PRICE means protection, rest, ice, compression and elevation. By doing this you help to protect your muscle from any further damage and help it to heal quickly and fully. For the first 72 hours after an injury there are certain things you shouldn’t do to ensure you don’t make the injury worse. These can be remembered using HARM.

    • Heat. Don’t use heat packs, hot water bottles or heat rubs on the affected area, as well as saunas or hot baths. Heat encourages blood to flow to the area, the opposite effect of using ice.
    • Alcohol. Don’t drink alcohol because it can increase bleeding and swelling to the area, slowing down the healing process.
    • Running or any other form of strenuous exercise. Such activities may cause more damage.
    • Massage. This can increase bleeding and swelling.

    It’s important to rest the affected muscle as much as you can for a few days after your injury. After this you can start to move around gently and slowly, gradually building up your activity until your muscle returns to normal. A physiotherapist or sports physician can guide through a rehabilitation programme that will consist of a progression of stretching and strengthening exercises.

    To prevent a muscle strain, would it help to stretch before I start exercising?

    Answer

    Research shows that doing stretches before you exercise is unlikely to prevent injury or any muscle soreness. However, a gentle warm up may help to prepare your body for activity and reduce your risk of injury.

    Explanation

    Research shows that doing stretches before you exercise is unlikely to have any benefits. Stretching doesn’t help to reduce any muscle soreness. It’s also unlikely to prevent you injuring yourself.

    However, warming up before you exercise can prepare you both physically and mentally for the activity you’re about to do. You can warm-up using the same activity as the one you have planned, but at a gentle level. For example, if you’re planning to run you can warm-up by walking. Do five to ten minutes of warm-up exercise before you begin your main activity. 

  • Resources Resources

    Further information

    Sources

    • MacAuley D. Oxford handbook of sport and exercise medicine. 1st ed. Oxford. Oxford University Press, 2007: 46
    • Sprains and strains. Prodigy. www.prodigy.clarity.co.uk, published September 2010
    • Give your body a sporting chance. Chartered Society of Physiotherapy. www.csp.org.uk, published April 2011
    • Musculoskeletal sprains and strains. BMJ Best Practice. www.bestpractice.bmj.com, published September 2011
    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press; 2010: 510
    • Hamstring injury. eMedicine. www.emedicine.medscape.com, published November 2011
    • Herbert RD, de Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews 2011, Issue 7. doi:10.1002/14651858.CD004577.pub3.
    • Starting to exercise. Bandolier. www.medicine.ox.ac.uk, accessed 22 November 2011
    • Warming up and cooling down. Diabetes UK. www.diabetes.org.uk, accessed 22 November 2011
    • Bruckner P, Khan K. Clinical sports medicine. 3rd ed. Australia: McGraw-Hill; 2006:289–99
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    Produced by Rebecca Canvin, Bupa Health Information Team, March 2012.

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