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Muscle strain

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

Your muscles are a band of fibres, which relax and tighten to make you move. Muscle strain (also called a pulled muscle) happens when one of your muscles is over-stretched or torn.

The main muscles that tend to be 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.

You can also get muscle strains in the lower part of your back, called your lumbar spine.

Muscle 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.
  • A grade three strain is a full tear of your muscle.

This grading can help your GP or physiotherapist choose the right treatment for you. A physiotherapist is a health professional who specialises in maintaining and improving movement and mobility.

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Details

  • Symptoms Symptoms of muscle strain

    The main symptoms of a muscle 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. You should still be able to move normally and carry on with your activities as normal.

    If you have 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 when the injury happens. You can lose all strength in the affected muscle so you can't put any weight on it and can't carry on with your usual activities.

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  • Diagnosis Diagnosis of muscle strain

    Usually, it’ll be obvious if you strain a muscle after doing a particular activity as you may feel pain either immediately or shortly afterwards. Because of this, you may not need to see your GP to make a diagnosis. However, if you're unsure, or your symptoms are severe or persistent, contact your GP or a physiotherapist. A physiotherapist is a health professional who specialises in maintaining and improving movement and mobility.

    Your GP or physiotherapist will ask you about your symptoms and examine you. They 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. You may need to have an ultrasound or an MRI scan if your injury is severe, or to check your diagnosis. An ultrasound uses sound waves to produce an image of the inside of your body and an MRI scan uses magnets and radiowaves.

  • Treatment Treatment of muscle strain

    Treatment for a muscle strain involves reducing your pain and any swelling, and keeping up movement and strength in your muscle. It aims 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. You may be able to manage grade one and two strains at home. If you have a more severe strain, you may need treatment in hospital.

    Self-help

    It’s important to allow 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 slowly start moving again 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 this can damage it.
    • 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 you go 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 should do to be sure you don’t make the injury worse. See our Frequently asked questions for more information.

    If your injury doesn't improve, get advice from your physiotherapist or GP. As soon as you feel able to, you can start to move around gently and build up your activity slowly.

    Medicines

    If you need pain relief, you can take over-the-counter (OTC) painkillers, such as paracetamol or ibuprofen. Ibuprofen is available as tablets or a cream or gel that you rub on your skin where the injury is. You can use the cream or gel straight away, but wait a couple of days after you get a strain to take the tablets. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    Physiotherapy

    If your injury is severe or you find that it keeps coming back (re-occurring), physiotherapy may help you to strengthen the damaged muscle.

    Your GP may refer you to a physiotherapist or you may be able to book an appointment with a physiotherapist directly. You can also 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 process.

    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.

    Surgery

    If your muscle strain is severe, or your muscle has completely torn, you may need an operation to repair it.

  • Physiotherapy

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including physiotherapy.

  • Causes Causes of muscle strain

    If you over-stretch a muscle, or your muscle is forced to contract against a force that's too strong for it, you can strain the muscle. This can happen when you’re exercising or playing sport, or when you lift something heavy, for example.

    You're more likely to develop a muscle strain in certain situations, such as those listed below.

    • 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.
    • You lift heavy objects incorrectly and put too much strain on your muscles.
  • Prevention Prevention of muscle strain

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

  • FAQs FAQs

    Can stretching before I exercise prevent a muscle strain?

    Answer

    At the moment, there’s no scientific proof to show that doing stretches before you exercise prevents injury or any muscle soreness. But, a gentle warm-up may help to prepare your body for activity and reduce your risk of injury.

    Explanation

    There’s no scientific proof to show that doing stretches before you exercise has any benefits. Stretching doesn't help to reduce any muscle soreness. It’s also unlikely to prevent you injuring yourself.

    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 10 minutes of warm-up exercise before you start your main activity.

    I have muscle strain – should I see my GP?

    Answer

    Most muscles strains can be treated 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, get medical help.

    Explanation

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

    • your symptoms get worse – you develop more swelling and pain
    • your 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, it's important to get immediate medical help. Go to the accident and emergency department of your local hospital. 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 you injure your muscle. 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 be sure 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, which slows down the healing process.
    • Running or any other form of exercise. Such activity may cause more damage.
    • Massage. This can increase bleeding and swelling.

    It’s important to rest your 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 can guide you through a rehabilitation programme that will consist of a progression of stretching and strengthening exercises. A physiotherapist is a health professional who specialises in maintaining and improving movement and mobility.

  • Resources Resources

    Further information

    Sources

    • Sprains and strains. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published October 2012
    • Overview of musculoskeletal injuries. The Merck Manuals. www.merckmanuals.com, published August 2013
    • Muscle strains in the thigh. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published March 2014
    • Medial gastrocnemius strain. Medscape. www.emedicine.medscape.com, published 6 March 2013
    • Hamstring strain. Medscape. www.emedicine.medscape.com, published 17 May 2013
    • Lumbosacral spine sprain/strain injuries. Medscape. www.emedicine.medscape.com, published 8 October 2012
    • Questions and answers about sprains and strains. National Institute of Arthritis and Musculoskeletal and Skin Diseases. www.niams.nih.gov, published July 2012
    • Sports-specific warm-up advice. Chartered Society of Physiotherapy. www.csp.org.uk, published July 2012
    • 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
    • Yeung SS, Yeung EW, Gillespie LD. Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database of Systematic Reviews 2011, Issue 7. doi: 10.1002/14651858.CD001256.pub2
    • Biceps rupture. Medscape. www.emedicine.medscape.com, published 28 February 2014
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