Muscles are made up of a band of fibres, which relax and tighten to make you move. Muscle strain – or a pulled muscle – happens when one of your muscles is over-stretched or torn. The main muscles that people tend to strain are:
- the calf muscles at the back of your lower legs – these help you to raise your heel
- the quadriceps muscles at the front of your thigh – these 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 strain muscles in the lower part of your back, which is called your lumbar spine.
Physiotherapists grade muscle strains, depending on how severe they are.
- A grade one strain is minor damage to your muscle fibres.
- A grade two strain is a partial tear of your muscle.
- A grade three strain is a full tear of your muscle.
This grading can help your physiotherapist choose the right treatment for you.
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, and you might have a bit of swelling and a bruise. But you should still be able to move normally and carry on with your activities as normal.
- If you have a grade two muscle strain, it’s likely to be more painful. You may also have a bruise and more swelling over the affected area. You’ll probably lose some strength in the muscle so might not be able to carry on with your usual activities.
- A grade three strain is usually really painful, and you’ll have a lot of swelling and bruising. You might have a lump at either end of the muscle. You might feel a popping sensation when you injure your muscle. You can lose all strength in it, which means you won’t be able to put any weight on it. So, you won’t be able to carry on with your usual activities.
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 might not need to see a health professional to get a diagnosis. But if you're unsure, or your symptoms are severe or persistent, contact a physiotherapist or your GP.
They’ll ask you about your symptoms and medical history, and will examine you and ask about how your injury happened.
Your physiotherapist or GP will usually be able to diagnose a muscle strain just by examining you and asking questions. But they might arrange for you to have an ultrasound or a magnetic resonance imaging (MRI) scan if your injury is severe, or to confirm your diagnosis. An ultrasound uses sound waves to produce an image of the inside of your body and an MRI scan uses magnets and radio waves.
Treating 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. Usually, you can manage grades one and two strains at home. If you have a more severe strain, you may need treatment in hospital.
It’s important to allow your muscle to 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. If you’ve pulled a muscle in your leg, use a support like a walking stick, for example.
- Rest 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 your pain. Don’t apply ice directly to your skin as you might injure your skin. Don’t leave it on while you sleep either.
- Compress the area by bandaging it to support the injury and help reduce swelling. The bandage should fit snugly but not be too tight. Take it off each night before you go to sleep.
- Elevate the injured area above the level of your heart (if possible) to control swelling. Keep the area supported on a pillow for example, and try to keep it elevated as much as possible until the swelling goes down.
As soon as you feel able to, you can start to move around gently and build up your activity slowly. But be careful. For information on how to protect your muscle while it’s healing, see our FAQ: How to help yourself.
If your muscle doesn't start to get better and you can’t put weight on it after about a week, contact a physiotherapist or your GP. They’ll give you some advice on what to do.
If you need pain relief, you can take over-the-counter (OTC) painkillers, such as paracetamol or ibuprofen. You can take ibuprofen as tablets or a cream or gel that you rub on your skin where the injury is. You can use the cream or gel straightaway, but wait a couple of days after you get a strain to take ibuprofen tablets. This is because they can delay healing. You can take paracetamol straightaway. Always read the patient information leaflet that comes with your medicine and, if you have any questions, ask your pharmacist for advice.
If your injury is severe or you find that it keeps coming back, physiotherapy may help you to strengthen your damaged muscle.
Your GP may refer you to a physiotherapist or you can book an appointment with a physiotherapist yourself. You can also choose to see a physiotherapist privately.
They’ll develop a programme of exercises to gradually strengthen and stretch your muscles and strengthen them. 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 that 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.
If your muscle strain is severe, or your muscle has completely torn, you may need an operation to repair it. The type of operation you have will depend on which muscle you have torn. Your GP will refer you to see an orthopaedic surgeon who will explain what type of procedure you need. You’ll probably need a course of physiotherapy after your surgery to get back to normal.
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, have a heavy blow to your muscle, or lift something heavy, for example.
You're more likely to develop a muscle strain in certain situations, such as if you:
- don’t warm up your muscles properly before exercise and cool them down afterwards
- don’t take enough time off to recover between training sessions and have tired or overused muscles
- have tight or stiff muscles
- have injured your muscle before
- have weak muscles, which can happen if you don’t exercise often
- lift heavy objects incorrectly, or have a poor technique in a sport and put too much strain on your muscles
- don't use the right sports gear – if you wear poorly fitting shoes, for example
- are overweight – this can put pressure on your muscles
You can reduce your risk of straining a muscle by doing a thorough warm-up before you exercise. Here are some tips to stretch the muscles that support your knee; for example, Exercises to prevent knee injury. Ask your physiotherapist about exercises for other muscle groups.
It’s also important to make sure your muscles are strong and flexible enough and you’re fit enough for the activity you’re doing. Build up your activities so you don’t push yourself too hard too soon. Eccentric (lengthening) strength training has been shown to prevent muscle strains.
If you have any minor injuries, make sure you take some time off to let them heal too.
At the moment, there isn’t any scientific proof to show that doing stretches before you exercise prevents getting an injury, or any muscle soreness. But it’s probably still worth doing a gentle warm-up to prepare your body for activity. It will also help to build some flexibility into your muscles to prepare you for sport.
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. As your muscles warm up, they’ll work better so won’t be as prone to injury. Start slowly, and then move slightly faster until you’re moving at the speed you need for whatever activity you’re about to do. So, you should be full speed at the end of your warm-up. If you’re unsure, ask a physiotherapist for advice about suitable warm-up exercises before you start your main activity.
It might help to do some gentle stretching afterwards to cool down too.
You can treat most muscles strains yourself at home and don’t need to see your GP. But get some medical help if:
- your symptoms get worse – you get more swelling and pain
- your movement doesn’t get better so if you have a muscle strain in your leg for example, you have difficulty walking
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’ll also likely be in a lot of pain and have some swelling and won’t be able to move the muscle.
A strained muscle should heal well if it’s protected from further injury, rested and rehabilitated quickly.
The most important way to help your injury to heal is to follow the PRICE method immediately after you injure your muscle. See ‘Self-help for a muscle strain’ above for information on PRICE. There are also some things to avoid doing in the first few days after an injury that could make your injury worse. It can help to remember these by using the HARM principle.
- Heat. Don’t use heat packs, hot water bottles or heat rubs on the affected area, or go in a sauna or hot bath. 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 will slow down the healing process.
- Running (or any other form of exercise). Don’t do this for the first couple of days as it could cause more damage. After that, you can start moving around more as it will help your muscle to heal – but take it slowly. Gradually increase how much exercise you do over the next days and weeks.
- Massage. Although it’s tempting, hold off for a few days as it can increase bleeding and swelling.
It’s important to rest your muscle as much as you can for a few days. After this, you can start to move around gently and slowly, gradually building up your activity until your muscle returns to normal. If you’d like advice about building up your muscle strength, ask a physiotherapist.
- The Chartered Society of Physiotherapy
020 7306 6666
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- The Chartered Society of Physiotherapy
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