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Muscle strain

Expert reviewer, Will Kenton, MSK Physiotherapist at Bupa
Next review due January 2025

A muscle strain, or pulled muscle, is an injury to your muscle fibres (a torn muscle). You may strain a muscle if you stretch it beyond its normal comfortable range or make it work too hard or fast. Muscle strains are common and can happen to any muscle in your body.

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Grading of muscle strains

Muscle strains are graded depending on how bad your injury is. This grading can ensure you get the right treatment.

  • A grade one muscle strain is slight damage to your muscle fibres. Your muscle may feel tender and you may have a bit of pain. You should still have normal strength in your muscle, but you may find it too painful to carry on with your usual activities.
  • A grade two strain is when more of your muscle fibres are injured. Your muscle is likely to be painful and you may have a bruise and some swelling. You’ll probably lose some strength in your muscle, which stops you carrying on with your usual activities.
  • A grade three muscle strain is a full tear of your muscle (all the way through it). Your muscle is usually really painful and you’ll have a lot of swelling and bruising. You may have a dent under your skin at either end of your muscle. And you may have felt or heard a popping sensation when you hurt your muscle. You may lose all strength in your muscle so you can’t use it – if it’s a leg muscle, you probably won’t be able to walk on it.

Causes of muscle strain

There are lots of things that might cause you to strain a muscle. You may strain a muscle if you:

  • are exercising for example, playing sport
  • have strained a muscle in the past
  • fall
  • move or twist suddenly for example, sprinting or catching a falling child
  • have a heavy blow to your muscle for example when playing contact sports such as rugby
  • are overweight because this puts more stress on your muscles
  • do a repetitive movement that puts stress on your muscle for example, painting a ceiling all day
  • don’t have enough strength in your muscles for the activity you’re doing

You’re also more likely to injure your muscles if:

  • you don’t warm up properly before you exercise
  • your muscles are tired or weak and not used to the activity you are doing; tired muscles are less able to support your joints.
    • See our section on prevention of muscle strains below for ways to protect yourself from strains.

Symptoms of muscle strain

Muscle strain symptoms vary depending on how severe your injury is, but may include:

  • pain
  • tenderness when you touch the muscle
  • swelling
  • bruising – it can take up to 24 hours before you can see the full bruise
  • weakness
  • loss of movement

For more information, see our section: Grading of muscle strains above.

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When should I seek medical help?

If you hear a pop or snap sound when you hurt yourself, you may have torn a ligament or broken a bone. You’ll need to go to your local hospital’s accident and emergency (A&E) for treatment. Seek medical help immediately if you have symptoms of a grade three strain.

For more information, see our section: Grading of muscle strains above.

Self-help for muscle strain

If your pulled muscle isn’t bad, there are several things you can do at home to ease your symptoms and speed up your recovery.

Follow POLICE

Follow the POLICE procedure as soon as possible after you’ve hurt yourself. This will give your muscle a chance to heal and to protect it from any more damage.

  • Protect your injury from further harm by resting it immediately. Depending on your injury, you may wish to use a support such as a brace.
  • Optimal Loading. It’s important to start moving your muscle again sooner rather than later. But only do what feels comfortable and speak to a physiotherapist for advice on building up your muscle strength.
  • Ice. Put an ice pack or ice (frozen peas is a good option) wrapped in a towel over your injury. Keep it on your injury for around 20 minutes roughly every two hours.
  • Compression. Wrap a bandage on your injury, but not too tightly. Take the bandage off before you go to bed.
  • Elevation. Raise your injured muscle above the level of your heart (if possible) – if you’ve a pulled calf muscle, for example, lie down and put your leg on a stool.

For more information, click to open our POLICE infographic (JPEG, 0.06 MB).

An image describing the acronym POLICE

Avoiding HARM

In the first 72 hours, you also need to avoid anything that could make your injury worse as detailed in the HARM principle.

  • Heat – don’t use heat packs, hot water bottles, heat rubs, or take a sauna or hot bath.
  • Alcohol – avoid all alcoholic drinks.
  • Running – don’t run, jog or do any other form of exercise.
  • Massage – don’t massage your injury.

For more information, click to open our HARM infographic (JPEG, 0.05 MB).

An image describing the acronym HARM

Medicines for muscle strain

If you need pain relief, you can use over-the-counter painkillers. You can take paracetamol tablets or rub an ibuprofen cream or gel into your injured muscle.

Always read the patient information leaflet that comes with your medicine and, if you have any questions, ask your pharmacist for advice.

Diagnosis of muscle strain

You’ll usually know if you’ve strained a muscle after an activity because you’ll feel pain straightaway or shortly afterwards. In most cases, you probably won’t need to see a healthcare professional. You may be able to manage your symptoms at home using the self-help measures outlined in our self-help section above.

But if you’re not sure what’s caused your symptoms or they’re very bad or don’t get better, contact a physiotherapist or your GP. There are lots of different ways to access physiotherapy – your GP may refer you to an NHS physiotherapist or you may be able to refer yourself.

A physiotherapist or GP will usually be able to diagnose a pulled muscle by examining you and asking questions about your symptoms and medical history. They’ll also ask how your injury happened. They’ll then manage your treatment.

You won’t usually need to have any further tests for muscle strain. But sometimes, if your injury is very bad or the cause isn’t clear, you may need to have a test, such as an ultrasound or a magnetic resonance imaging (MRI) scan. An ultrasound uses sound waves to create an image of the inside of your body and an MRI scan uses magnets and radio waves to do the same.

If you have symptoms of a grade three strain, go straight to your local accident and emergency (A&E).

For more information, see our section: Grading of muscle strains above.

Treatment of muscle strain

You can usually treat mild muscle strains at home. But sometimes you may need to see a physiotherapist for muscle strain treatment. If you’ve completely torn your muscle, you may need an operation to repair it.

Physiotherapy for muscle strain

If your injury is very bad or it keeps coming back, physiotherapy may help to strengthen your damaged muscle.

Your GP may refer you to a physio or you can book an appointment yourself. You can also see a physio privately.

Your physio will create a programme of exercises to gradually strengthen and stretch your muscles. These exercises will depend on the type of injury you have and how bad it is.

Surgery for muscle strain

You won’t usually need surgery for a muscle strain. But if your injury is severe or you have a completely torn muscle, you may need an operation to repair it. Your GP will refer you to an orthopaedic surgeon who will explain which type of procedure you need. You’re most likely to need surgery if:

  • you’re not recovering as quickly as you should be
  • your symptoms are getting worse
  • you’re getting new symptoms
  • your symptoms are worse than they should be for your type of injury

The type of operation you need will depend on the location of the tear and muscle involved.

You’ll probably need to see a physiotherapist after your surgery to get back to normal.

Recovery from muscle strain

How long it takes to recover from a pulled muscle will depend on how badly you’re injured. It also depends on how active you need to be afterwards. It may take you a few weeks to be able to walk around as normal and it may take longer for you to go back to sports. If you have a very bad strain, it may take months for you to fully recover.

Prevention of muscle strain

It’s important to keep your muscle moving after an injury, but you may need to make some changes to the way you do things. You may be more prone to hurting that muscle again in the first four to six weeks, so take extra care. To prevent another injury, warm up properly before you exercise.

To prevent muscle strains in the future, take care when you exercise.

  • Warm up your muscles first – do some gentle exercise to get your body ready for more vigorous activity.
  • Cool down properly afterwards – gradually decrease your activity levels until your breathing and heart rate return to normal. And do some gentle stretches while your muscles are still warm.
  • Use the correct exercise or sports equipment.
  • Wear properly fitting sports shoes – and the right shoes for your activity. And replace these when they wear out.
  • Don’t exercise when you’re tired or in pain.
  • Have regular days off exercise between training sessions.
  • Balance your activities so you include different forms of exercise such as cardiovascular exercise, strength training, and flexibility.
  • Build up your activities so you don’t push yourself too hard too soon.
  • If you have any minor injuries, make sure you take some time off to let them heal.

If you don’t exercise very often, your muscles may get weak, which can make them more prone to damage. So, it’s important to keep them as strong and flexible as possible. You can do exercises to strengthen specific muscles in your body. A physiotherapist can give you advice.

Frequently asked questions



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    • Musculoskeletal sprains and strains. BMJ Best Practice. bestpractice.bmj.com, last reviewed 15 October 2021
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    • Cervical sprain and strain. Medscape. emedicine.medscape.com, updated 9 April 2021
    • Elbow and forearm overuse injuries. Medscape. emedicine.medscape.com, updated 5 January 2021
    • Quadriceps injury. Medscape. emedicine.medscape.com, updated 2 June 2017
    • What is first contact physiotherapy? Chartered Society of Physiotherapy. csp.org.uk, last reviewed 4 February 2019
    • Zideman DA, Singletary EM, Borra V, et al. European Resuscitation Council guidelines 2021: First aid. Resuscitation 2021; 161:270–90. doi: 10.1016/j.resuscitation.2021.02.013
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    • First aid in general practice. Patient. patient.info last edited 15 February 2017
    • Find a chartered physiotherapist. Chartered Society of Physiotherapy. csp.org.uk, last reviewed 18 March 2021
    • Physiotherapy and football injuries. Chartered Society of Physiotherapy. csp.org.uk, last reviewed 7 May 2017
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, January 2022
    Exert reviewer, Will Kenton, MSK Physiotherapist at Bupa
    Next review due January 2025

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