A muscle strain commonly referred to as a “pulled muscle” is a muscular injury that occurs when a muscle is stretched or torn1.  This can occur during high exertion activities such as sports and activities2,3, heavy lifting, repetitive work tasks, or even prolonged posture like watching a movie marathon.

Muscles are comprised of bands and bundles of soft tissue fibers that contract and elongate together.1,3  Take a pile of rubber bands and lay them out side-by-side.  Practice bending and stretching the bands together.  Our muscles work very similarly with stretch and tension! 

Ultimately, muscles are responsible for body movement.  When a muscle contracts, it can move other parts of the body or help us interact with our environment, like bending over to tie a shoe. 

Muscle strains affect the integrity of the muscle fibers. They can occur during three scenarios: when a muscle is stretched beyond its limits, when a muscle is forced to contract too strongly, or when a muscle remains in a prolonged position for an extended amount of time.1,3,4,5,6

Muscle strains can also be acute, such as those associated with a car accident, or chronic over time with repetitive motions, like coughing due to prolonged illness.1,3  Lots of activities can cause a muscle strain because of our everyday dependence on muscles!

Some muscle strains are minor and usually go away with rest.1,6  An example of this is feeling sore from lifting furniture.  Lifting requires our muscles and lifting something too heavy can result in small muscle fiber tears. Typically, muscle fiber tears that occur from healthy exertion heal quickly, and the muscle remains intact and whole.  However, muscle strains can also be significant and result in large tears, bruising, and even reduced movement or loss of function.1,2,3,6  Use that same bundle of rubber bands from earlier, cut several in half, or even break most of them by overstretching.  Your pliable bundle cannot stretch or bend effectively, if at all, and if rubber bands could feel pain – they would at this point!

What does a muscle strain feel like? 

One way to describe the discomfort of a muscle strain is like a cramp or spasm.3  Muscle strains vary in discomfort from general tenderness or achy feelings to sharp pain and muscle pain that occurs with contraction of the muscle.  According to Harvard Health3, a person should also look for:

• Swelling, bruising, or discoloration.

• Pain that increases with movement and decreases with rest.

• Decreased movement and/or loss of muscle strength.

• A “pop” feeling in the muscle at the time of injury.

• A gap, dent, or other defects in the muscle that was not there before.

One or more of these signs may indicate a muscle strain.

Are all muscle strains the same? 

Muscle strains can be divided into three categories of severity3,7:

• Grade I strain.  This is a mild strain with only a few small tears in the muscle fibers.  It is often self-resolving, meaning the discomfort goes away on its own in a few hours to a few days.  There is no loss of movement or function of the muscle.

• Grade II strain.  This is a moderate strain with multiple tears in the muscle fibers. Bruising, uncomfortable and/or diminished movement, and swelling may accompany this injury.  The pain and discomfort are often greater than a Grade I strain and may last several days to severe weeks.  A Grade II muscle strain may go away on its own, or it may need evaluation from a medical professional depending on the severity.

• Grade III strain.  This significant and severe muscle strain may result in a complete tear in the muscle belly or rip away from a tendon, often accompanied by a “pop” sensation.  This painful level of strain presents with swelling, bruising, discoloration, significant loss of function and movement, and/or even the formation of a “lump” or indented area of the muscle if it tears from where it was previously attached.  This injury requires a medical evaluation and may need surgery or treatment intervention depending on presentation and impact on regular activities.

As you can see, muscle strains vary in severity and pain — and aren’t as straightforward as a sore low back after moving boxes or “feeling it” after playing a great game of tennis!

How do I decrease my risk of straining a muscle?

Age and different activities have increased risk of developing muscle and soft tissue injuries.1  Although muscle strains are often associated with lifting heavy pianos, contact sports, or taking up a new exercise routine, they can occur with repetitive movements such as stocking a warehouse or small motions like stepping off a curb incorrectly.  Remember that coughing example?  Forceful contractions from excessive or prolonged coughing can strain the small muscles around the ribs and can occur with illnesses like pneumonia or bronchitis. A “Feel better soon” card is very appropriate here!

How to heal a muscle strain?

You can do several things at home as first-line responses to help a strained muscle heal and prevent further injury. If you are in significant pain or your ability to perform routine activities is impacted, then calling your doctor for guidance is the best course of action.

If your discomfort is mild to moderate, avoid activities that increase muscle pain in the affected area until the pain has improved. Over-the-counter medication to reduce inflammation and pain may also help.2,3,6  

If there is bruising or swelling, an ice pack swaddled in a paper towel or thin cloth may help.  Early application of heat is not recommended if there is swelling and pain, but heat can be used when the swelling has lessened.  And, if possible, elevating the affected body part can help reduce swelling.  Compression and elevation of the affected area can also help reduce swelling and improve pain. 2,3,6

Is a chiropractor the right doctor for managing muscle strains?

Absolutely.  If you’re not sure about what step is appropriate to take, call your chiropractor.  An evaluation will determine the extent of muscle injury and if further intervention is required.1,2,3  The doctor can also determine if you need to restrict activities, take days off work, or, depending on the severity, undergo physical therapy and rehabilitation.

Prevention of muscle strains is the best form of treatment. Taking breaks to get up and move can reduce or even eliminate the impact of posture-related strains.2,3  Stretching before and after exercising can help reduce the likelihood of muscle strains, too.3  However, not all muscle strains can be prevented, such as those that occur with contact sports and motor vehicle collisions.  For those, a medical evaluation and treatment are both appropriate and encouraged.

Proper treatment and time usually relieve mild discomfort associated with muscle strains.3,6 Addressing ergonomics and making changes to movement is part of an effective recovery plan. If repetitive activities or postural stress that caused your muscle strain is part of your job, you may not be able to avoid the activity altogether. Still, your chiropractor can help provide alternate instructions and give stretches and exercises to help alleviate any discomfort.

References

1. Fernandes, T.L, Pedrinelli, A., and Hernandez, A.J. (2011). Muscle injury—physiopathology, diagnosis, treatment, and clinical presentation. Rev Bras Ortop. 46: 247–255.

2. Maffulli, N., et al. (2015). Muscle injuries: a brief guide to classification and management. Transl Med UniSa. 12: 14–18.

3. Harvard Health. (2018). “Muscle strain.” Retrieved April 2021 online from https://www.health.harvard.edu/a_to_z/muscle-strain-a-to-z

4. Garrett Jr., W.E. (1990). Muscle strain injuries: clinical and basic aspects. Med Sci Sports Exerc. Aug;22(4):436-43.

5. Järvinen, T.A., Kääriäinen, M., Järvinen, M., and Kalimo, H. (2000). Muscle strain injuries. Curr Opin Rheumatol. Mar;12(2):155-61.

6. Mayo Clinic. (2020). “Muscle strains.” Retrieved April 2021 online from https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/symptoms-causes/syc-20355603

7. Grassi, A., Quaglia, A., Cantana, G.L., and Zaffagnini, S. (2016). An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems. Joints. Jan-Mar; 4(1): 39–46.