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Managing Muscle Strains

Muscles make up over half of the weight of a human body and they are required to make even the smallest of movements such as nodding your head or tapping your toe.  If too much stretch is put through one of your muscles you may end up with a painful muscle strain.  If the similar type of injury occurred to one of the ligaments in your body, it is termed a sprain.

Anatomy
Muscles are composed of many fibers bundled together; the bigger, more frequently used muscles have more fibers than the smaller, lesser-used ones. Among the muscles are voluntary and involuntary muscles. Voluntary, or striated muscles, are those that we move by choice (for example, the muscles in your arms and legs). Involuntary muscles, or smooth muscles, are the ones that move on their own (for example, the muscles that control your diaphragm and help you breathe). The muscles in your heart are called involuntary cardiac muscles.

Voluntary muscles are attached to bones by tendons, a sinewy type of tissue.  The area where the muscle attaches to the tendon is called the musculotendinous junction.

What causes a muscle strain?
A muscle strain, or a muscle pull occurs when a muscle in your body is overstretched or overworked. 

Even if the injury from overstretching or overworking occurs more to the attaching tendon it can also be classified under the term muscle strain. A muscle strain can occur in any of your voluntary muscles (or tendons which attach to the muscle), but they are most common in the low back, the calves, the front and back of the thighs, the pectoral muscles, and the muscles of the neck and the shoulder. Muscle strains occur more often in muscles that cross two joints (such as the thigh or calf muscles) and often occur when the muscles are working eccentrically (working while under a stretch).

Most often a strain occurs at the musculotendinous junction but can occur anywhere along the muscle.

A muscle strain can occur due to a one-time overstretching or overworking of a muscle (acute injury) or can occur from repetitive use of a muscle over time (overuse injury).

How are muscle strains classified?
There are several classification systems developed and in use regarding muscle strains but the most commonly used system includes three grades. All muscle strains include tearing of some muscle fibers:

Grade I (mild): Very few muscle fibers have been injured. Pain may not be felt until the following day after the instigating activity. Strength and range of motion of the muscle remains full but pain can be felt when engaging the muscle often when it is at its end range of stretching. No swelling or bruising is noted.

Grade II (moderate): A large category including all strains between a grade I and grade III.  Being that this category is so large, it is sometimes further divided into having a mild, moderate or severe grade II strain. With this category many muscle fibers are torn which results in a decrease in strength and often a limited range of motion.  Some muscle fibers remain uninjured and intact. Pain is present both when stretching the muscle and on muscle strength testing. Swelling and bruising may be noted.

Grade III (severe): All fibers of the muscle are completely torn. This means that the muscle is completely torn into two parts or the muscle belly has torn from its attachment to the tendon.  Severe swelling, pain, and bruising accompany a grade III strain.  There is generally limited ability to generate any force on strength testing of the muscle due to the tear (however other muscles may compensate to initiate some strength) and the range of motion is either severely limited due to pain, or the range of motion testing may show excessive range due to the torn muscle not providing any limitation as it is stretched.

What does a muscle strain feel like?
Several symptoms can indicate that you have incurred a muscle strain but the symptoms you feel will depend on the grade of strain you have incurred:

  • sudden onset of pain, or pain/soreness that comes on the next day related to a specific event
  • pain on touching the injured area
  • mild, moderate, or severely limited range of movement, or an extreme abnormal range of motion
  • decreased strength in the injured muscle
  • bruising or discoloration in the area or at a distal location to the strain
  • swelling
  • a "knotted up" feeling
  • a local divot or bump in the affected area due to the torn muscle fibers
  • muscle spasm in the area
  • stiffness in the area


Assessing a muscle strain
Your Physical Therapist at Ascend Physical Therapy & Wellness will ask a number of questions to determine if you have strained your muscle and to determine how severe the damage is.  They will want to know exactly when you injured yourself and if you injured the muscle from one specific event or if a repetitive injury caused your pain.

They will want to know what you felt immediately after the injury and whether or not you feel that you have lost any strength or range of motion. Your therapist will also want to know if there has been any swelling or bruising around the area or anywhere down one of your limbs.  They will also want to know what sort of things are aggravating your pain or if you have been able to do anything to make your pain feel better.

They will inquire about any medications you are taking and whether or not you have ever injured this muscle in the past.  After a thorough history your Physical Therapist will do a physical examination. 

Firstly they will observe how you are holding your affected limb or your neck or back, if this is the area in question. 

Next they will examine the area to determine if there is any swelling or bruising present.  They will palpate (feel) your muscle to find out which area is most sore.  They will also check to see if there are any divots or unusual bumps in the area, which would be the result of a section of torn muscle fibers; this would indicate a more severe strain. Finally, they will ask you to move your muscle in order to determine how much you can move it and whether or not moving it causes you pain.

In order to help determine the severity of the strain your Physical Therapist will also assess how much they can passively stretch your injured muscle, and will check how much strength against resistance you can generate with your muscle.  
If you are able to they may ask you to push, pull, bend, stand, sit, or jump in order to help assess your strain.

Lastly, they will check the integrity of the joints that are closest to your injured muscle to ensure that you haven’t also injured them.

After a thorough history and physical examination your Physical Therapist will determine the grade of your muscle strain. 

If they determine that your strain is severe (severe grade II or a grade III) they may send you to your physician for a review as further investigations are possibly required, and medication may be needed to control some of your symptoms. 

If you have a severe strain to one of your lower extremity muscles you may require the use of crutches in order to get around; your Physical Therapist can teach you how to use them.

The general rule regarding when to use crutches is such that if you are limping when walking without crutches you should use crutches until your strain heals enough so that you are able to walk without limping when not using crutches.

Conclusion
Muscle strains involve a tear to the fibers of a muscle and vary in healing time depending on how severe the strain is. If you experience a muscle strain, let the Physical Therapists at Ascend Physical Therapy & Wellness assist you in determining the severity of your strain as well as help get you back to your everyday activity or sport by guiding you through the appropriate rehabilitation program.