Muscle strains, or pulled muscles, typically happen when the muscle is stretched beyond its limits, overloaded with too much weight, or through repeated motions.
The most frequent muscle strains occur in the thighs and calves (hamstrings, rectus femoris, and the gastrocnemius muscles). They are also common in the neck, shoulder, and lower back.
Degrees of Muscle Strain Severity
There are three degrees or grades of muscle strain severity:
- Mild: minor swelling and discomfort, little or no loss of strength or range of motion, minimal tearing of muscle fibers, risk of worsening if activity continues, typically heals in a few days
- Moderate: loss of function or ability to contract the muscle, moderate tearing of muscle fibers, visible signs of bruising, swelling, or defect, typically heals in a few weeks
- Severe: total loss of muscle function, complete rupture of the muscle, rehabilitation can take many months, often requiring surgical treatment
If you are experiencing moderate or severe muscle strain signs, see a doctor or physical therapist for an accurate diagnosis and appropriate treatment.
First Phase of Recovery
For the first 2 or 3 days after the injury occurs, treatment aims to reduce pain and swelling. The standard course of management is known as the PRICE protocol.
- Protection: use a brace, sling, crutches, or other devices to limit movement and protect the muscle from further damage
- Rest: stop any activity that caused the injury, and rest the muscle as much as possible
- Ice: apply ice or a cold pack to the strained muscle for 20 minutes every 2 to 3 hours
- Compression: Wrap the injured muscle with an elastic bandage or compression wrap to further reduce swelling and inflammation
- Elevation: raise the affected area up as much as comfortably possible to minimize pressure and bleeding, and promote drainage
Second Phase of Recovery
The goal of this stage is to prevent further damage and to begin rebuilding stability and balance.
A more recent innovation, the POLICE protocol, suggests replacing ‘Rest’ with ‘Optimal Load.’ Instead of completely resting the muscle (which may cause it to become weak and atrophied), it might be better to carefully and gradually introduce controlled movement and weight-bearing activity.
This may begin with massage throughout the first week after injury and progress to light stretching and low-intensity exercises. These should only be performed if they do not increase pain and should respect the healing process and recovery time.
Third Phase of Recovery
By week 2, your muscle tissues are now repairing and regenerating. This stage aims to rebuild muscle strength over the next month or two progressively.
You may start to increase the intensity of your exercises but must still be careful not to overdo it or risk re-injury.
Rehabilitation programs often use an exercise program specified for your injury and the sport-specific movements you aim to return to.
Returning To Action
When returning to activity, start slowly and gradually increase intensity and workload. Allow plenty of time for your body to adapt, and be aware of any early warning signs of a re-injury.
If you experience any pain or discomfort during your return to activity, stop and seek further guidance from a healthcare professional.
