Muscular injuries are common in sport and in general day to day life. Epidemiological studies report that in sporting environments muscular injuries account for over 30% of all injuries. Certainly muscle strains are a common reason for patients to present to our clinic in Eskbank near Edinburgh. Therefore whether you are a keen sports person, you have a physically demanding job or you are just active in everyday life, it is likely that you will encounter muscle strains or tears from time to time. They are generally self limiting injuries that will settle well with appropriate advice and management. However it is important to make sure that you restore full range, pain free movement and power to reduce the risk of reoccurrence. Commonly we will see patients who have had several episodes of a recurrent problem before coming to see us, often the reason for this is that while their pain had settled they had returned to their chosen activity lacking muscle power or length or both.
Why do we get muscle strains or tears?
Acute muscle strains occur when a muscle’s capacity to tolerate mechanical load is exceeded, this results in some or all of the fibres that make up the muscle tearing. This often occurs with a powerful contraction such as sprinting or jumping or when a muscle is forcibly overstretched. Whilst there are a number of different methods for categorising muscle strains or tears, commonly they are categorised into 3 categories:
Grade I (Mild) strains, only a few muscle fibres are affected. There is no significant loss of strength or power and there is full or near full active and passive range of movement. Often pain and other symptoms are not apparent for 24 hours.
Grade II (Moderate) strains, a significant amount of muscle fibres are affected. There is significant pain and swelling with some loss of muscle strength or power and range of movement.
Grade III (Severe) strains, a complete or near complete rupture of the muscle, There is severe swelling, pain and loss of function.
Following the initial injury the tissue repair process begins, this can be divided into 4 stages. These stages overlap to a certain extent however knowledge of them guides the rehabilitation process.
Initially following injury there is the bleeding phase, how significant this is and how long this lasts depends on the degree of damage and the structure that has been damaged. However it normally lasts around 4-6 hours. Following this is the inflammatory phase. In the case of a soft tissue injury such as a muscle tear in a otherwise healthy individual this will take 2-3 days to reach it’s peak and then persist for 1-2 weeks. Obviously this will differ in individuals with rheumatoid arthritis or other auto immune diseases.
The next state is the proliferative phase, this is when tissue regeneration starts and involves the production of scar tissue or collagen. This normally starts after 24-48 hours however it does not reach its peak until around 2-3 weeks following injury. It can then carry on for up to 6 months following the initial injury.
The final phase is that of remodelling, this is the phase where the scar or collagen deposited during the proliferative phase is organised or remodelled into a strong, flexible and functional scar. It is reported to start around 2 weeks after injury and can last up to a year. In many ways this is the most important phase, as this is the phase where the strength, flexibility and function of the scar is optimised. These factors are key in enabling return to sport and other activities and the prevention of reoccurrence.
So if you have a muscle strain or tear what should you do?
For the first 24-48 hours the simple answer is not much, you should rest, apply ice and compression and keep the affected area elevated as much as possible. This blog post about acute ankle sprains may be useful. If you are in doubt as to whether there is serious underlying injury then seek medical assistance via your GP, A&E or minor injuries unit. In certain cases you may require the use of crutches or devices such as a moonboot to enable you to mobilise safely. Very infrequently your injury may require surgical repair, however this is not commonly required. As with any acute injury adequate pain relief is important to allow adequate rest and to facilitate appropriate rehabilitation.
Your physio will initially thoroughly assess the injured and surrounding areas, commonly patients present to the clinic with what they think are “hamstring tears”, these subsequently turn out to be lumbar spine or sacroiliac joint(SIJ) problems. In particular if this is a recurrent or chronic problem it is essential to thoroughly assess both the painful area and the structures above and below the affected area.
Assuming it is in fact a muscle strain and not some other pathology, it is essential to fully rehabilitate the muscle whilst respecting the stages of soft tissue repair mentioned above. The reason for this is that while good rehabilitation will facilitate the recovery process and optimise the quality of the repair; overloading the repair i.e. too much too soon can be counter productive. In order to do this, full range of motion both active and passive, muscle strength, power, control and endurance need to re-established. Once these goals have been achieved, a graded return to function can be started. Your physio may use a variety of methods including electrotherapy, soft tissue techniques, manual therapy, stretching, strengthening and finally a graded return to sport or other activity. For example in the case of running this could include a walk/jog programme, where you progressively increase the degree of loading within comfortable limits, while respecting soft tissue healing timescales.
If you suspect that you have strained or torn a muscle please contact us to make an appointment and we’ll do our best to get you back to being fully fit as quickly as possible. We can normally see you within a few days and we have appointments from 8 am to 8 pm at our clinic in Eskbank near Edinburgh, so we can see you at a time that is convenient for you.