Muscle Injuries are the most common injury in sport, commonly in sports that require sprinting or jumping. The majority of these injuries are caused by either a contusion or by excessive strain of the muscle. The site of the injury is commonly where the muscle meets the tendon (musculotendinous/myotendinous junction) and is often in muscles that work across 2 joints, such as Rectus Femoris (Quadricep) or Semitendinosus (Hamstring).
Diagnosing Muscle Strains
Diagnosis of a muscle strain is typically made by your physiotherapist who will palpate the area, assess your muscle length & strength, and clinically reason the injury from information gathered from your history, palpation of the area, and assessment of your muscle length & strength. If imaging is required, ultrasound is commonly used to evaluate muscle strains & tears.
Classification of Muscle Strains
The classification of muscle strains is dependant on the severity of the injury
- a tear of a few muscle fibers
- minor swelling
- none or minimal loss of strength or movement
- greater damage to the muscle
- significant loss of strength
- a tear extending across the whole muscle belly
- total loss of muscle function
Muscle strains often result in a large haematoma (bleeding/bruising) due to the tearing of blood vessels within the muscle. These haematomas can be classified either as Intramuscular or Intermuscular.
Intramuscular Haematomas: Bleeding occurs within the muscle itself, however is limited by the intact connective tissue that surrounds the muscle.
Intermuscular Haematomas: Bleeding within the muscle spreads into the spaces between other muscles (intermuscular space) due to a rupture of the connective tissue around the injured muscle. As the pressure within the injured muscle may not increase, the patient may not experience major pain.
Treatment of Muscle Strains
The first line of treatment for muscles strains in known as RICE which should be continued for the first 48-72hrs. The principle of this approach is to minimise bleeding and prevent the formation of large haematomas.
Rest - Ice - Compression - Elevation
The application of cold packs should be applied to the injured area for approximately 15-20 minutes. Reapplication of ice should occur every 30-60 minutes.
Depending on the severity of the injury, a rest period that offloads the injured area should last from 1- 5 days. Crutches are commonly used to protect the muscles following a significant injury.
The use of a compression bandage helps reduce the size of an intramuscular haematoma. Compression should be applied as soon as possible following an injury.
Elevation of the injured area decreases blood flow to the injured site and helps to increase venous return. Therefore elevation may help to reduce the size of the forming haematoma.
What Shouldn't You do?
During the acute phase of injury, the No HARM procedure should be applied. This means no heat, no alcohol, no running or activity, and no massage. By following this principle bleeding and swelling of the area can be kept to a minimum.
How Long Until You Can Get Back To Sport?
The timeframes for returning to sport vary depending on the nature and severity of the injury.
- Grade 1 strains should be rested from sporting activities for approximately 3 weeks
- Grade 2 injuries require a minimum of 4 - 8 weeks
- Grade 3 injuries may require surgical repair and the following rehabilitation may take approximately 3 months
What Is Commonly Involved In Rehabilitation?
- During the rehabilitation phase, your physiotherapist will address;
- muscle shortening through stretch and/or massage
- address muscular weakness through a rehabilitation strengthening program
- depending on the area injured
- proprioceptive training may be required
- sport specific exercise to get you back to your best
- Järvinen, T. A., Kääriäinen, M., Järvinen, M., & Kalimo, H. (2000). Muscle strain injuries
- Brukner, P., & Khan, K. (2006). Clinical sports medicine. McGraw Hill.