Definition & Overview

A muscle strain, also known as a pulled muscle, is a condition characterized by overstretched muscles and the tendons attached to it due to enormous pressure caused by physically-demanding activities or simple yet repetitive everyday tasks. This injury can affect any muscle but is more common in the lower back, shoulders, neck, and hamstring (the muscles behind the thigh). Most minor cases can be treated with first aid methods while severe cases may require more extensive medical attention including surgery.

Patients who are suffering from muscle strain have a higher risk of having their muscle fibers and tendons damaged, which can affect the small blood vessels and can result in local bleeding, bruising, and pain. The nerve endings of the affected area can also get irritated, and this can cause a lot of pain.

Cause of Condition

The common causes of muscle strain are:

  • Poor flexibility
  • Lack of proper warm up before engaging in physical activity
  • Poor conditioning of the body
  • Overexertion
  • Fatigue

Meanwhile, the common causes of acute muscle strain, which is a sudden occurrence, are:

  • Slipping
  • Losing one’s footing
  • Jumping
  • Running
  • Lifting heavy objects or in an awkward position

While an acute muscle strain can happen in a snap, a chronic muscle strain occurs due to repetitive movements. More serious muscle strains usually occur due to the following activities and situations:

  • Participating in sports such as tennis, golf, baseball, and rowing
  • Having poor posture
  • Holding the neck or back in an awkward position for long periods of time such as when sleeping or working at a desk for hours

The muscles that move the bone are also more likely to get strained. Those that have the highest risk of suffering from this condition are the following:

  • Lumbar
  • Hamstring
  • Abdominal
  • Biceps
  • Triceps
  • Adductor
  • Quadriceps
  • Calf muscles
  • Upper back muscles
  • Trapezius muscles of the upper back
  • Rhomboid muscles of the upper back
  • Neck muscles
  • Intercostal muscles of the chest
  • Oblique muscles of the chest

Key Symptoms

Aside from pain, the key symptoms of a muscle strain are:

  • Swelling
  • Bruising or redness
  • Open cuts
  • Onset of pain
  • Inability to use the muscle
  • Muscle spasms
  • Stiffness
  • Weakness

Who to See & Types of Treatments Available

Most cases of muscle strain can be treated with success using simple first aid methods at home. Minor cases are typically managed using the R.I.C.E method, which stands for “Rest, Ice, Compression, and Elevation.” Resting the muscle means not using it or keeping it steady for few days particularly if movement triggers pain. However, too much rest can result in muscle weakness, which may lengthen the healing period. The appropriate amount of resting time is around two days, after which, the injured individual can slowly start using the strained muscles again.

As a first aid technique, ice must be immediately applied to the affected region to lessen the swelling. The technique in this remedy is to not directly put the ice in contact with the skin. Instead, it must be placed inside an ice pack or wrapped in a towel or piece of cloth, and then placed on the injured area for about 15 minutes. This should be done every hour for the first day of injury, and every four hours on the following days until the pain and swelling subside.

The swelling can also be managed through wrapping or compression, which is done by wrapping the injured area with an elastic bandage until the swelling completely disappears. It's important to ensure that the bandage is not wrapped too tight as this could disrupt the blood circulation in the affected area.

Along with resting, putting a pack of ice on the affected area, and wrapping it with an elastic bandage, it also helps to keep the affected area elevated above heart level.

Aside from the R.I.C.E method, other self-care methods are also effective in relieving minor cases of muscle strain, including the following:

  • Taking anti-inflammatory medications - Anti-inflammatory medications such as acetaminophen and ibuprofen are effective in helping relieve the pain and swelling. These medications are considered as over-the-counter drugs and are thus easily accessible.
  • Applying heat to the injured muscle
  • Stretching
  • Warming up and exercising

Although minor muscle strain cases can be relieved using first aid methods, some of the more severe cases require medical attention. A doctor must be contacted if the following symptoms manifest:

  • Pain that does not subside after a week
  • The affected area feels numb
  • Blood is coming out of the injured area
  • Inability to walk
  • Inability to move arms and legs

Upon going to the doctor, a physical examination will be conducted followed by an x-ray and magnetic resonance imaging (MRI) scan to assess the severity of the condition. Depending on the extent of the injury, the doctor may treat the patient with the help of a physical therapist and by prescribing the suitable anti-inflammatory medications and pain relievers to lessen both pain and swelling. Physical therapy is a crucial part of treatment as it restores the muscle’s ability to move and regain its strength.

In very severe cases, where first aid treatments and anti-inflammatory medications do not work in treating the condition, the doctor may recommend surgery to repair the affected muscle.

References:

  • Brinker MR, O’Connor DP, Almekinders LC, et al. Physiology of Injury to Musculoskeletal Structures: 1. Muscle and Tendon Injury. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 1, section A

  • Biundo JJ. Bursitis, tendinitis, and other periarticular disorders and sports medicine. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 271

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