By Ryan Jones, DPT, CSCS
Whether it's "pulled hammy" or "twinge" in your shoulder it seems that every active adult at some point has suffered a strained muscle. Most times a little rest and activity avoidance for a few days is all that's needed to manage a light strain. But what happens when the pain lingers more than three days - that's the amount of time by which most people expect relief? I know you're quizzing your friends, family and co-workers on what to do next, or diagnosing yourself via Dr. Google. Don't deny it!
So here's some guidance regarding the most common questions: should I push through the pain? Do I stretch it to make sure I don't tighten up and get worse? Do I ice? Do I heat? What do I do?
First, you need to understand exactly what's going on in your body. The word muscle "strain" is synonymous with muscle "pull" or "tear." It simply refers to damage to some part of a muscle or the tendon it connects to. Muscles become injured from excessive pressure that can arise from many different activities, such as heavy lifting or sprinting. In addition to damaging the muscle fibers themselves, other structures may be injured, including nerves and arteries, that will cause increased pain and possibly bruising and swelling. Symptoms of a strained muscle include a sudden onset of localized pain into a specific region of a muscle. Immediately after the injury, there may be some pain at rest and the pain will immediately worsen with any active contraction of that muscle.
In contrast to pain with contraction, passive stretching of the muscle should also cause some pain. Depending on the extent of the strain, you may have heard a "pop" when it happened and there can be some bruising and swelling, as well. You may also notice a feeling of weakness depending on the severity of the strain. If you suspect a very severe muscle injury, it is always best to seek medical help as soon as possible. For less-severe injuries, here's how to address a mild muscle pull.
Proper initial management of a muscle strain follows to PRICE principles: Protection, Rest, Ice, Compression, Elevation. Protect the muscle from any further injury by avoiding any activities that increase your pain. This may involve using ace wraps or braces to help support your injury. Rest also encompasses this principle of not causing any more damage to the injured muscle. Simple rest is at times the best remedy. Ice is the ideal choice immediately following any injury in order to help minimize the acute swelling and inflammation, as well as to help manage pain. You may ice for up to 20 minutes every hour. In the later stages of healing, heat can be used to help loosen up your muscle -- however make sure to avoid hot packs during the initial phase as they may worsen the inflammation. Compression should be gently applied to assist in minimizing swelling and offering mild support of the affected area. Lastly, elevation will assist to decrease swelling as well.
Often you will hear people recommend light stretching as soon as possible to prevent the injury from tightening up. This is old-school thinking. Recent research has shown that early stretching is actually detrimental to tissue healing. If you have just torn a muscle tissue, the last thing you want to do is tear it initial post-injury first phase. Once your pain has completely subsided (meaning you are able to contract the muscle without pain and stretching elicits a feeling of tightness and discomfort but NOT PAIN), you may then begin the next phase of rehab and healing, which involves light stretching and exercises.
The key is to slowly resume to your old routine to ensure that you do not put too much pressure on a healing tissue and aggravate your strain. In most cases, people will completely recover from a muscle strain with proper early management. More significant strains may require medical attention and more specified treatment. That's when you give us a call!
Some interesting food for thought...research has not shown that being more flexible decreases your risk for a muscle strain. Research does however show a correlation between increased core strength and decreased risk for muscle strains.