Strain

A strain is an injury to a muscle or the tissue that connects muscles to bones (tendon). In a strain injury, the muscle or tendon is either stretched or torn. Muscles are more susceptible to strains if they cross two joints, such as:

  • Hamstrings.

  • Quadriceps.

  • Calves.

  • Biceps.

There are three categories of strains:

  • A first-degree strain is a small tear in the muscle. There is no lengthening of the muscle, but pain may be present with contraction of the muscle.

  • A second-degree strain is a small tear in the muscle accompanied by lengthening of the muscle. Muscles with a second-degree strain are still able to function.

  • A third-degree strain is a complete tear of the muscle. Muscles with a third-degree strain cannot function properly.

Strains often have bleeding and bruising within the muscle.

SYMPTOMS

  • Pain, tenderness, redness or bruising, and swelling in the area of injury.

  • Loss of normal mobility of the injured joint.

CAUSES

A sudden force exerted on a muscle or tendon that it cannot withstand usually causes strains. This may be due to a sudden overload of a contracted muscle, overuse, or sudden increase or change in activity.

RISK INCREASES WITH:

  • Trauma.

  • Poor strength and flexibility.

  • Failure to warm-up properly before activity.

  • Return to activity before healing is complete.

PREVENTION

  • Warm-up and stretch properly before and activity.

  • Maintain physical fitness:

  • Joint flexibility.

  • Muscle strength.

  • Endurance and conditioning.

  • Strengthen weak muscles with exercises to prevent recurrence.

PROGNOSIS

If treated properly, strains are usually curable. The time it takes to recover is related to the severity of the injury and usually varies from 2 to 8 weeks.

RELATED COMPLICATIONS

  • Re-injury or recurrence of symptoms, permanent weakness.

  • Joint stiffness if the strain is severe and rehabilitation is incomplete.

  • Delayed healing or resolution of symptoms if sports are resumed before rehabilitation is complete.

  • Excessive bleeding into muscle, especially if taking anti-inflammatory medicines. This can lead to delayed recovery and injury to nerves, muscle, and blood vessels; this is an emergency.

TREATMENT

Treatment initially involves ice and medicine to help reduce pain and inflammation. Use of the affected muscle should be limited by a:

  • Brace.

  • Elastic bandage wrapping.

  • Splint.

  • Cast.

  • Sling.

Strengthening and stretching exercises may be necessary after immobilization to prevent joint stiffness. These exercises may be completed at home or with a therapist. If the tendon is torn, then surgery may be necessary to repair it.

MEDICATION

  • Avoid aspirin or ibuprofen in the first 48 hours after the injury. These medicines may increase the tendency to bleed. During this time, you may take pain relievers, such as acetaminophen, that do not affect bleeding.

  • After the first 48 hours, if pain medicine is necessary, then nonsteroidal anti-inflammatory medicines, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medicine within 7 days before surgery.

  • Prescription pain relievers may be prescribed. Use only as directed and only as much as you need

  • Ointments applied to the skin may be helpful.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak your injury in warm water.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve despite treatment.

  • Pain becomes intolerable.

  • You experience numbness or tingling.

  • Toes or fingernails become cold or develop a blue, gray, or dusky color.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).