A muscle strain is a stretch or tear of muscle fibers. In the legs, arm,
shoulder or back, muscle strains happen when a muscle is either stretched
beyond its limits or forced into extreme contraction. Because the body has
many different muscles, it is vulnerable to several different types of
muscle strains. Some of the more common ones are:
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Plantaris strain — The plantaris is a thin muscle that begins at the
lower end of the femur (the large bone of the upper leg), stretches across
the knee joint and attaches to the back of the heel along with the Achilles
tendon. Because the plantaris doesn't contribute much force in bending the
knee, a tear in this muscle may not seriously affect your knee function.
However, a severe plantaris strain can cause significant pain, usually at
the back of your calf rather than near the knee. A plantaris strain can
occur alone or accompany a gastrocnemius strain or a tear of the anterior
cruciate ligament (a major, stabilizing ligament in the knee).
strain (pulled hamstring) — Hamstrings are long muscles that extend
down the back of the thigh. Because hamstrings work to pull back the leg and
bend the knee, they can be injured during running, kicking or jumping. As in
gastrocnemius strain, you may feel a pop, usually at the back of the thigh,
when the muscle tears.
Quadriceps strain — The quadriceps are a large group of muscles in
the front of the thigh that straighten out the knee, an opposite action from
the hamstrings. Like hamstring strain, quadriceps strain is a common injury
in runners. However, it also may occur during a strenuous leg press at the
gym. The pain of a quadriceps strain is felt in the front of the thigh, and
the strain may be described as a "groin pull" if the tear occurs fairly high
in the muscle. To help simplify diagnosis and treatment, doctors often
classify muscle strains into three different grades, depending on the
severity of muscle fiber damage.
Grade I — Only a few muscle fibers are stretched or torn, so the
muscle is mildly tender and painful, but muscle strength is normal.
Grade II — A greater number of muscle fibers are torn, so there is
more severe muscle pain and tenderness, together with mild swelling,
noticeable loss of strength and sometimes bruising (called ecchymosis).
Grade III — The muscle tears all the way through. Either it rips
into two separate pieces, or the fleshy part of the muscle breaks away from
the tendon. Grade III muscle strains are serious injuries that cause
complete loss of muscle function, as well as considerable pain, swelling,
tenderness and discoloration. A Grade III strain also causes a break in the
normal outline of the muscle, often producing an obvious "dent" or "gap"
under the skin where the ripped pieces of muscle have come apart.
In the United States, leg, ankle, elbow,shoulder (rorator cuff) and back
muscle strains account for more than a million office visits to doctors
every year. More than half of these injuries happen to active young adults
between the ages of 25 and 44. Men are twice as likely to be injured as
women. On the job, leg strains, sprains and tears are the second most common
type of work-related injury in American adults, with approximately 100,000
cases reported annually to the U.S. Bureau of Labor Statistics. Muscle
strains also are common among teenage athletes, especially those who
participate in football, soccer or wrestling as well as older or retired
athletes who still exercise with prior muscle injuries.
Symptoms of a strained muscle can include:
Muscle pain and tenderness, especially after an activity that stretches
or violently contracts the muscle. Pain usually increases when you move the
muscle, but it is relieved by rest. Local muscle swelling, black and blue
discoloration or both Either a decrease in muscle strength or (in a Grade
III strain) a complete loss of muscle function. difficulty moving, lifting,
or exercising, A pop in the muscle at the time of injury A gap, dent or
other defect in the normal outline of the muscle (Grade III strain)
Your doctor will want to know what activity triggered your muscle pain
and whether there was a pop in the muscle when you injured it. The doctor
also will ask about your symptoms, especially any decreased muscle strength
or difficulty in normal use of the muscle.
Your doctor may suspect that you have a strained muscle, based on your
symptoms and the history of your injury. To confirm a diagnosis, the doctor
will perform a physical examination. If the results of your exam point to
Grade I or II muscle strain, then usually you will not need any additional
testing. However, if the diagnosis is in doubt, X-rays or a magnetic
resonance imaging (MRI) scan may be necessary. Also, in calf muscle
injuries, Doppler studies may be done to check for a blood clot.
Most Grade I or Grade II strains begin to feel better within a few days.
In most cases, symptoms are either totally gone, or very much improved,
within eight to 10 weeks. Symptoms of a Grade III strain may persist until
the torn muscle is repaired surgically.
To help prevent muscle strains, you can:
Warm up before you participate in high-risk sports. Follow an exercise
program aimed at stretching and strengthening your injured or sore muscles.
Increase the intensity of your training program gradually. Never push
yourself too hard, too soon.
If you have a Grade I or Grade II strain, your doctor will probably
recommend that you follow the RICE rule:
Rest the injured muscle (take a temporary break from sports activities).
Ice the injured area to reduce swelling. Compress the muscle with an elastic
bandage. Elevate the injured leg. In addition, you can take a nonsteroidal
anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin and other
brand names) or aspirin, to ease pain and relieve swelling. As pain
gradually subsides, your doctor may recommend a rehabilitation program to
restore the normal range of motion in your leg and to gradually strengthen
the injured muscle.
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For many Grade II strains, evaluation by a specialist, such as an
orthopedist, will be appropriate. To allow the injured muscle to heal, you
may need to wear a cast for a number of weeks.
If you have a Grade III strain the torn muscle may need to be repaired
surgically by an orthopedic specialist. One exception is a Grade III
plantaris strain, which usually is treated without surgery.
When To Call A Professional
Call your doctor promptly if:
You hear or feel a pop in your muscle at the time of injury You have
severe pain, swelling or discoloration in the injured muscle Your injured
muscle is obviously weak compared to your opposing uninjured muscle. You
have muscle pain You have milder muscle symptoms that do not improve after
Muscle Injury Prognosis
The prognosis depends on the location and severity of the muscle strain.
In general, almost all Grade I strains heal within a few weeks, whereas
Grade II strains may take two to three months. After surgery to repair a
Grade III strain, most patients regain normal leg muscle function after
several months of rehabilitation.