Muscle Strain: So you’ve pulled a muscle, now what?
As soon as I woke up, I instantly felt it.
My alarm blared beside my head and my habit of rolling over and striking my alarm off kicked in.
I quickly regretted that and could feel this pain in my back.
It seemingly came out of nowhere and hurt with every motion – even breathing.
I quickly deduced it was a standard muscle strain – considering the location, what aggravated it, and narrowing out anything else it could be.
The prior day I had done a lot of exercises that challenged my back and had spent more time bent over my computer than usual.
I made my way out of bed and struggled to make my morning cup of coffee.
Starring at the kettle needing to be boiled, I questioned how badly I needed my coffee.
I’m a serious coffee fanatic, so I opted to breathe through the pain and make it happen, but it definitely kicked the wind out of me.
Pretty irritating, yesterday I’m crushing life and today I’m being crushed by it – at least that’s how it felt in the moment.
Now we are two weeks out from that and I’m fine, you’d never know it had happened, you wouldn’t be able to tell that two weeks prior I was contemplating how badly I needed my fix.
What did I do?
Muscle strains are one of the most frequent things I get asked about and see a lot of patients for.
The majority of these strains are what we’d call “minor” ones, even though they can be very painful initially.
A muscle pull and muscle strain are the same thing. Muscle strain is the medical terminology that reflects what most people call a pull or tear.
When we look at the grading of their severity, we see it go from grade 1 (minor) to grade 3 (severe). Grade 1 is essentially just a big stretch of the muscle with microtears to no tearing of fibers. Whereas grade 2 is a big range, starting with some tearing, and going all the way to just a couple fibers holding on. Finally grade 3 is a complete rupture/tear of the fibers.
It’s pretty common to experience a grade 1 strain – many people report having some kind of strain per year.
If you’re someone who is pushing yourself in the gym or with sports, you’re very likely to have at least a grade 1 or 2 strain occur at some point.
Most of the time when people are asking me about this – whether it be at the gym, at the clinic, or online – they’re usually referring to a grade 1 or 2. Usually people are asking about what they can do to make it better and what is safe to do with it – since it’s “injured.”
Before I go further, if you have experienced a severe strain, are having a lot of swelling, having a lot of bruising, it is important to go and have it checked out! These can be serious injuries that should be examined and ensured nothing scary has occurred.
The majority of muscle strains though are not severe and require no medical attention.
When most people are asking me about them, the person is in pain, might have some swelling, might have some tenderness to touch, and it might be red.
My go to response for most cases is pretty simple:
Our first part actually has two aspects to it. The first part of relaxing is to actual relax and calm down.
It’s normal for people to catastrophize, to start worrying that something serious has happened, and that there needs to be concern.
In reality, for most people you’re going to be fine in 1-4 weeks, with some people needing a bit longer to recover. If you get really concerned and start freaking out, you actually stand a chance of doing more harm.
We’ve got a strong body of research pointing out that most of the time these sorts of things will fade, but when people start seeking out unnecessary care they can actually be put back by being given something we call a “nocebo”.
Unless you’ve got a red flag or signs of something serious, just give it some time and see how it responds. This can be hard, but calming down is huge for getting better and healing.
The second aspect is to take some load of the area and let it relax.
Most of the time we are experiencing symptoms because we’ve challenged the area with more load than it can handle – this might be load from physical activity, work stress, life stress, poor sleep, etc. It can be a range of factors, regardless, its asking for a bit of a chill time.
For the first while, just focus on letting if have some time off, train around it, live life around it, and move forward as best you can – not challenging it too much.
If you’re someone who likes ice or heat, go for it. This can be helpful for pain management for many people – it doesn’t really matter which one – research pretty much says either is fine. These shouldn’t be things you need for long term management, but short term is totally understandable.
You can also try out some other options like elevation and compression if possible – though this is not always an option depending on where you’re feeling issues.
Now some people are going to want to know about medication usage – such as advil or tylenol. Firstly, this is not medical advice and you should speak to your doctor before taking anything. With that said, as a general rule, in the first few days, we are in the inflammatory phase of tissue healing and we do not want to stop inflammation, so anything that says anti-inflammatory (NSAID = Non-steroidal anti-inflammatory drug) is best to hold off. In contrast, tylenol isn’t an NSAID and could be used in this time – then transitioned to advil.
This phase should only last 3 days to 2 weeks depending on the case. If you get past 2 weeks, it’s time to move on and get moving.
If you’re past those first few days, it’s time to get moving more.
The short rest time should have allowed things to calm down and be less irritated. If we continue resting, we stand a chance of doing more harm than good due to underloading, so we need to transition.
Here we want to find ways to begin moving more, even if it’s not directly what you were doing before, but just getting in more general activity. This is very beneficial to help in the progression of return and getting your entire system more ready to return.
For me, this was just getting back to my daily activities after having 3 easier days of relaxing my upper back.
It’s usually at this point a lot of people set themselves back. They’re feeling good and then jump back at things aggressively.
Going from non-loading to a period of time of gradually getting back to normal loading is valuable. We see that having a sharp change in activity can put us at risk of an injury, so as you return back to activities do so in a progressive manner.
If you’re returning back to sports, speak to your trainers and coaches about a gradual return to practice/play. If you’re getting back to the gym, go easier than usual and slowly ramp it up. If you’re just trying to get back to regular activities, try your best to return progressively where possible.
In my case, I was back to normal for daily activities and then took a week to ramp back up to my normal training weights and then have been training normal the last 3 days.
This is a general outline and will require you customize it to your needs, but the principles all remain the same – relax, recover, rebuild.
Do your best to relax and be positive, get back to daily tasks gradually, and then build back up and stronger over time!