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Muscle strain, pulled muscle, torn muscle
Two images of the same strain. One of the pictures was shot through a mirror.
A strain can occur as a result of improper body mechanics with any activity (e.g., contact sports, lifting heavy objects, overstretching) that can induce mechanical trauma or injury. Generally, the muscle or tendon overstretches and is placed under more physical stress than it can exert. Strains commonly result in a partial or complete tear of a tendon or muscle, or they can be severe in the form of a complete tendon rupture. The most common body location for strains to occur is in the foot, leg, or back.
Acute strains are more closely associated with recent mechanical trauma or injury.
Chronic strains typically result from repetitive movement of the muscles and tendons over a long period of time.
Degrees of Injury (as classified by the American College of Sports Medicine):
First degree (mildest) - little tissue tearing; mild tenderness; pain with full range of motion.
Second degree - torn muscle or tendon tissues; painful, limited motion; possibly some swelling or depression at the spot of the injury.
Third degree (most severe) - limited or no movement; severe acute pain, though sometimes painless straight after the initial injury
To establish a uniform definition amongst healthcare providers, in 2012 a Consensus Statement on suggested new terminology and classification of muscle injuries was published.
The classification suggestion were:
The major difference suggested was the use of "indirect" muscle injury verse "grade 1" to provide a subclassifications when advanced images were negative.
Indirect Muscle Injury
FUNCTIONAL (Negative MSK US & MRI)
Type 1: Overexertion-related Muscle Disorder
Type 1a: Fatigue induced
Type 1b: DOMS
o Type 2: Neuromuscular muscle disorder
Type 2a: Spine-Related
Type 2b: Muscle-Related
STRUCTURAL MUSCLE INJURY (Positive MSK US & MRI)
o Type 3: Partial Muscle Tear
o Type 4: (Sub) total tear
DIRECT MUSCLE INJURY
o Bump or Cut: Contact-related
Although strains are not restricted to athletes and can happen while doing everyday tasks, people who play sports are more at risk for developing a strain. It is common for an injury to develop when there is a sudden increase in duration, intensity, or frequency of an activity.
Elevation: Keep the strained area as close to the level of the heart as is possible in order to promote venous blood return to the systemic circulation.
Immediate treatment is usually an adjunctive therapy of NSAIDs and Cold compression therapy. Controlling the inflammation is critical to the healing process.Cold compression therapy acts to reduce swelling and pain by reducing leukocyte extravasation into the injured area. NSAIDs such as Ibuprofen/paracetamol work to reduce the immediate inflammation by inhibiting Cox-1 & Cox-2 enzymes, which are the enzymes responsible for converting arachidonic acid into prostaglandin. However, NSAIDs, including aspirin and ibuprofen, affect platelet function (this is why they are known as "blood thinners") and should not be taken during the period when tissue is bleeding because they will tend to increase blood flow, inhibit clotting, and thereby increase bleeding and swelling. After the bleeding has stopped, NSAIDs can be used with some effectiveness to reduce inflammation and pain.
A new treatment for acute strains is the use of platelet rich plasma (PRP) injections which have been shown to accelerate recovery from non surgical muscular injuries.
It is recommended that the person injured should consult a medical provider if the injury is accompanied by severe pain, if the limb cannot be used, or if there is noticeable tenderness over an isolated spot. These can be signs of a broken or fractured bone, a sprain, or a complete muscle tear.
^TJ Noonan and WE Garrett, Jr, "Muscle strain injury: diagnosis and treatment," Journal of the American Academy of Orthopaedic Surgeons, 7 (4), July-August 1999, pp. 262-9, see web version (accessed August 25, 2008)