A muscle strain is an injury to the muscle as a result of strenuous activity. Almost anyone can put undue tension on muscles during the course of normal daily activities, with sudden, quick heavy lifting, while performing work tasks or during sports. It is possible to strain any muscle that moves bones.
Muscle strains are very common in sports. They constitute 31% of all injuries in elite football; their high prevalence is well documented in the international literature in both football and other sports. Thigh muscle injuries present the most common diagnosis in track and field athletes (16%), but have also been documented in team sports like rugby (10.4%), basketball (17.7%) and American football (46% in training, 22% in games).
In football, 92% of muscle strains affect the four major muscle groups of the lower limbs: hamstrings 37%, adductors 23%, quadriceps 19% and calf muscles 13%.
Though common in sports, muscle strains can happen to anyone over the course of normal activities of the day or as a result of sudden use of a muscle with activity.
The fact that 16% of muscle injuries in elite football are re-injuries and associated with 30% longer absence from competition than the original injury emphasises the critical importance of correct evaluation, diagnosis and therapy of the index muscle damage. This concerted effort presents a challenging task in light of the existing inconsistent terminology and classification of muscle injuries.
Symptoms of a muscle strain can include swelling, bruising or redness, pain in the affected muscle at rest, pain in the muscle or associated joint during use, muscle spasms (when the muscles contract tightly and painfully), weakness and loss of some, or all, of the function in the affected muscle
The general injury and repair mechanism is similar in most types of muscle injuries. Three stages are distinguished: the destruction and inflammatory phase (1 to 3 days), the repair phase (3 to 4 weeks), and the remodelling phase (3 to 6 months), though the last two phases tend to overlap.
Rest is advised during the first 3 to 7 days to allow the scar tissue formed during recovery to gain strength. Subsequently, mobilization within the pain free limits is initiated through self-exercise or with a therapist. Continued inactivity can lead to weakening of the healthy muscles surrounding the injured one; excessive deposition of connective tissue within the muscles and a substantially retarded recovery of the strength of the injured skeletal muscle. Because of this, exercises should be started gradually with light exercises initiated early and progressed during the rehabilitation.
Most people will regain full use of the affected body part within six to eight weeks, although severe injuries may take longer to heal and some people may experience persistent problems lasting several months or longer.
Mueller-Wohlfahrt H, Haensel L, Mithoefer K, et al. Terminology and classification of muscle injuries in sport: The Munich consensus statement, Br J Sports Med 2013;47:342-350.
Baoge, E. Van Den Steen, S. Rimbaut, et al., “Treatment of Skeletal Muscle Injury: A Review,”ISRN Orthopedics, vol. 2012, Article ID 689012, 7 pages, 2012
(P)RICE (Rest, Ice, Compression, Elevation) has been for decades the magic four-letter word in the acute management of injuries, more recently P for Protection has been added. In sports medicine and among the general population when administering first aid, putting the ice bag on a painful area has become one of those rituals, like stretching, which are simply ‘part of the game’. In many cases, the athletes say ‘it just feels good’ or ‘it helps’.
In reality, there is little or no evidence in the literature to support the use of PRICE.
The immediate application of ice aims to provide a cold induced analgesic effect, thereby reducing the appreciation of pain. The magical skin temperature frequently reported in the literature to produce local analgesia is between 10 and 15°C, and this is readily achievable with most ice modalities.
Pain relief is the main reason you should be applying ice to a musculoskeletal injury, and there are numerous scientific papers that will support this. However, most people believe that reducing swelling is the main aim – you may be surprised to learn that there is currently no research involving human subjects which supports this.
The cooling effect is influenced by the depth of the injury and adipose thickness at the injury site; therefore, for deeper injuries, applying the ice bag may have limited effect on the injured tissue itself. While ice, compression, elevation (ICE) may retain its role for pain relief, more debatable is the amount of protection and rest needed after injury.
Studies have examined the effect of ice application on metabolism (which is what the ice needs to suppress to influence swelling) in animal studies and identified the target tissue temperature to be between 5 and 10°C. At first you may think this is achievable, however, this temperature reduction needs to be reached at depth rather than at the surface. No study to date has achieved this at 2cm below the adipose tissue. Although having said that, whilst it may not be possible to reduce the tissue at depth to 10°C, you could argue that even if the temperature declines by 1°C then that is of benefit.
In reality the use of ice may feel as though it helps which it may to a small degree with pain relief but it’s no substitute for helping the repair process regarding inflammation and tissue damage. Getting correct therapeutic intervention with ultrasound, massage, mobilisation, manipulation and muscle stimulation is far superior to speed the recovery process up.
C M Bleakley, P Glasgow and D C MacAuley(2012). PRICE needs updating, should we call the POLICE. Br J Sports Med 46: 220-221
Mario Bizzini (2012) Ice and modern sports physiotherapy: still cool? Br J Sports Med;46:219
Update on Matthew
Matthew is now 14 months into his Masters degree where he has developed his skills in assessing and rehabilitating many sporting injuries. He is currently working on his dissertation, investigating the effects of a half time re-warm up in football. Having already investigated the effects a passive half time period can have on jump and sprint performance in football players; he is keen to find out if players can be better prepared, thus enabling them to gain a competitive edge over their opponents.
Matthew received very positive feedback from the first project and, after some minor changes, has been encouraged to try to get the study published. Fingers crossed for the same for the second piece of work!
Alongside his clinical work and Masters, Matthew has spent the last season working at Peterborough United FC as part of the academy medical team. Matthew’s responsibilities include assessing injuries for under 18s to under 14s and providing them with rehabilitation programmes, providing pitch side cover for academy matches, and has also recently been given the responsibility of providing pitch side care for the under 23s side, including travelling with them to all away games.
As someone who has always been very interested in sport, particularly football, this has been a fantastic experience for Matthew, allowing him to see what a professional club is like from the inside. This work has helped broaden Matthew’s rehabilitation abilities, from exercise selection and prescription to progressions and regressions and delivery with coaching points.