.:the runner's remedy : muscle strains:.


	Contents Definition Causes Facts & Statistics Symptoms Similar Conditions Diagnosis When to Seek a Professional Predisposing Factors Progress & Duration of Muscle Strains Treatment/ Rehabilitation Examples Specific Muscle Strains Prevention References Definition A muscle strain is a term that is often used that with words such as a muscle pull or muscle tear because they al refer to the same condition. An acute muscle strain is a type of injury that often occurs when a muscle contracts quickly and strongly, or when a muscle is stretched beyond its capacity of the weakest structure. However, the overuse of certain muscles during repetitive movements for an extended period of time, can lead to chronic muscle strains. Strains are more common in muscles that cross over 2 joints, for example the hamstring muscles which cross over both the hip and knee joints. The injuries to the muscle usually are located closer to where the muscle belly and tendon meet at a site called the musculotendonous junction. Muscle strains can be classified into 3 categories: Mild (1st degree) A couple of muscle fibers are torn Mild sudden pain lasting up to 1-2 hr Minimal swelling or a slight bruising due to the trauma to the muscle tissue Slight discomfort and minimal to no loss in strength or restriction to movement Moderate (2nd degree) A greater amount of damage occurs to the muscle fibers but the muscle is not completely torn Immediate, moderate pain that is present for an extended period of time Localized swelling and bruising. The bruising/ discoloration may not be initially present but it usually appears at the end of the muscle closest to the ground due to gravity Movement is painful and the site of the muscle damage is sore to touch. Loss of strength is evident Severe (3rd degree) The tear is through the whole muscle belly and the muscle is no longer attached Constant pain, which is severe and occurs suddenly Minimal pain when muscle is contracted as it is no longer attached and the sensory fibers are damaged Will be less painful than 2nd degree strain in most cases Swelling, bruising and a total loss of muscle function Causes The cause of a muscle strain is due to a multitude of factors. For instance, any motion that causes a muscle to contract quickly or forces a muscle to stretch beyond its ability, will lead to tearing of the muscle fibers. A muscle strain is common in those who: Neglect a proper warm-up Participate in an overly intense work-outs, for example excessive sprinting Build-up their distance too fast, participate in runs that have too much mileage, or do not plan enough rest in between training sessions Change running routine or environment too quickly e.g. switch suddenly from hill running to running or hard surfaces or an indoor track Have an abnormal alignment of their lower extremity which puts their muscles and joints under chronic stress Have muscle tightness, which can be prevented with proper stretches after their warm-up or after their run When an injury occurs to a muscle, the muscle will undergo a series of stages as it moves through the healing process. It is crucial that special consideration is given to each stage as proper progression is required for the muscle to heal properly. Stage 1: Destruction A hematoma(bruise) is formed due to damage to surrounding blood vessels The injured muscle fibers die Cells in the tissue under go the inflammation response The site of the rupture is often close to the far end of the muscle-tendon junction Stage 2: Repair Cells migrate to the injured area and remove injured/damaged tissue Muscle fibers regenerate Cells begin to grow over the tear Scar formation begins The key to muscle regeneration is vascularization to the injured area New capillaries sprout from surviving blood vessel trunks and head toward the middle injured site The blood vessels are what transport the nutrients that are responsible for healing Stage 3: Remodeling The regenerated muscle fibers begin to mature The scar tissue undergoes reorganization through the various stress applied to the tissue through daily activities The repaired muscle begins to restore to it’s previous functional capacity Note: phase 2 and 3 often occur at the same time Facts & Statistics Muscle injuries are extremely common in most sports; their incidence varies from 10-55% of all injuries More than 90% of the muscle injuries are due to either a direct blow to the muscle (contusion) or a muscle strain A previous muscle strain injury is a strong predictor for future muscle strains in the same muscle group Older individuals are more susceptible to calf and hamstring muscle strains Symptoms A muscle strain will appear with the following symptoms: Pain with contraction of the involved muscle Possible burning sensation in the area of the injured muscle At the time of the injury, you may have felt like something “popped" or "tore" Bruising or swelling may be evident The muscle may spasm, meaning it contracts suddenly and involuntarily, which produces severe pain Similar Conditions Conditions whose symptoms are similar to muscle strains and need to ruled out by health care professional: Fracture Myositis Ossificans Calcified mass located in the muscle tissue, more common with complete tears Ligament sprain Bursitis Compartment syndrome Nerve or artery entrapment Neoplasm (tumor) or Cancer Infection Diagnosis The tests a health care professional uses to confirm that you may have a muscle strain include: Muscle Testing The individual muscles are isolated and then actively contracted by the client Normally an injured muscle will cause pain when it is contracted and when it is stretched in the opposite direction However, if the muscle is completely torn, the patient feels minimal to no pain as the sensory elements have been destroyed Palpation With a complete tear of a muscle, there are noticeable changes For instance there may be large gaps or the muscle may appear to have “rolled-up”. If the muscle is still attached, the client usually feels discomfort when the therapist applies pressure with their hands around the location of the tear X-Ray Though an x-ray can not give a picture of the muscle damage, this tool maybe used to see if there has been any damage to the bone where the muscle originates or inserts MRI (Magnetic Resonance Imaging) Considered the most effective method for diagnosis and locating the muscle tear Used when all other diagnostic measures have been exhausted or when professional athletes need a rapid diagnosis Very expensive and not practical option for most cases When to Seek a Professional Many runners will try to run “through the pain” produced by the muscle strain, even though this is not recommended. An individual should typically seek the advice of a professional such as a Physiotherapist when they are experiencing any of the following: A large muscle bulge is noticed or you can feel a “gap” in the muscle You heard or felt a pop in your leg muscle at the time of injury You are unable to weight bear or difficulty walking There is unremitting/constant pain You have severe pain, swelling or discoloration in the injured muscle Your injured leg is obviously weak compared to your uninjured leg You experience persistent night pain The pain that does not subside when activity is over (other than regularly experienced muscle pain) There is pain with the activity that has not resolved with adequate rest Pain is not resolved with medication or other rehabilitation techniques (i.e. RICE) You have milder leg symptoms that do not improve after 48 hours Predisposing Factors There are factors that a runner should be aware of, that will increase the likelihood of developing a muscle strain, they include: Poor General Conditioning The lack of conditioning can leave your muscles weak and more likely to sustain injury Poor Muscle Strength If the muscles are weak and haven’t been trained, they will not be able to handle the repetitive stresses that you apply Fatigue Tired muscles are less likely to provide good support for your joints When you're tired and muscle are fatigued you’re also more likely to not be able to react when the surface you are running on quickly changes Improper warm-up A proper warm up is required as it loosens your muscles and increases joint range of motion, making the muscles less tight and less prone to trauma and tears Improper rehabilitation from a previous injury If you had suffered an injury to the area or surrounding structures, you need to allow proper rest and rehabilitation for the involved tissues to heal Muscle Imbalances These are differences in strength and flexibility between two opposing muscle groups, meaning that the muscles surrounding a given joint differ with respect to their strength or flexibility (ie. quads vs hamstrings) A tightened muscle is more likely to be strained compared to the lengthen muscle Muscle imbalances are caused by repetitive movements, prolonged postures, or poorly organized exercise programs In order to produce a desired movement, the muscles surrounding a joint are activated and the various muscle groups will have different functions. In order to bend your knee, the hamstrings muscles will contract but at the same time the quadriceps muscle lengthen in order to provide control to the movement The Agonist is the muscle that is the prime mover about the given joint and the Antagonist is the muscle that will produce the opposite movement During bending of the knee, the hamstrings will act as the Agonist and the quads will act as the Antagonist Normally, if the range of motion is restricted the Antagonist has shortened or it is unable to relax The cause of a muscle imbalance is dependent on a couple of factors: A muscle whose main purpose is stability usually becomes inactive and/or lengthens beyond its desired range A muscle whose key function is movement usually becomes overactive and shortens Muscles that normally tend to be overactive and shorten are: Calf muscles Hamstrings Hip adductors Iliopsoas (hip flexors) Rectus femoris (central quad muscle) TFL (tensor fascia latta) Piriformis Lower back extensors (erector spinae) Muscles that tend to be inhibited or lengthened are: Tibialis anterior Vastus medialis (VMO, inside quad muscle that controls kneecap) TA (transverse abdominus) Obliques Lower traps Gluteus medius & minimus Progress & Duration of Condition Following a muscle strain there is no strong consensus of when an athlete can return to their sport. There is also no clinical test or observation that is the gold standard for measuring the ability of injury to withstand the stresses accompanying running. Therapists commonly use the following guidelines as a measure of the ability to return to sport after an injury such as a muscle strain: Full range of motion Full strength of pre injury Can perform daily functional activities such as work All without pain The timing of return to sport post muscle strain injury is very challenging as it does not usually correspond to full recovery or healing of the injury One must remember you “carry” your injury with you as you return to sport and that since muscle strains have a high rate of recurrence, it is important to “ease” yourself back into your training program For our advice on proper post-injury return to running, click here Most Grade I or Grade II strains begin to feel better within a few days Runner’s who have suffered this degree of injury are suggested to rest and carry on with normal daily activities It is recommended to postpone running initially after sustaining a Grade I or Grade II muscle strain and to wait approximately 7- 10 days before returning fully to the sport When a runner does return to running post injury they should be able to run without experiencing pain In the majority of cases, the symptoms are either totally gone or very much improved within 8 to 10 weeks Symptoms of a Grade III strain will last until the torn muscle is surgically repaired After surgery to repair the Grade III strain, most people regain normal leg muscle function after several months of rehabilitation Runner’s who have sustained a Grade III strain are strongly recommended to first seek medical assistance and then to follow the rehabilitation program set out by their therapist and medical doctor Factors that contribute to recurrent muscle stains are: Reduction to the tensile strength of the scar tissue at the site of the previous injury Animal studies have shown that when the muscle tissue is cut, scar weakness is the limiting factors until 10days post injury. After the 10days, muscle wasting & weakness appears to be the predisposing factor Muscle weakness is due to atrophy, pain inhibition or reflex inhibition A reduction to the flexibility of the muscle-tendon unit due to scar formation Biomechanical adaptive changes and changes to muscle recruitment patterns following the original injury For example, when an athlete returns to sport post hamstring muscle strain, they are just as likely to injure their quadriceps muscle as they are to re-injure their hamstring muscle. This is because of possible biomechanical changes that have become adapted during the recovery from their initial injury Overall, it is important to remember that muscle strains are treatable and that you will see the best rehabilitation results if you stop and treat your injury before carrying on with running Waiting for the pain to stop or trying to run through it, will only prolong the healing time that the injury requires and will keep you away from running longer Treatment/ Rehabilitation Examples If you sustain a 3rd degree (complete tear) of a muscle, you should report to your local emergency room as you will require surgery to re-attach the muscle. Post-surgery, you should follow your doctor’s advice regarding physiotherapy A typical muscle strain treatment program will include the following: RICE (Rest, Ice, Compression, Elevation) Rest and ice are beneficial to reduce bleeding from injured blood vessels, to prevent formation of a large bruise; therefore, reducing the size of a scar formed later in healing phase Compression should be applied immediately post-injury to help decrease inflammation, the size of the bruise and accelerate regeneration. Often compression is applied with cold for 15-20 minutes Elevation helps to decrease possible swelling due to the pooling of fluids in the injured area Overall, the above steps can be combined and applied all together. NSAIDS Are normally started immediately after the injury; to decrease inflammation and it is reported that they have no adverse effects to the injured muscle properties Please consult with your doctor if you have any questions or concerns regarding medications. Ultrasound This is a therapeutic dosage of ultrasound that is applied to your injury by your physiotherapist Though there is little evidence in the literature to support the effectiveness of this treatment, many therapist use this techniques to help with healing and pain relief Relative Rest Short immobilization of the injured muscle is beneficial in the early phase of muscle regeneration but long term immobilization can cause healthy muscle tissue to waste away and / or can reduce the muscle strength The literature suggests immobilizing for a short period i.e. 1-2 days immediate post injury; then begin active movement Two ways to determine if a muscle should be mobilized and not immobilized: The injured muscle can be stretched to the same degree as the non injured muscle on the opposite limb The injured muscle is pain-free in basic movements such as walking One should note that movement with the injured muscle is actually beneficial to the healing process as early movement/ mobilization induces physiological healing for the injury Once a muscle strain occurs, the muscle is vulnerable to re-injury; therefore it is important to treat the muscle properly to begin with Stretches Stretching should not be preformed immediately after injury as this may further damage the muscle. Stretching should always be done in a pain free fashion and it is advisable to wait 3-5 days to give muscle adequate time to heal Adductor Stretches Glute Stretches Hip flexor Stretches Quadriceps Stretches Hamstring Stretches Calf Stretches Cross training If you want to remain active during the rehabilitation stages, there are activities that you can participate in You may want to consider non weight bearing exercise if you are in the early phases of healing, such as: Arm ergometer ( hand bike) Resistance training for the upper extremity If you are able to tolerate weight bearing activities they may want to consider: Swimming Deep water walking/ running Biking Walking Specific Muscle Strains Quadriceps The quadriceps group is made up of four muscles: Rectus femoris Vastus lateralis Vastus intermedius Vastus medialis Quadriceps muscle strain usually involves local pain and tenderness at the front of the thigh Rectus Femoris is the most commonly involved muscle as it is the only quad muscle crossing two joints Injury often occurs during kicking, sprinting or jumping If a quad strain has occurred, runners will compensate through the following adaptations: Greater reliance on unaffected leg Shortened running stride with decreased hip flexion Decreased running velocity Outward rotation of the leg so the adductors muscles can assist to move the leg Treatment Specifics Stretch Hamstrings, Quadriceps, Hip flexors, IT band Strengthening Hip flexors, Hamstrings, Glutes, Quadriceps 24 - 48 hrs after injury Maintain hip and knee range of motion through gentle pain-free motion of the hip and knee 7 – 10 days after injury Stretching, massage & physiotherapy 10 days + after injury Begin gentle resistance training in pain free range of motion that is progressed to full range as tolerated Hamstrings The hamstring muscle group consists of three muscles: Biceps femoris Semitendonosis Semimembranosis The action of these muscles is to bend the knee and extend the hip Muscle strain of the hamstrings involves local pain and tenderness at the back of the thigh This injury can include all hamstring muscles (3), but most commonly the short head of biceps femoris is involved Hamstring muscle strains commonly occur in sprinters, hurdlers, jumpers or athletes that sports involve sudden sprinting (hamstrings act as a brake for the leg when it is straightening) Excessive stretching of the muscle during the contraction is usually related to the hamstring strain Many hamstring strains occur at heel strike during the stride, as the hamstrings work maximally eccentrically (lengthen) to decelerate the leg Contributing Factors Poor flexibility, strength, endurance or an imbalance of these factors between muscles in the leg Disc Degeneration in the lumbar spine Sacroiliac joint dysfunction Increased neural tension (tightness in nerves supplying the leg) Poor walking or running biomechanics Pelvic tilt or instability Poor warm up or recovery from running Diagnosis The runner may report a “pop” or tearing sensation Tenderness to touch (origin, muscle belly or distal insertion) Pain is intensified with resisted knee bending or hip extension Weakness in the involved hamstring group Tight hip flexors and weak glute muscles Treatment Specifics Stretching of Quadriceps, Hamstrings and Hip flexors Strengthening of hamstrings as tolerated (emphasis on eccentric loading) Possibly an x-ray to rule out the muscle pulling out (avulsion) at the origin in the buttock Adductors Aka “groin” strain The adductor group is made up of five muscles that are located on the inside of the thigh: Adductor brevis Adductor longus Adductor magnus Gracilis Pectineus A strain of the adductor muscles can occur from quick changes in a direction from a stretched out lunge position, ballistic stretching or an eccentric loading activity. Diagnosis Hip or pelvic pain on the same side as their injury that worsens with walking or running Pain in the groin which worsens with passively abducting the hip (legs moving apart) or actively adducting (legs moving together) or flexing the hip against resistance A trained therapist can also identify the exact muscle at fault with these sensitizing tests during resisted adduction: External Rotation = Adductor Magnus Neutral = Adductor Longus Internal Rotation = Pectineus If an adductor strain has occurred, runners will compensate through the following adaptations: Tight adductors on the side of the strain and tight TFL on the opposite side Weak gluteus medius & minimus on the same side & weak lower abs Pelvis dropping/ instability (trendellenburg) Knee (patellofemoral joint) overload that may lead to pain Treatment Specifics Passive range of motion of hip adductors Strengthening of hip adductors (muscles that pull the thigh inward) TFL and Piriformis muscle massage/ trigger point release Strengthening the Glutes Calf Muscles Consists of the gastrocnemius, soleus and plantaris muscles The function of this muscle group is similar to pushing foot down on gas pedal of a car (plantarflexion) These muscles are most active during the toe-off phase of running and walking Injury to these muscles usually occurs about 5cm above the insertion of the Achilles tendon into the heel Symptoms involve a sudden onset of pain while running or jumping Can be associated with a "pop" or the feeling of someone "kicking the back of the leg" Diagnosis Pain with dorsiflexion Walking with a limp Swelling Possible deformity to the touch Weak plantar flexion Inability to stand on the injured leg and raise the heel off the ground Treatment Specifics Stretching Gastrocs, soleus and hamstrings Strengthening Calfs and dorsiflexors Muscle Cramps These are another common condition that can affect the gastrocnemius muscle Muscle cramps are a painful involuntary muscular contractions The cause of this condition is uncertain but include dehydration, electrolyte disturbances or an increased use of supplement creatine Muscle cramps may also show up as muscle twitches or fasciculations Treatment Stretching both actively and passively of calfs and hamstrings Proper re hydration Prevention One of the best methods to prevent a muscles strain is to be aware of the factors that can easily cause someone to become more susceptible to the injury. Muscle Strain prevention includes: Proper warm-up and cool-down For an example of how to properly warm-up & cool down for runners, click here Stretch to maintain muscle flexibility or correct muscle shortening For our advice on stretching for runners, click here Running on hard surfaces (i.e. paved bike paths) is ok only if you do not have pain and you have proper shoes However, if you do have pain, you may want to try running on softer surfaces (i.e. packed trail) Allow proper healing times from previous muscle injuries; this mostly likely includes a rest in your running program Excessive mileage can cause/aggravate injuries. Run below the pain level and gradually increase activity, especially after an injury Proper nutrition Your body needs proper fuel in order to run smoothly, if you don’t provide your body with it’s required energy, your muscles will not be able to react to present obstacles which puts you at an increased risk for injury. Therefore, it is important that you re-hydrate your body with water after each run and to take water with you if you are running 30 plus minute. If you are running 45 or more minutes, you may want to consider an energy drink powder mixed with water If you are running longer than 60minutes, you may want to start using sports gels to replenish the calories and nutrients that you are expending during your long runs For advice on nutrition & running click here Avoid running to fatigue Stop the activity when you are fatigued When you become fatigued, you put yourself at greater risk to injury because your muscles are no longer able to react quickly if they are required to Correct Muscle imbalances in the lower extremities Visit a Physiotherapist to help diagnosis the location of the muscle imbalance and they will prescribe an individualized program that includes treatments covered in this website Correct biomechanical problems in the lower extremities Visit a Physiotherapist or Orthotist for orthotics if needed References top

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