Muscle Strains – Treatment and Recovery Guide

So… you think you pulled a muscle.

You’re not alone!

Muscle strains are one of the most common injuries in athletes.

It’s estimated that 10 to 55% of all injuries in sports are in muscle, and 90% of those are strains ¹. So yeah, it’s a bit of an issue.

Luckily, most of them heal pretty well on their own (depending of course on the severity). They hurt, they suck, but they will get better!

However, there does seem to be a high rate of re-injury (12-31%!) ². Therefore, it’s probably a good idea to treat them the best we can. So let’s review this type of injury.

Here’s a detailed, evidence-based (yet simple and easy to read) guide about what a strain is, how you tell if you have one, why it happened, how it heals, and how you can optimize recovery.

We’ll use the Hamstrings as our example for treatment (exercises and such), as it is probably the most common muscle strain of them all. We’ll also talk about complications, as well as pain management. Prevention will be covered in another article.

Let’s go!

---

Contents

Introduction

• Why is this so long!?
• How to use this guide
  - Disclaimer

Part I – Understanding Strains

• Muscle Strains – What are they?
  - Grades I to IV
• How do strains happen?
• When do strains happen?
• Where do strains happen?
• Healing

Part II – Treatment and Recovery

• Diagnosis
• How long? A Note On Recovery Time
• Recovery : Days 1 – 3 : (be careful)
  - Medications
• Recovery : Days 3 – 7 : (experiment with movement)
  - What NOT To Do
• Recovery : Days 8 – 21 : (active recovery)
• Recovery : 3 Weeks and on : (Gradual Return to Athletics)
• Recurring Strains (re-injury)
• Persistent Pain
• Possible Complications
  - Myositis Ossificans

Final Thoughts

• Where’s the comments?
• F.A.Q.
• References

---

Introduction

---

Why is this so long!?

This isn’t so much a blog post. I’ve simply used the blog format to present it easily. Then what is this?

This is a self management guide for muscle strains.

This guide will use an example: Hamstring strains. But the information is detailed enough to build an understanding for treating almost any strain. Future articles about specific strains will refer back to this article as a model, and they will only include injury specific information that might be different from this article.

It’s also something that will be updated FREQUENTLY. As I come across new research, realize I wrote something terribly, and receive feedback (especially constructive criticism – so don’t hold back!), I’ll return and edit this guide relentlessly.

This will forever be a work in progress – getting better with age.

However, I also promise not to make it too long and boring. Part of my mission is to make this information simple and accessible. Only the important things will be covered.

---

How to use this guide

If you think you’ve strained (or pulled, tore, etc. etc.) a muscle, then you’ve come to the right place. Here’s how you use this guide:

1. First, skim the whole article briefly to see what it’s all about.
2. Read in detail the relevant sections as you progress through recovery.

Yes, it’s long. But the more you learn, the better decisions you will make. For example: understanding how muscle heals will keep you from doing stupid things (I hope).

However, if you want, you can just skim over what isn’t interesting. Use the table of contents to see where you might be in the healing process, and skip to that section. Still, much of it is written under the assumption that you’ve read the prior sections. We won’t be wasting time defining or explaining things twice.

Let’s be honest… if you are not going to take the time to read this guide, then you should probably just go get help face-to-face with a professional (not that this guide is a replacement for a professional consultation anyway – it’s not)

But like people who want to lose weight, but won’t even take the time to cook a proper meal… you probably aren’t going to get the best results you can unless you invest the necessary time.

I’ve seriously tried my best to keep things short and to the point. I may have even skipped some useful things in the effort of trying to be concise. This article reviews the essentials, and little more. So stop complaining about the length.

Go on. Read.

DISCLAIMER: As expected with any credible health advice you find on the internet, there’s a disclaimer: by reading this article, you here-by agree not to sue me for any reason at all for the rest of time. Please, read my disclaimer!

---

Part I – Understanding Strains

---

Muscle Strains – What are they?

A muscle strain is literally a tearing of muscle fibers. Not like sprains, which are tears of ligaments. See: Strains vs. Sprains for a review of the difference.

This is a different type of muscle damage than you get from exercise. Muscle fibers (see picture above) are made up of many ‘myofibrils’ – the individual units of muscle responsible for contraction. Myofibrils are microscopic (you need a microscope to see them… duh), and that’s where damage from exercise happens. That damage is what causes muscle soreness from exercise. But it’s a good thing – the repair process is one of the ways you make a muscle stronger. Strains, however, are bigger.

Muscle strains are tears of one or more whole muscle fibers.

Sounds pretty harsh. But if you ever had a cut or a scrape, you probably did as much damage to the skin as you would in a ‘Grade I’ (see below) muscle strain.

It might seem like more damage than that because it might hurt more. Why? Well… as we know, pain is complex. But here’s a simple explanation: if you touch a cut or scrape, it hurts, but it’s easy to avoid. However, every time you activate or ‘contract’ a strained muscle, it will probably hurt too. That’s much harder to avoid.

Grades:

Muscle strains are classified into grades of severity. Here’s a four grade system, but note there are different grading systems out there.

• Grade I – Just a few muscle fibers are torn.
• Grade II – Tearing of less than half the fibers of a muscle.
• Grade III – Tearing of more than half the fibers of a muscle.
• Grade IV – Complete tearing of a muscle.

Obviously, healing times are different between grades. We’ll go over this more later.

---

How do strains happen?

Strains occur when too much force is applied to a resisting muscle. Excessive tensile force causes over-stressing of the muscle fibers, eventually causing them to rupture. ¹

This typically occurs within the normal range of motion during ‘eccentric’ contractions ^{4, 5}.

What’s an eccentric contraction?

Eccentric contractions are when the muscle is actively contracting, but instead of shortening, it’s lengthening.

For example, say you are doing the exercise: bicep curls – see image to right. The up part is called a ‘concentric’ contraction. The down part is called ‘eccentric’.

Eccentric contractions are normal, and a part of every day movement. It’s the extreme situations that cause strains. This can happen when breaking a fall, switching directions, and during powerful movements like kicks or sprints.

In the end, it’s the extreme force that’s the problem.

---

When do strains happen?

While it’s helpful to know how, what might be more important to know is when. What types of activities that can cause these high forces? Here are some common examples:

Quick direction switches – most common during sports that involve running and require fast turns and twists. Soccer, football, rugby, or anything like that. Remember: F = ma (force equals mass times acceleration), and switching directions can cause a huge increase in acceleration.

Lifting something too heavy – when you’re not strong enough, you simply won’t lift the weight. Likewise, if you get tired during an exercise (reaching “muscle failure”), you’ll simply stop being able to lift the weight, and have to stop the exercise safely. This might cause micro-trauma, but usually not a strain. However, if you struggle with the weight, or move in a funny way, you can shift the weight to weaker muscles or apply the load on a weird angle. That might be how you strain a muscle when lifting too heavy.

Overstretching – less common than you might think, but still possible. When you stretch a muscle, you are applying a lot of force to it. Even doing it slowly can cause a slow tearing of muscle fibers. See: Stretching for Dancers – Discussing the Research for more information on this.

In general, most injuries are simply mistakes… See: How Injuries Happen. This is why it’s very hard to prevent them. So don’t be afraid to do difficult things, and don’t feel like you did anything wrong when you do get injured. It’s the reality of being athletic.

---

Where do strains happen?

Strains can happen in pretty much any muscle.

There are more common ones of course (for example, the groin, quads, lower back, etc.). The most common seems to be the hamstrings (a group of three muscles in the back part of your leg).

In fact, it is estimated that between 6% and 29% of all injuries in field sports are hamstring strains ².

Strains can even happen in different parts of a muscle. According to some research ², it might depend on what type of activity you are doing. It seems things like sprinting is more likely to cause strain in the ‘biceps femoris’, but overstretching is more likely to cause strain in the medial hamstrings (the ‘semimembranosus’ and ‘semitendinosus’).

The injuries in the biceps femoris are much more common than injuries in the medial hamstrings. ²

Strains also typically occur close to the myotendinous junction or ‘MTJ‘ – the part of the muscle that starts to turn into tendon – the white part of the muscle on the picture. ¹

Check out the picture to the right for a summary.

---

Healing

Learning how muscle strains heal can give us important insight on how to treat them.

Generally, muscles heal well, and heal quickly. However, they are also sensitive to re-injury and healing can be disrupted easily. As long as you’re careful, recovery should go well.

According to a review article ^huh? from 2005 ³ there are three main phases of healing. It’s worth noting how muscle injuries heal differently from a bone. Bone heals by ‘regeneration’, while muscle heals by ‘repair’. When healing is done, the new bone is made of the same stuff it was before; but when muscles heal, it’s left with some scar tissue. Not much, but some. This might be a big factor explaining why re-injury is such a problem.

Healing proceeds similarly for each ‘grade’ of injury – ‘grades’ refer to the amount of injury. But while the body’s healing process is similar either way, it still takes longer for a more severe grade to heal. There’s just more work to do. And rehab will take longer.

Now, the three phases (note that phases 2 and 3 overlap in time):

1. ‘Destruction phase’ : Day 1 – 3 : Injury happens, ‘hematoma’ (blood filling up space) develops between the rupture, the broken muscle fibers ‘necrotize’ (die off), and the inflammation ^wha? process begins.
2. ‘Repair phase’ : Day 3 – 14 : ‘Phagocytosis’ (swallowing up and breaking down) of the ‘necrotized’ (dead) tissue is going on. Muscle fibers start regenerating, and scar tissue begins to form. Blood capillaries start growing back into the injured area.
3. ‘Remodelling phase’ : Day 8 – 21 : The new muscle fibers mature, scar tissue is re-organized neatly in the middle, and the muscle starts to regain it’s functional capacity.

In the end, what you are left with is isn’t a totally brand new muscle. You have two independent muscle fibers connected by scar tissue in between. It seems that the better the healing process goes, the less scar tissue you are left with.

Can you speed healing up? Nope, sorry. Actually, you should be amazed at how good your body is at this. It’s pretty awesome. You can, however, slow healing down. Read: What Affects Healing? One of the main things you can do to slow and complicate your healing is exercising the injured muscle during the first phase of healing. You need to give it a chance to start forming some scar tissue, or you’re going to re-rupture the injury! But after a few days, it’s typically safe to start moving the injured muscle again.

That thought leads us nicely into the next half of this article – Treatment and Rehabilitation.

---

Part II – Treatment and Rehabilitation

---

Diagnosis

First, are you sure you have one?

Read: Disclaimer! The information is provided since we all know some of you won’t go to a Doctor like you should. But this is in no way a replacement for a real professional diagnosis. Even professionals can get confused, and you may need to get an MRI or CT scan to be sure. Now that I’ve written that, let’s proceed:

• History – one of the most important parts of the diagnosis is a recognizable incident. If you strained a muscle, you probably remember it! Some call it the “oh %*&#” moment, when you feel or hear some kind of pop, rip, tear, pull, stretch, or whatever. It’s usually immediately followed with pain at the muscle. However, some grade I strains may not involve a sound or feeling, and you might not notice it until after your exercise session has calmed down.
• Location – is the pain at the muscle, or at a joint? Sometimes it’s hard to tell. But if the pain feels “in the knee” it’s probably not a strain. You would feel a strain “in the muscle” like in the picture of the hamstrings above.
• When it hurts – strains can hurt constantly a little (“background pain”) but you especially feel it when you touch the muscle, and even more when you actually activate (contract) the muscle. If it’s in a thigh muscle, you’ll feel it walking, but maybe not sitting around. It may even be too painful to walk up and down stairs. Stretching the muscle will usually hurt too, although a light stretch sometimes feels good (wait to read below before you start stretching).
• Weakness – the muscle in question is likely weak. Not just because of the muscles are damaged, but because pain and inflammation can actually inhibit muscle activation. Compare it to the other leg.
• Swelling, redness, or bruising – as inflammation and swelling occurs, you’re probably going to have one of more of these signs as well. Of course, many things can cause this, so the above points are important to consider when trying to make a specific strain diagnosis.

You may also have muscle cramping. This is common. But cramps and strains are not the same thing, and don’t necessarily cause each other.

Also, don’t get a grade I strain mixed up with severe exercise soreness (a.k.a. DOMS or PEMS). It’s sometimes really hard to tell between the two. Strains usually have that “oh %*&#” moment, and even if they don’t, you usually feel pain quickly. Severe exercise soreness usually waits a day or two to start. Also, strains are more specific and tender to touch, while severe exercise soreness feels like it’s in the whole muscle, and usually isn’t in just one muscle either – it will effect your whole legs, and both of them!

DISCLAIMER: Even if you’re confident you have a strain, please see a Doctor (Physician) or Physical Therapist for a qualified clinical diagnosis. If you are confused, then you especially need a professional to look at it. While I strive to provide the best, most up-to-date and accurate health information possible, I can’t personally see and assess your problem.
Read: Disclaimer! again!

---

How long? A Note On Recovery Time

Every injury, and every person will recover differently.

The time course described below applies best to Grade I to II strains which are by far the most common. Without any complications, the injured muscle should be reasonably well healed in three weeks. However, full recovery (functional ability and pain relief) may take longer (or shorter if you’re lucky).

Read: Healing vs. Recovery to understand this difference in more detail.

Don’t be surprised to have some bruising, swelling, and slight pain even up to 6 weeks after the initial injury. What is described below is a ‘good’ case scenario… not the ‘best’, but not the ‘worse’. It is written to apply to the most situations possible.

If you are ever confused about what you should be doing, and when, please, see a professional face to face!

---

Recovery : Days 1 – 3 : (be careful)

Immediately after injury : ‘P.R.I.C.E.’

For more severe injuries, this may need to continue for up to 7 days, maybe more.

Here we’ll talk about how ‘PRICE’ relates to muscle strain specifically. For more general information on the ‘PRICE’ method, read: PRICE

P – Protect: Use a brace, tape, sling, or anything that can stop it from sustaining more damage. This is more important for sprains, but not really for strains. It’s hard to ‘protect’ a muscle, other than resting as described next.

R – Rest: Don’t use the injured body part.

This is even more important if it’s a muscle strain, because it is easily disrupted early in the healing process. You have to let the strain rest long enough to develop a scar strong enough to sustain the tensile forces of movement. Otherwise, you risk re-rupture.

But remember, you are resting the strained muscle, not your whole body. You can try ‘active rest’ as described here: Rest for Injuries.

I – Ice: Primarily a way of dealing with the pain. Ice might also help with muscle injury as it could reduce bleeding between muscles, possibly preventing further damage. It’s recommended you try icing for 15-20 minutes, leaving about 90 minutes between icing to allow circulation to return to normal. You may need to do this for 6 hours to get a significant effect. ⁶ More details here: How to Ice.

C – Compression: In some cases, this also helps excessive swelling. Like a tight sock/stockings. It’s debated whether this is all that important for muscle strains specifically, but it’s worth a shot, and might feel good. Try something like Compression Shorts.

E – Elevation:  If you sprained your ankle, sleep with a few pillows under it, so the inflammation drains back into the body.  Again, not such a big deal for muscle strains.

Movement of the injured muscle starts in the next phase.

MEDICATIONS:

It seems NSAIDs (non-steriod anti-inflammatory drugs) like ibuprofen (Advil, Motrin, etc.) can be quite helpful for controlling the pain in the first week. ¹

This should allow for better movement as described in the next section. Of course, only use them as the bottle instructs, or as your doctor or pharmacist recommends.

Taking them too much and too long can negatively affect healing.

Read: Should I use pain-killers and anti-inflammatories? for more details.

---

Recovery : Days 3 – 7 : (experiment with movement)

This is an interesting phase of healing.

It’s still in the first week – so swelling, inflammation and pain are still present. But after a couple days, sufficient scar should have formed to withstand some movement.

Generally, research has shown that early movement can significantly improve the recovery of almost any injury. ^{1, 7, 8, 9} See: ‘Early Mobilization’ for more details.

This new research is why ‘M’ has been added to the PRICE method stated above. But as we’ve discussed, you shouldn’t start this within the first couple days for muscle strains. Instead, after a couple days, ‘PRICE’ turns into ‘PRICEM’ (or, if you don’t include ‘P’, then RICE turns to MICE… cute).

So that’s the deal: “MICE”

• M. ‘Early Mobilization‘ of the injured muscle can begin. Take it easy – it’s still nowhere near healed. Gentle stretches and (preferably) full body movements involving the injured muscle can be performed, as long as you work around the edge of where pain begins. Pain tolerance may be different between people, but this early in an injury most people can tell if their going too far or not. Don’t push it – less is more.
• I.C.E. – Keep using ‘Ice’, ‘Compression’, and ‘Elevation’ as necessary for the pain and swelling. This should be much less of an issue by the end of the first week.

Everyone and every injury is different, so how much you can move will vary. This is why it’s an ‘experimental’ phase of recovery. You have to test the waters.

Stretching:

HOW TO: When it comes to injuries, don’t try the ‘stretch and hold’ type of stretching you might be used to (a.k.a. static stretching). Instead, constant slow and controlled movement (‘passive dynamic stretching’) within the tolerated range of motion tends to work better.

Here’s an example of a stretch you would use for a Hamstrings strain:

‘Stretches’ (or should we say ‘movements’) should be performed for one minute, about 3-5 times a day. Gradually increase the range of motion as you can tolerate.

NOTE: Just move to the edge of pain – this is rehab, not flexibility training! The injured muscle itself (Hamstrings) shouldn’t be actively contracting during this stretch.

Exercises:

HOW TO: Start with ‘passive’ exercise. This means moving the injured muscle without actively contracting it (i.e. keep the injured muscle relaxed as you move it). You’re working other muscles while adding gentle stress to the healing muscle

Q: How is this different from stretching as described above? A: There will be some ‘co-contraction’ of the injured muscle as you work other muscles around it. It’s minimal – but a good amount to start in the first few days).

Examples for the Hamstrings: Each exercise should be done, again, for about one minute at a time, 3-5 times a day.

After a day or two, carefully add ‘active’ exercise with ‘isometric’ contractions. This means contracting the muscles that are injured – but not moving them at the same time (like when someone shows off their muscles, for example – during a bodybuilding pose).

Hamstrings Example: look at the first ‘stretch’ picture above, the ‘Sit-and-Reach’ stretch. Simply push your heel into the ground, and you’ll be actively contracting the hamstring muscle. Push gently for about 5 seconds, doing up 3 sets of 10 repetitions. Slowly increase the intensity of your contractions.

---

WHAT NOT TO DO (especially in the first week or two):

• Moderate to Hard Stretching (especially beyond the point of pain) – Some people think they will “heal faster” with more stretching, and the reason it feels tight is because it needs more stretching! It feels tight because of the swelling, and the muscles might be cramped or ‘hyper-tonic’ (constantly ‘switched’ on). You can’t stretch that away.
  Plus, think about it – the problem is you literally tore muscle apart… it needs to heal back together… and you’re gonna stretch it? No.
• Moderate to Intense Exercise – While walking around and light movement can help things heal better, hard exercise can similarly load the healing tissue too intensely and cause re-rupture. Bad idea.
  Remember – this is not one of those ‘more is better’ things, like practicing.
• Intense Massage – This is my personal (*cough* ‘professional’) opinion – but here’s my reasoning: similar to the above… within that first week, why would a hard massage help things stick back together and heal? A LIGHT massage may be excellent to treat pain and relax the muscles, which my help restore range of motion.
• Take Anti-Inflammatory Medications longer than a week. Or longer than your doctor prescribes. This even counts for over the counter stuff like ‘Ibuprofen’. While it’s helpful at first, in the long term it can slow healing. Again, read: Should I use pain-killers and anti-inflammatories? for more details.

---

Recovery : Days 8 – 21 : (active recovery)

This phase of healing involves active recovery and pain management geared towards a safe return of normal functional ability – and preparing for more intense athletic activity.

Pain management

‘R.I.C.E.’ is probably not necessary anymore. ‘Heat Therapy’ may provide pain relief and make the exercises described below easier when done before activity. See: ‘How to use HEAT therapy’ for more details. Ice can still be a good option for pain relief after exercises. Another option could be both – ‘Contrast Therapy’, using 20 minutes of heat, then 20 minutes of ice, resting an hour, and repeating as necessary. It’s all up to you.

Thing’s are going to hurt. Don’t worry about pain too much unless it seems to be unusually severe. Instead of worrying, respectfully use pain as your guide for ‘how far’ and ‘how much’ with the exercises described below.

Active Recovery

Essentially, the idea is that ‘rehabilitation’ should start before healing is 100% complete.

Why wait?

Once again, research has shown that the best return to athletic activity comes with an ‘Active Recovery’. This involves progressively increasing the complexity, intensity, and amount of activity while the injury is in its middle to late stages of healing. For more details, read: How to rehab an injury – ‘active recovery’.

Same rules apply: don’t go too far past that ‘edge’ of pain. Move around that edge.

Goals:

1. Full range of motion of the injured muscle.
2. Normal strength of the injured muscle.
3. Restore coordination and functional ability of full body movements.

The goal is not to return to full athletic performance. The goal is to prepare for it.

People usually do well with the first two goals. You can always compare things with the non-injured side. But it’s goal number three that people tend to neglect. However, this is probably the most important goal for preventing further injury. See: Coordination Training for more details on why.

Stretching:

You can continue to perform the same passive stretches described above as you feel necessary for flexibility. Continue to take it easy and work around the ‘edge’ of pain.

Once full range of motion is achieved, no additional stretching (other than what you would have done before the injury as a requirement of your sport) is necessary. Progression of functional exercise is a more important now.

Exercises:

It’s all about progression. Don’t skip steps! The first week of ‘Early Mobilization’ involved light ‘passive’ stretches and ‘isometric’ exercise to gently load the healing muscle. Now we can start using the injured muscle functionally.

Active movement while moving, a.k.a. ‘isotonic’ exercise is the next step. This involves moving the injured muscle while it’s contracting. Since coordination is so important, full body exercises tend to work best as soon as they’re tolerable.

For any muscle strain in the lower body – If you haven’t already, start by simply walking as normally as possible (get rid of that limp). Walk around the house, and up / down stairs. This should be a constant thing.

Of course, more deliberate exercises can be done once or twice a day.

Hamstrings Examples: some great exercises for the Hamstrings (or Quads, or Groin, or any lower body muscle) would be simple body-weight squats.

Do all the following exercises for about 3 sets of 10 repetitions, 5 times a week.

Build complexity and intensity: for example, if 20 or so squats are easy, then try front and side lunges. Don’t just do the injured side – always do both sides.

Once you feel comfortable doing these movements, move on the the next level:

Coordination: Balance, Stability, and Agility:

Once the muscle is capable of a normal range of motion, and can tolerate a reasonable amount of stress, you should begin coordination exercises. This is ‘sport-like’ movements.

<Photo / video examples coming soon!>

For more details on this topic, read: Coordination Training.

---

Recovery : 3 Weeks and on : (Gradual Return to Athletics)

Technically, healing should be complete, or at least in it’s final stages.

If you followed the above advice, which is basically this sequence…

• Days 1 – 3 : P.R.I.C.E.
• Days 3 – 7 : Early Mobilization
• Days 8 – 21 : Active Recovery

…then the healing process should have gone quite well! De-conditioning should have been minimized, with the muscle should be reasonably functional from the rehabilitation.

You should be ready for a gradual return to athletic activity.

How do you know you’re ready for sports specific training ¹?

1. You should be able to stretch the injured muscle just as much as the same non-injured muscle on the other side.
2. You should be able to use the injured muscle without pain in basic movements (like the squat, as above).

Devise a plan for returning to your athletic activity that involves a safe progression.

Start with a lower frequent to allow for extra rest. If you used to practice 5 times a week, then start with 2 or 3 practices for the first couple weeks. Start with the basic skills of the sport, and use a low intensity – take it easy.

Gradually build up the frequency, complexity, and intensity. Within a couple of weeks, you’ll likely be doing things just as well as before, and exercising at full capacity without even realizing it.

Hopefully, you’ve rehabilitated your muscle strain and minimized your chance or re-occurrence. Done.

That’s it!

---

Recurring Strains

As mentioned in the introduction, strains have a very high rate of re-injury (it’s estimated to be 12-31%!) ².

Even if you have included ‘coordination training’ in your rehabilitation (which is much more effective for preventing recurrence than strength/stretching ¹⁰) you still might be unlucky and experience a re-injury. This might have something to do with the healing process as described above. Either way, it’s a harsh reality of this type of injury.

Let’s go over some things to think about:

First of all – it may simply be that the original injury was more severe than you thought. Or, maybe you haven’t been behaving yourself – you never gave your strain a chance to heal properly (especially in those early days). In this case:

1. Try Rest First. Ask yourself, did you truly rest that thing yet? Take a serious break. Try a solid month off from using that muscle significantly. Don’t underestimate the importance of this – stop leaving rest as a last resort. It’s probably all you need, and should be tried first. Read: Rest for Injuries.
2. Eat Well. Get your veggies and lay off the junk food. Read: What Affects Healing?
3. Lower Stress. Stop worrying about the injury – that makes pain worse. Plus, that inability to let yourself rest is probably what made you return to exercise too soon.
4. Rehabilitate more deliberately. Take your time through each of the healing stages described above, and really prioritize exercise. Never move on until you are truly ready; don’t skip steps. Strengthen the injured muscle really well before moving to the next step. Include coordination training (full body stability & agility) before you start returning to full sports performance. Do this rehab like you mean it!

Still no luck?

Maybe you are developing a pain condition. See next section.

---

Persistent Pain

If it’s been three months or more since the last time you remember actually ‘straining’ your muscle (see diagnosis), but it still hurts, then you may have developed a persistent (a.k.a. chronic) pain condition.

This is can happen after a series of recurring strains in the same muscle. Because of the re-occurring strains, you’ve had pain with moving that muscle for a long time. Even if you haven’t re-strained it in a long time and it’s had plenty time to heal, you can still have pain with movement. Why?

Remember – persistent pain can often be thought of as a ‘pain memory’, and even after healing has completed, simply moving a certain way can cause pain. But these changes in the brain can be reversed!

Therefore, more appropriate treatment for this condition would include things like Pain Science Education to start helping with that ‘pain memory’, and ‘Graded Exposure‘ to help with re-gaining movement without aggravating the pain. Your concern isn’t so much a strain anymore – it’s a pain condition.

Therefore:

1. You’re best bet is to move over to the ’Pain Section‘ of this website.
2. Check out and follow the advice in the section above regarding recurring strains. This will ensure the problem isn’t poor healing or inadequate rehabilitation.

---

Complications

Myositis Ossificans

This is a rare complication of muscle injury. ¹

‘Heterotrophic Ossification’ (H.O.) basically mean’s bone growth where there normally shouldn’t be. Myositis Ossificans (M.O.) is essentially H.O. in a muscle.

M.O. can form after a major injury / trauma, repeated injury, or hematoma. Basically, the body decides for some reason that the best solution is to grow some bone tissue in the muscle… it may be a last resort defense mechanism, or simply a ‘bad code’ in your body’s healing response, like a bug in computer program. Who knows. The point is, if you think it’s happening, go see a doctor.

What are the signs? 1. If pain and swelling are clearly not decreasing after 10-14 days, or especially 2. when the symptoms are actually getting worse instead of better. Another sign is a decrease in range of motion (flexibility) instead of an increase. You would expect at least some recovery even without ideal rehabilitation, so if things get worse instead of better, see your doctor.

---

Final Thoughts

---

Where’s the comments?

First of all, review ‘Why is this so long!?’ in the introduction. This guide has a very broad scope, and isn’t just a regular blog post. I am even debating turning it into an ‘e-book’, as it might be easier to read that way.

I repeat: this is a guide – not a blog post. Do you ever see random comments (like reviews on amazon.com) attached to the back of a book? No.

To those of you who have questions, PLEASE, do not hesitate to ask. You’re questions will make up the next section – F.A.Q. Frequently Asked Questions!

Email me!

To other professionals: I’d love some constructive criticism and it will only make this information better. I’ll also give credit where it’s due. I’d also like to say that I am certainly not trying to hide anything by disabling the comments here. Just simplifying. So go ahead and call me out on the bboyscience.com Facebook page or another blog post if you think I mis-represented any information, or provided any bad advice in general.

But keep in mind that I intend to keep this guide short and sweet, and will not discuss every single possible type of therapy, no matter how cool the latest “specific tissue release”, “nutraceutical”, “alternative spirit energy therapy”, or “electro-stimulator-2000 machines” might sound. Only things with solid science and research qualify for this guide.

---

F.A.Q.

< Coming Soon! >

<help this get started by emailing me with questions, or commenting on the Facebook page!>

- speaking of which – follow me on Facebook and Twitter!

---

References

1. Järvinen TA, Järvinen TL, Kääriäinen M, Aärimaa V, Vaittinen S, Kalimo H, Järvinen M. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol. 2007 Apr;21(2):317-31. Review. PubMed PMID: 17512485.

2. Mendiguchia J, Alentorn-Geli E, Brughelli M. Hamstring strain injuries: are we
heading in the right direction? Br J Sports Med. 2012 Feb;46(2):81-5. Epub 2011
Jun 15. Review. PubMed PMID: 21677318.

3. Järvinen TA, Järvinen TL, Kääriäinen M, Kalimo H, Järvinen M. Muscle injuries: biology and treatment. Am J Sports Med. 2005 May;33(5):745-64. Review. PubMed PMID: 15851777.

4. Shrier I. Stretching before exercise: an evidence based approach. Br J Sports Med. 2000 Oct;34(5):324-5. PubMed PMID: 11049139; PubMed Central PMCID: PMC1756248.

5. Garrett WE Jr. Muscle strain injuries. Am J Sports Med. 1996;24(6 Suppl):S2-8. Review. PubMed PMID: 8947416.

6. Schaser KD, Disch AC, Stover JF, Lauffer A, Bail HJ, Mittlmeier T. Prolonged superficial local cryotherapy attenuates microcirculatory impairment, regional inflammation, and muscle necrosis after closed soft tissue injury in rats. Am J Sports Med. 2007 Jan;35(1):93-102. Epub 2006 Dec 1. PubMed PMID: 17197574.

7. Faria FE, Ferrari RJ, Distefano G, Ducatti AC, Soares KF, Montebelo MI, Minamoto VB. The onset and duration of mobilization affect the regeneration in the rat muscle. Histol Histopathol. 2008 May;23(5):565-71. PubMed PMID: 18283641.

8. Kannus P, Parkkari J, Järvinen TL, Järvinen TA, Järvinen M. Basic science and clinical studies coincide: active treatment approach is needed after a sports injury. Scand J Med Sci Sports. 2003 Jun;13(3):150-4. Review. PubMed PMID: 12753486.

9. Oldmeadow LB, Edwards ER, Kimmel LA, Kipen E, Robertson VJ, Bailey MJ. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg. 2006 Jul;76(7):607-11. PubMed PMID: 16813627.

10. de Visser HM, Reijman M, Heijboer MP, Bos PK. Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med. 2012 Feb;46(2):124-30. Epub 2011 Oct 19. Review. PubMed PMID: 22011915.

---

That’s it!

GOOD LUCK!