Sprains, Strains and Muscle Injuries
Do not let these common injuries stop your active lifestyle. Follow these steps to treat and prevent them.
Sprains, Strains and Muscle Injuries
An active life is a healthy one. Yet sometimes we overdo it and injure our muscles, tendons, or ligaments. Strains, sprains, and muscle injuries are a common source of pain and fortunately, these injuries often respond well to treatment.
Muscle Injury Myths and Misconceptions
Muscle injuries occur when we experience pulled muscles, over stretch or even tear muscles and tendons.
They occur most often in the shoulders, neck, abdominal area, back, hips, and legs.
Believe it or not (yes… this is true even in 2020) muscle pain remains a scientific mystery and many myths and misconceptions surround it.
Even a major scientific review couldn't find enough evidence to support some of the most popular treatments for muscle strains, sprains and injuries! 
A torn muscle is arguably among the most medically neglected of all common injuries largely because of misdiagnosis.
Muscle injuries as a whole are not only surprisingly complex topics, but most clinicians are not aware of the research that has been done to understand them.
More important is the fact that most physicians, general practitioners and medical doctors are not competent enough to assess and treat musculoskeletal problems, including low back pain and muscle injuries. 
Strain, pain, spasm, contractures, scar tissue, tone, tension, and stiffness are all poorly understood and routinely confused among similar types of injuries.
It's very common for someone to think that they have an injured disc, or sciatic nerve, when in fact it's a muscle strain.
What is a Muscle Strain?
A muscle strain is any physical trauma to our muscles caused by force applied along the length of the muscle.
The injury often happens when you need to exert force with speed, like in sports such as tennis, golf, and running.
Typically, the injury occurs when the muscle contracts at the same time it is being lengthened but it can happen when the muscle is being contracted as well.
Muscle Strains are generally graded from 1 to 3, depending on the severity.
Muscles that are fatigued, overused, or not warmed up are also at increased risk of a strain.
An imbalance between weak and strong muscles—for example, a strong quadriceps (front of the thigh) paired with weaker hamstrings (back of the thigh)—can also cause a strain.
Muscle injuries can also be due to bruised, crushed, or torn muscles, but those are quite different traumas.
This article is only about muscle strains or ligament sprains, not all kinds of muscle injuries.
We also won’t discuss full muscle ruptures in much detail, because they are so extreme that they are easy to diagnose — even doctors can do it!
Certain over-the-counter medications, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil, Motrin) and naproxen (Aleve), may help relieve pain, but you shouldn't use these over-the-counter drugs compounds for an extended time.
These medications can cause complications, especially if you have heart, liver, stomach, or kidney disease.
Here’s a checklist of the signs and symptoms of a true pulled muscle.
- Did it hit you suddenly during strong stretching or a moment of athletic intensity? Were you lifting something way too danged heavy and/or awkward? In other words, did you have an “oh, shit” moment?
- Is the injury fairly recent? A few weeks old at the most? If it’s been a long time, it’s probably not a muscle strain any more — certainly not an acute one!
- Do you have just one muscle (or muscle group) that’s both weak and painful to use?
- Is there a spot in the muscle that’s especially sensitive?
- Is the skin flushed and hot? Does it look puffy? Is the area raised? Injured muscle fibers swell up to about five times their normal size!
- Does the muscle seem deformed? In addition to overall swelling, more sharply defined bumps or depressions can form. If the muscle fibers tear enough, they muscle will be significantly thinned, causing a depression, and adjacent muscle may bunch up.
If you “woke up with it,” or the pain came on slowly over several days, or if it’s six months old, or if the pain isn’t consistently in one particular place … then we're not talking about muscle strains.
If your real problem is actually a painful “muscle knot,” you should consider a nice massage — but massage is mostly pointless for muscle strains.
Sprains are small tears to ligaments, which are bands of connective tissue that join bone to bone.
Most people confuse muscle strains with ligament sprains and vice versa.
Muscle strains will cause the muscle to feel weak and contraction of that muscle is painful.
On the other hand, ligament sprains do not cause weakness or pain with muscle contraction; there's just instability which can cause pain.
In other words, if you clench your muscles in place, without moving the joint, and nothing hurts (much) … that could be a ligament sprain: strong and painless.
But if you contract your muscle without moving and you still feel pain, that's a muscle strain.
Strength/pain combinations are very useful diagnostically, and a good practitioner is always looking for such combinations when assessing your case.
A “weak and painful” contraction test indicates muscle strain.
“Strong and painful” or “Weak and painless” are something else.
Many people under chiropractic care have injured ligaments and tendons that could be causing their pain.
Ankle sprains are the most frequent and can last from a few days to several weeks.
They often happen when you lose the awareness of your foot's position in space (a sense known as proprioception) and your foot lands awkwardly. Recurring sprains are usually because the ligament did not completely heal.
Sprains have the same injury grades as strains.
A grade 1 sprain is mild pain, swelling, and tenderness, but no instability. You can walk with little or no discomfort.
Grades 2 and 3 involve greater pain, may be accompanied by a popping sound or sensation, and have associated bruising and difficulty walking.
After addressing initial pain and swelling, work on foot range of motion by doing sets of foot circles.
Strengthen the muscles of the foot and ankle with resistance band exercises.
Balancing exercises can help too, such as standing on one leg, supported by a wall or sturdy object, for 30 seconds or longer. (Consult your doctor or personal trainer to ensure you perform exercises safely.)
Categories of Sprain/Strain Injuries
A muscle strain is the stretching or tearing of muscle fibers.
Most muscle strains happen for one of two reasons: either the muscle has been stretched beyond its limits or it has been forced to contract too strongly.
In mild cases, only a few muscle fibers are stretched or torn, and the muscle remains intact and strong.
In severe cases, however, the strained muscle may be torn and unable to function properly.
To help simplify diagnosis and treatment, doctors often classify muscle strains into three grades, depending on the severity of muscle fiber damage:
Grade I strain. In this mild strain, only a few muscle fibers are stretched or torn. Although the injured muscle is tender and painful, it has normal strength.
Grade II strain. This is a moderate strain, with a greater number of injured fibers and more severe muscle pain and tenderness. There is also mild swelling, noticeable loss of strength and sometimes a bruise.
Grade III strain. This strain tears the muscle all the way through, sometimes causing a “pop” sensation as the muscle rips into two separate pieces or shears away from its tendon. Grade III strains are serious injuries that cause complete loss of muscle function, as well as considerable pain, swelling, tenderness and discoloration. Because Grade III strains usually cause a sharp break in the normal outline of the muscle, there may be an obvious “dent” or “gap” under the skin where the ripped pieces of muscle have come apart.
Symptoms of muscle strain and sprain injuries can include:
- Muscle pain and tenderness, especially after an activity that stretches or violently contracts the muscle — Pain usually increases when you move the muscle but is relieved by rest.
- Muscle swelling, discoloration or both
- Muscle cramp or spasm
- Either a decrease in muscle strength or (in Grade III strains) a complete loss of muscle function
- A pop in the muscle at the time of injury
- A gap, dent or other defect in the normal outline of the muscle (in Grade III strain)
Sprain/Strain Treatment & Prevention
To help prevent muscle strains or ligament sprains:
- Warm up before participating in sports and activities.
- Follow an exercise program aimed at stretching and strengthening your muscles.
- Increase the intensity of your training program gradually. Never push yourself too hard, too soon.
- Maintain a healthy body weight. Obesity can stress muscles, especially in your legs and back.
- Practice good posture when you sit and stand.
- Use the correct technique when you lift heavy loads.
If you have a Grade I or Grade II strain, your doctor will ask you to follow the RICE rule:
- Rest the injured muscle (and take a temporary break from sports activities).
- Ice the injured area to reduce swelling.
- Compress the muscle with an elastic bandage.
- Elevate the injured area.
To help relieve muscle pain and swelling, your doctor may suggest that you take acetaminophen (Tylenol and others) or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin and others).
For someone with a painful back strain that does not improve with NSAIDs or acetaminophen (Tylenol), prescription pain medications or muscle relaxants may be appropriate.
If you have a severe Grade II or Grade III strain, your doctor may refer you to an orthopedic specialist. Depending on the severity and location of your muscle strain, the orthopedist may immobilize the injured muscle in a cast for several weeks or repair it surgically.
Mild strains may heal quickly on their own, but more severe strains may require a rehabilitation program.
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