I think I have a Muscle Strain. What should I do?

So I was reading this post yesterday at crossfitinvictus and it got me thinking about muscle recovery after injury.  When you are into muscle strengthening and fitness you tend to walk a fine line between strengthening and over doing it.  For more information on why exercise can make you stronger check out this post.  I know that if you are like me you want to make decisions on your own about recovery so I thought this would be a good time to give you information on muscle injuries and a little on the physiology of muscle healing.  First things first, muscle injuries are known as strains and ligament injuries are sprains.

There are two parts of a muscle:  the belly and the musculotendinous unit.  All skeletal muscles are elastic meaning that they have the ability to lengthen or stretch, extensible which means the ability to shorten but able to return to normal length, excitable which means they respond to nerve impulses, and are contractile which mean they will contract and shorten when a nerve tells them to.  You can tear the muscle belly by over stretching and over doing it and/or over stretch the musculotendinous unit resulting in a muscle strain.

What is important to know about muscles and soft tissue injuries is that they do not regenerate if damaged but are replaced with an inferior and weaker scar tissue.  So listen to your bodies and your coaches!

Muscle strains are classified like ligament sprains into categories:

Grade I - some muscle fibers are actually torn and movement will be somewhat painful but you will still have full motion.

Grade II -  Can you see the depression where
the strain occurred?  

Grade II - Active motion will be extremely painful because more muscle and tendon fibers are torn.  You can actually feel the site at where the injury occurred.  You can feel a divot.  This will probably come with swelling due to bleeding.  Check out the ankle strain here.

 Biceps ruptures

Grade III - This is when there is a complete tear of the muscle fibers in the muscle belly or where the muscle attaches to the bone.  You have heard of biceps rupturing and Achilles tendon ruptures.  Biceps ruptures are fondly referred to as  Popeye muscles.  Pain is usually very severe initally but then subsides quickly because the nerves are separated too.  Movement is severely limited and sometimes totally lost.  A fun fact to know is they rarely operate on proximal biceps ruptures. This just leaves more room for tattoos : )

Achilles tendon ruptures generally require surgery and is a more serious injury.  I have heard that muscles that cross two joints such as your achilles, biceps, hamstrings, and quadriceps are more susceptible to injuries.

So depending on what you are dealing with treatment options will vary but they all start with RICE.
R est  (four-letter word)  I had to say it!  Sorry!
I  ce  (cold pack, frozen peas or corn in a pillowcase) 20 minutes at a time...you don't want frostbite too!
C ompression  (ace wrap)  Snug but not too tight you don't want to cut off circulation!  Wrap from the bottom up to assist with venous flow.
E levation  (injured area elevated above your heart)  Don't go crazy hanging upside down on rings or anything...a nice pillow on the couch will do.        More on the RICE principle

You can begin full gentle range of motion exercises if there isn't any pain.  It would be advantageous to get in at least 5 repetitions every two hours and more often if there is no pain.  Once there isn't any pain then you can begin gentle resistance exercises.  

All injured tissues go through an inflammatory phase which generally lasts less than 5 days.  So ice is really only useful in the first 2 -  5 days of injury.  After that the inflammatory cells are replaced by fibroblasts.  This stage of healing known as the tissue repair stage can last up to 3 weeks.  I like to add gentle range of motion exercises so that the muscle will heal in the line of stress.  You want full movement by the third week so that optimal repair can occur.  However you don't want to overdo it either.  If you do too much too soon you are actually re-injuring yourself and are now back to square one in the inflammatory phase.  Which means the dreaded 4-letter word R-E-S-T again!

The Remodelling stage is very important.  You want to stretch and strengthen the scar tissue so that you will have optimal recovery.  This process can take several months and you may never get full strength back.  So you don't want to mess this process up!  All of these phases have to be gone through to have an optimal recovery.  There really isn't anything you can do to speed this process up other than to proceed with caution and to provide an optimal environment for recovery including nutrition and adequate sleep.

My husband,  Matthew Grimm, MD,  the CrossFitting orthopedic surgeon,  says that if it seems more serious, you don't have to go to the Emergency Room but can wait to see him the next day if there is no deformity.  Check him out at Jefferson Orthopedics or catch him at the gym .

So the bottom line is exercise is good for you and good for healing of strains as long as you don't over do it. We all know how devastating no exercise can be for you.  You know I am going to say that   "Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!"  Here at Grimm Physiotherapy we will teach you how to manage your injuries including strains so that you can achieve optimal healing.  We encourage self-management and don't want this to be a chronic problem for you.

Call or text Grimm Physiotherapy at 504-228-0524, visit us on the web at grimmpt.com  to schedule your mechanical assessment today.