Strains are an injury to the muscle and the tendon, where the muscle and tendon connect or where the tendon connects to the bone. There are two main causes for a strain to occur. They are over stretching the muscle, causing the fibers go beyond what they can tolerate. Or too heavy a load is placed on the muscle, such as picking up something too heavy.
There are three different levels of strains:
Grade 1: some of the fibers are pulled, possible small tear, and causes some discomfort when doing the action that it was hurt in. However, can still preform the action, with only slight loss in strength of the muscle.
Grade 2: several to most of the fibers have a tear. The action that caused the injury to the muscle is very difficult to repeat due to pain and muscle weakness. At the point of injury there could have been an audible snap or popping sound.
Grade 3: the injury site ruptures completely, or the tendon can stay intact but lifts the point it attaches to the bone, causing an avulsion fracture. At this point no activity can be done due to pain and having zero muscle strength. In this case, depending on the area, you may see a bulge where the muscle bunched up under the skin as it is no longer attached to the bone.
Treatment for a strain greatly depends on the grade of the strain. If you have a grade 3 strain, surgery, to reattach the tendon to the bone, and a cast may be used to help with the healing process and to gain back muscle strength later on in the healing process. Even a severe grade 2 strain can have some form of brace over the injury to help prevent moving the muscle too much and causing more damage to the muscle. This level of severity will mean that progress will take longer, and more treatment will be needed compared to a grade 1 strain or a more mild grade 2 strain. Not to mention that if you do have a severe grade 2 strain or a grade 3 strain, a massage therapist won’t see you until you have been assessed by a doctor to make sure that you are able to have massage, as sometimes hematomas or blood clots can form in the injury, and you will need to go on medication to help with treating those conditions prior to having a massage.
If you have a low grade strain, or have permission from your doctor, you can start treatment. Positioning during this time will be to elevate the area of the strain. This changes depending on where the strain is. Ice is used, along with lymphatic drainage to help bring down the swelling in the area. After decreasing some of the swelling, light techniques are used above the strain to help decrease pain in the form of a relaxation massage. There is no treatment done to the areas below the injury to make sure that there isn’t any build up of congestion in the injured area.
Compensating areas are then treated to keep them from being overused and painful along with reducing but not getting rid of the protective spasm. There is also some range of motion done, with the joints above the strained muscle as long as it doesn’t cross the above joint as well. This form of range of motion is done passively with no pain.
In the second phase of healing, a lot of the treatment stays the same. The only difference is that cold and warm contrasts can be used on and around the injury to help flush out the swelling from the area of injury. More work to reduce the protective muscle spasms are done, as well as treating trigger points that refer to the injured area without disturbing the injury itself. However, local work can be done during this time. Grade 1 strains can have more specific work done whereas the higher grades, much lighter and broad strokes are done, more as a form of relaxation then treatment. Range of motion does change slightly, where the joints above and now below the injured site are done, but still passively and with no pain. The last motion that is done is where it can stretch the injured muscle.
In the third phase of healing depends greatly on how you have been healing. For example, if you still have swelling in the area, that will still have to be elevated and use lymphatic drainage to treat, however if you don’t have any more swelling then you will be able to be positioned to what is most comfortable, and lymphatic drainage will be skipped other then at the end of treatment, just to make sure that you don’t have an acute reaction to the treatment, which can happen. During this phase hot and cold contrasts can be used, but caution is used if a flare up in the swelling occurs, then only cold is used again. Also more direct work is allowed to the injured site, including working on trigger points in the muscle, or adhesions that are restricting the muscle’s movements. Work is now allowed to be done below the injured sight as congestion is less of a concern. Range of motion is still done passively, however, now it is done to the point of pain, with more joint play being used on the joints that have difficulty in moving.
Now the last and final stage of healing. In this stage, no matter what grade the strain was, you will be positioned for comfort. Also during this stage all casts, stitches or other braces have been completely removed, by your doctor, so compensating structures will still be worked on to make sure that proper posture can be resumed as soon as possible. Deep moist heat can be used directly over the injured site to help with treating trigger points and tight muscles and can help the therapist in breaking up any last few adhesions at the site of injury. Full range of motion is brought back to the muscle and all the joints involved, pain should no longer be felt when doing this passively. The therapist may do some resistance training as well to help strengthen the muscle as well as the other muscles around to keep you from needing a brace when you preform activities, especially in the activity that you were doing when you strained the muscle to begin with, for example, during running.
Lastly, if you had a grade 3 strain, and required surgery, it would be during this final stage of healing that it would be treated. You can look at the article on this website about Scar Tissue for more information. The therapist will also advise you to be careful with returning to your regular activities, and to start slowly to make sure that you don’t injure the muscle again. Even with having surgery to reattach the muscle or muscles, it does not completely bring it back to the strength it had before the tear. Care must be taken as it can be easier to strain the same muscle again, especially if it is due to lifting things that are too heavy, or being in multiple car accidents (whiplash).