Muscle strains

A muscle strain is an injury to a muscle or a tendon. Tendons are fibrous tissues that connect muscles to bones. Strains can range from mild to serious. A mild strain happens when muscles or tendon fibers are simply stretched too far. With a serious strain, the tissue is partially or completely torn.

Muscle strains often are called pulled muscles. They most commonly affect the lower back and the hamstring muscles at the back of the thigh.

The difference between a strain and a sprain is that a strain involves an injury to a muscle or tendon, while a sprain injures a ligament. A ligament is a band of tissue that connects two bones together.

Initial treatment for strains includes protection of the injury, rest, ice, compression and elevation. This is often called the P.R.I.C.E. method. Mild strains typically can be successfully treated at home. Serious strains may need medical treatment, including surgery.

Symptoms of a muscle strain depend on how bad the injury is. They may include:

• Pain or tenderness.
• Changes in skin color over the injury. This may look red, purple or grey depending on the color of your skin.
• Limited movement.
• Muscle spasms.
• Swelling.
• Muscle weakness.

When to see the doctor

Mild strains can be treated at home. See a healthcare professional if:

• Your symptoms get worse.
• Pain is serious or not improving.
• You have numbness or tingling.
• You have trouble using the injured muscle.

Acute strains happen suddenly, often from a single event. For example, a strain may come from lifting something heavy with poor form or from sprinting while running.

Chronic strains develop over time from repeating the same movement. This puts ongoing stress on a muscle, which can cause a strain.

You are more likely to get a strain if you play contact sports, such as soccer, hockey, boxing or wrestling. And you are more likely to get a strain if you run fast or use certain body parts repeatedly in sports or activities. For example

• Legs and ankles. Running sports that require speed, such as sprints, can strain the hamstring muscles. Sports with quick starts and jumps, such as basketball or hurdling, can strain the Achilles tendon.
• Hands. Sports that require strong gripping, such as gymnastics or golf, may lead to hand strains.
• Elbows. Throwing sports, such as baseball, and racquet sports, such as pickleball or tennis, can cause elbow strains.

You can lower your risk of muscle strains by:

• Stretching regularly. This improves flexibility so your muscles and tendons move more easily. And it increases the range of motion in your joints.
• Strengthening exercises. These build muscle support and stability, which protects tendons and joints.
• Conditioning for your sport or activity. This means slowly preparing your body for the specific demands of your sport or activity. For example, runners can build up mileage slowly and add core and leg strengthening. Tennis and pickleball players can practice agility drills and shoulder-strengthening exercises. And people with physically demanding jobs can train with lifting, carrying or endurance exercises that mimic their work tasks.

During the physical exam, your healthcare professional will check for swelling and tender spots. The location and intensity of your pain can help your healthcare professional figure out how serious the injury is.

If the muscle or tendon is completely torn, your healthcare professional may be able to see or feel an issue in the injured area. An ultrasound may help show the difference between types of soft tissue injuries.

For immediate self-care of a muscle or tendon strain, use the P.R.I.C.E. method:

• Protect. Protect the injured area. Use crutches or a cane to keep weight off an injured leg or foot. Your healthcare professional may recommend a brace or splint, depending on your strain.
• Rest. Stop activities that cause pain, swelling or discomfort. Light movement is OK if it doesn't make symptoms worse.
• Ice. Apply ice right away, even if you plan to see a healthcare professional. Use an ice pack or a bag of crushed ice wrapped in a towel for 15 to 20 minutes at a time. Do this every 2 to 3 hours while you are awake for the first few days after the injury. Always put a thin cloth between the ice and your skin for protection.
• Compression. Wrap the area with an elastic bandage to reduce swelling. Start wrapping at the point farthest from your heart. Make sure the wrap is snug but not too tight. Loosen the bandage right away if you feel pain, numbness or swelling below the wrap.
• Elevation. Raise the injured area above the level of your heart, especially at night, to help reduce swelling.

You also can manage pain by taking pain medicines you can buy without a prescription, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others).

You may first see your primary healthcare professional. Depending on your injury, you may be referred to a sports medicine specialist or a doctor who specializes in bones, joints and muscles, typically an orthopedic surgeon. Or you may be referred to a physical medicine rehabilitation program.

What you can do

Bring a list that includes:

• A detailed description of your symptoms, including what they feel like, when they started and what makes them better or worse.
• Information about past medical issues.
• Information about health issues of your parents or siblings.
• All medicines, vitamins and dietary supplements you take.
• Questions you want to ask.

What to expect from your doctor

Your healthcare professional may ask questions such as:

• What were you doing when the injury occurred?
• Did you hear or feel a pop or snap?
• When did the injury happen?
• What home treatments have you tried?
• Have you ever injured this part of your body before? If so, how?