Although different sports cause different injuries and complications, but muscle strains are by far the most common of all sports-related injuries. Muscle strain also known as muscle tear or pulled muscle, often happens when a muscle is stretched beyond its normal range, by sudden pressure. The lower back, hamstrings, quadriceps, and gastrocnemius muscles are most prone to such strain, while they are rapidly accelerated and decelerated. There is a range of treatments for muscle strain that help to reduce pain, swelling and encourage full recovery. Physiotherapy is one such treatment, the physiotherapist will devise a sports-specific rehabilitation program tailored to the needs. In this blog, we will discuss muscle strain and its physiotherapy management.
There are many degrees of muscles strain from mild to severe. Symptoms can include pain, swelling, stiffness, and bruising. Depending upon the severity they are graded as:
Grade 1 strains-The signs may not be observed until the activity is over. There may be a sensation of muscle tightness, cramps, or a feeling of slight pain when the muscles are stretched or contracted but there is no loss of strength or movement.
Grade 2 strains - Immediate pain on stretching or contracting the muscle, swelling, reduced strength, and movement are limited due to pain.
Grade 3 strains - It is a very serious injury. An athlete is unable to walk due to burning pain. The muscle is completely torn and a large lump of muscle tissue is observed. There is immediate pain, swelling, bruising and complete loss of function.
Role of physiotherapist in the prevention of muscle strain
The physiotherapist prescribes the following steps to prevent the occurrence of muscle strain:
- Proper warm-up and cool-down exercises
- Maintains full joint range of motion
- Treats muscle tightness and fatigue
- Prevents muscle strength imbalances
- Prevents reinjury.
Physiotherapy treatment for muscle strain
Physiotherapy treatment depends on the healing phase. As an immediate treatment, POLICE protocol is followed i.e. – protect, optimal loading, ice, compression, and elevation. This protocol aims to reduce the bleeding and damage within the muscle tissue. Rehabilitation can be started after 48 hrs post-injury. The physiotherapist designs the treatment program to meet the requirement of the player, it can take 12 months to achieve full strength and endurance.
Physiotherapy interventions used for muscle strain include:
Inflammation and swelling can be decreased by applying cryotherapy in form of ice packs, and cold water baths to the affected area. Continuous application of cold several times a day for 20-30 minutes at a time is recommended.
Compression helps reduce swelling and inflammation, which results in a decrease in pain and enhances the process of healing. Static compression can also be used with an elastic bandage to apply consistent pressure and help prevent additional swelling. To remove excess fluid in the injured area active compression (pumping action) can be given, this action also increases the flow of oxygenated blood, required for tissue repair and healing.
Therapeutic massage helps to increase blood flow and loosen the tight muscles which help to heal the damaged tissues. By applying pressure to the injured muscle tissue, excess fluid and cellular waste products are removed. Massage to the injured and surrounding muscles helps decrease pain and improve the range of motion.
Thermotherapy may be applied to help relieve pain. Thermotherapy can be given in the form of hot water bottles, electric hot pads, hot cloths, warm baths, etc. Thermotherapy increases blood flow, thus promotes healing and relaxation of the muscles. Alternate use of thermotherapy and cryotherapy helps to reduce pain and swelling caused by a muscle strain.
Transcutaneous electrical nerve stimulation (TENS) provides pain relief, caused by muscle strain.
Ultrasound is very effective in breaking adhesions and thus increases circulation and mobility.
Shockwave therapy carries high energy to painful spots and promotes regeneration resulting in healing.
LASER helps in the reduction of inflammation, pain, and healing of damaged tissues thus causes an overall reduction in healing time by increasing intracellular metabolism.
Range of motion
A physiotherapist uses hands-on techniques to maintain joint range of motion. Initially simple range of motion exercises are given to maintain mobility in the injured area. After acute management of the injury such as crutches, bracing or pain relief interventions are also given.
Strengthening exercises begin with gentle muscle toning exercises. Later, exercises with weights are added. Minimal resistance exercises are recommended for muscle strength. Progression of the weights, repetitions, and sets are changed depending on the patient's condition. During the recovery phase, the exercises should be done safely to promote muscle strength and healing to prevent reinjury.
The physiotherapist recommends stretching exercises that may help to maintain flexibility and range of motion. Gentle resistance and stretching exercises are important as they help to align the scar tissue that is formed during the process of healing.
Sports should be avoided for a few weeks, even if the player no longer feels pain. Once the injury is healed, full strength and mobility are attained the player can return to play successfully and reduce the risk of occurrence.