Muscle strain: what you need to know about pulled muscles (2023)

Muscle strains are one of the most common reasons for missed playing time in the NFL. But you don't have to be a professional football player to get such an injury. They are quite common among professional and recreational athletes.

  • What is a muscle strain?
  • What causes muscle strains?
  • Are there different types of muscle tension?
  • What are the signs and symptoms of muscle strain?
  • How is a muscle strain diagnosed?
  • What is the treatment for a pulled muscle?
  • When can I return to sports after a muscle strain?

What is a muscle strain?

Muscle strain or "pulled muscle" is a partial or complete tear of a muscle.

These injuries usually occur:

  • in the muscles that cross two joints
  • during explosive action such as sprinting
  • during times when athletes suddenly increase their exercise regimens (such as during training camps)

Normal muscle anatomy and function

A muscle is surrounded by an outer sheath that allows it to move smoothly over surrounding tissues as it contracts. Within the outer sheath are bundles of muscle fibers known as fascicles, which are further made up of myofibrils. These myofibrils are made up of millions of microscopic units called sarcomeres, which are responsible for muscle contraction. In the sarcomere, muscle proteins called myosins pull thin strings of protein called actin when stimulated by nerves. When this occurs, the sarcomeres shorten, resulting in contraction. When the myosin proteins relax, the sarcomeres return to their original position and so does the muscle.

The combination of muscle contraction and relaxation is coordinated by the nervous system. This is what allows athletes to run, kick, throw and, for that matter, even walk and breathe.

What causes muscle strains?

Muscle strains occur when the force on a muscle is so great that the tissue begins to tear. Rupture can occur in one of three places

  • inside the muscle itself
  • at the junction between muscle and tendon (most common)
  • in the tendon, where it attaches to the bone

The muscles, through their tendinous attachments at each end, attach to the bones and provide the necessary force for movement. During activities that require explosive movements, such as pushing during a run or changing direction during racquetball, the force across the musculotendinous unit (the connected muscle and tendon) can be so great that the tissues tear, partially or completely.

These injuries usually occur during excessive muscle loading; that is, when the muscle contracts as it lengthens. Muscles that cross two joints, such as the hamstrings (hip and knee joints), calf (knee and ankle joints), and quadriceps (hip and knee joints) are the most susceptible to injury. The hip adductor muscles are also commonly affected, although they only cross the hip joint.

Factors that can predispose an athlete to injury include older age, previous muscle injuries, less flexibility, lack of muscle strength, and fatigue. Many athletes experience muscle injuries when starting a training regimen. This is why they are much more common at NFL training camps than they are during the regular season.

Are there different types of muscle tension?

The severity of a strain can be gauged by the amount of strength and range of motion a person loses, and this can also give you an idea of ​​how long it will take to recover. Muscle strains can be categorized into three grades based on severity:

  • Grade 1: Mild damage to individual muscle fibers (less than 5% of fibers) that causes minimal loss of strength and movement.
  • Grade 2: More extensive damage with more muscle fibers involved. However, the muscle is not completely torn. These injuries show significant loss of strength and movement. These injuries can take two to three months before a full return to athletics.
  • Grade 3: Complete tear of a muscle or tendon. These may have a palpable defect in the muscle or tendon. However, swelling in the area can make it difficult to assess. These injuries sometimes require surgery to reattach the damaged muscle and tendon.

What are the signs and symptoms of muscle strain?

The main symptoms of a muscle strain are: sudden pain that gets worse during muscle contraction, swelling and bruising, loss of strength and range of motion. People often report the feeling of pain as feeling like being "stabbed". When the muscle is initially injured, significant inflammation and swelling occurs.

After this inflammatory phase, the muscle begins to heal through the regeneration of muscle fibers from stem cells that live around the injured area. However, a significant amount of scar tissue also forms where the muscle has been injured. Over time, this scar tissue remodels, but muscle tissue never fully regenerates. This is thought to make a strained muscle prone to future injury.

How is a muscle strain diagnosed?

The diagnosis is usually made based on the patient's history and physical examination. In severe grade 3 cases, the examining physician can actually feel the defect where the muscle has completely torn.

OneX-rayit may be helpful to rule out a fracture or dislocation as the cause of pain. Occasionally, in young athletes, the tendon can tear off a piece of bone where it attaches, which can be seen on x-rays.

However, pure muscle injuries cannot be seen on regular radiographs. OneMRIit can sometimes be helpful to determine where the injury has occurred and whether there is a complete tear or not. MRI scans can also show collections of blood, called a hematoma, which sometimes occur after severe injuries.

What is the treatment for a pulled muscle?

Non-surgical and conservative treatment

Most muscle strains do not require surgery and a full recovery is expected.

If there is a partial tear, the athlete can return when they are free of pain and have normal strength and movement. This usually occurs after a few weeks to a few months of proper treatment and therapy. When the muscle is completely torn, the athlete may benefit from surgical repair.

Most acute muscle injuries are partial-thickness tears. Most of the time, they can be successfully treated with:

  • the RICE protocol:
    • rest
    • whether
    • compression
    • elevation
  • Material- non-steroidal anti-inflammatory drugs (such as ibuprofen)

These treatments will be performed in the first week, followed by progressive functional physical therapy as needed.

Many athletes are able to return to their previous level of competition, but because scar tissue forms at the injury site, they may be susceptible to another injury at that location.

Surgery and platelet-rich plasma injections

Complete muscle injuries can lead to significant functional impairment and loss of playing time and may require surgical repair. This is especially the case for patients who need to be able to run or be agile enough to play sports.Platelet-rich plasma (PRP) injectionscan help speed up regeneration of damaged muscle tissue.

When can I return to sports after a muscle strain?

Return to full activity is generally permitted when the patient is pain-free, with full range of motion and full strength. If an athlete attempts to return to sport before these criteria are met, there is a high chance of re-injuring the muscle and suffering a setback. Minor Grade 1 injuries may only require two to three weeks before the athlete can return. More serious injuries may require significantly more time.

Such a long period of lost game time is not ideal for professional and elite athletes, and some have advocated more aggressive treatment of this group. In a study examining professional soccer players with severe hamstring injuries with palpable defects, an intramuscular injection of cortisone led to a time to return to full activity of 7.6 days, and 85% of players did not miss a single game.1However, the use of cortisone injections in the recreational athlete should be reserved for chronic or prolonged injuries, as there is a possibility of weakening the remaining muscle and increasing the severity of the injury.

Updated: 11/19/2019


Lawrence V. Gulotta, MD
Head of the Shoulder and Elbow Division, Institute of Sports Medicine, Hospital for Special Surgery
Associate Assistant Orthopedic Surgeon, Hospital of Special Surgery

    1.Levine WN, Bergfeld JA, Tessendorf W, Moorman CT 3rd. Intramuscular corticosteroid injection for hamstring injuries. A 13-year experience in the National Football League. I'm J Sports Med. 2000 May-June;28(3):297-300.

    2.Bedair HS, Karthikeyan T, Quintero A, Li Y, Huard J. Antiotensin II receptor blockade given after injury improves muscle regeneration and decreases fibrosis in normal skeletal muscle. I'm J Sports Med. August 2008;36(8): 1548-54.

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