What is the treatment for muscular strain (muscle strain)?

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From the Guidelines

The treatment of muscular strain should prioritize nonpharmacological approaches, including the RICE protocol, and pharmacological treatments should be considered only if symptoms are not controlled, starting with acetaminophen or aspirin at the lowest efficacious dose. When considering pharmacological treatments, it's essential to weigh both safety and efficacy, opting for the least risky medication first and escalating only if necessary 1. The RICE protocol involves Resting the affected muscle, applying Ice for 15-20 minutes every 2-3 hours during the first 48-72 hours, using Compression with an elastic bandage, and Elevating the injured area above heart level when possible.

For pain management, medications such as acetaminophen (500-1000mg every 4-6 hours, not exceeding 4000mg daily) can be used for pain relief, while nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can reduce both pain and inflammation, but their use should be cautious due to potential cardiovascular risks, especially in patients with established cardiovascular disease 1. After the initial 48-72 hours, gentle stretching and gradual return to activity can begin, with heat therapy (15-20 minutes several times daily) to increase blood flow and promote healing.

Key considerations in the treatment of muscular strain include:

  • Adequate hydration and proper nutrition to support muscle recovery
  • Avoiding re-injury during the healing process through proper rest
  • Seeking medical attention for severe strains with significant pain, swelling, or inability to move the muscle, as these may require professional evaluation and more intensive treatment
  • Recognizing that muscular strains heal through the body's natural inflammatory response, which repairs damaged tissue. The application of ice, as recommended in the 2010 American Heart Association and American Red Cross International Consensus on First Aid Science, should be done with intermittent cooling to avoid discomfort 1.

From the Research

Treatment Options for Muscular Strain

  • The treatment of muscular strain can be conservative or surgical, depending on the severity of the injury 2
  • Conservative treatment involves a short period of immobilization followed by early mobilization to promote healing and prevent atrophy 2
  • Pharmacologic management of acute pain, including muscular strain, can include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatment options 3
  • Topical NSAIDs are recommended for non-low back, musculoskeletal injuries, such as muscular strain 3
  • Muscle relaxants may be useful for acute low back pain, but their efficacy and safety for muscular strain are not well established 4, 5

Rehabilitation and Recovery

  • Early mobilization is essential to promote healing, prevent atrophy, and restore function after a muscular strain injury 2
  • The optimal length of immobilization depends on the grade of the injury and should not be longer than needed for the scar to bear the pulling forces without rerupture 2
  • Rehabilitation programs should be tailored to the individual's needs and goals, and may include exercises to improve strength, flexibility, and range of motion

Medication Safety and Efficacy

  • The use of muscle relaxants for muscular strain is associated with uncertainty about their clinical efficacy and safety 5
  • Non-benzodiazepine antispasmodics may provide small reductions in pain intensity, but may also increase the risk of adverse events 5
  • Large, high-quality, placebo-controlled trials are needed to resolve uncertainty about the efficacy and safety of muscle relaxants for muscular strain 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Muscle strain injuries.

Current opinion in rheumatology, 2000

3
Research

Pharmacologic Therapy for Acute Pain.

American family physician, 2021

4
Research

Muscle Relaxants for Acute and Chronic Pain.

Physical medicine and rehabilitation clinics of North America, 2020

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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