From the Guidelines
To treat a muscle strain, the most effective approach is to follow the RICE protocol, which includes rest, applying ice for 20 minutes every 2-3 hours for the first 48-72 hours, using compression with an elastic bandage, and elevating the injured area above heart level when possible, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The main goal of treatment is to reduce pain, swelling, and inflammation, and to promote healing.
- Resting the injured area is crucial to avoid further injury and allow the muscle fibers to heal.
- Applying ice can help reduce pain and swelling, and it is recommended to use a bag filled with ice and water surrounded by a damp cloth for the greatest tissue cooling 1.
- Compression with an elastic bandage can help reduce swelling, and elevation of the injured area can help reduce inflammation. Some key points to consider when treating a muscle strain include:
- Limiting the use of the injured extremity to avoid worsening the injury 1.
- Using cold therapy, such as an ice and water mixture, to decrease pain and swelling 1.
- Avoiding direct contact between ice and skin to prevent cold injury 1.
- Taking over-the-counter pain relievers, such as ibuprofen or acetaminophen, to manage pain and reduce inflammation. It is essential to seek medical attention if symptoms persist or worsen over time, or if there are signs of a more serious injury, such as severe pain, inability to move the affected area, or significant swelling 1.
From the Research
Definition and Causes of Muscle Strain
- Muscle strain is a common injury that occurs when a muscle is stretched or torn, often due to excessive strain on the muscle tendon unit or a forceful blow to the muscle 2.
- Muscles that are frequently involved in strain injuries are those that cross two joints, act mainly in an eccentric fashion, and contain a high percentage of fast-twitch fibers 3.
Symptoms and Diagnosis of Muscle Strain
- Muscle strain usually causes acute pain and occurs during strenuous activity 3.
- The diagnosis can be made on the basis of the history and physical examination, with magnetic resonance imaging (MRI) recommended only when radiologic evaluation is necessary for diagnosis 3.
- The current classification divides muscle injuries into mild, moderate, and severe, with signs and symptoms including edema, discomfort, loss of function, gaps, ecchymosis, and complete rupture 4.
Treatment and Management of Muscle Strain
- Initial treatment consists of rest, ice, compression, and nonsteroidal anti-inflammatory drug therapy, with physical therapy initiated to restore flexibility and strength as pain and swelling subside 3.
- The application of ice, compression, and elevation is well tolerated by patients, but there is no evidence that these methods enhance tissue repair 2.
- Early mobilization is required to invigorate adhesion, orientation of the regenerating muscle fibers, revascularization, and resorption of the connective tissue scar, with the optimal length of immobilization depending on the grade of the injury 5.
- Surgery has precise indications, including hematoma drainage and muscle-tendon reinsertion and reinforcement 4.
Prevention and Complications of Muscle Strain
- Avoiding excessive fatigue and performing adequate warm-up before intense exercise may help to prevent muscle strain injury 3.
- Complications after strain injuries include risk of recurrence, muscle atrophy, and development of scar tissue, with ectopic bone formation rarely occurring after severe contusion injuries 2.
- The long-term outcome after muscle strain injury is usually excellent, with complications being few 3.