From the Guidelines
For a pulled muscle in the leg that remains tight after one month, I recommend a comprehensive rehabilitation approach, prioritizing exercise therapy to recover joint functionality, as advised by the most recent evidence-based clinical guideline 1. This approach should include gentle stretching exercises 2-3 times daily, holding each stretch for 30 seconds without bouncing, to improve flexibility and reduce muscle tightness.
- Apply heat therapy before stretching using a warm towel or heating pad for 15-20 minutes to increase blood flow and reduce muscle spasms.
- Take over-the-counter anti-inflammatory medications like ibuprofen (400-600mg every 6-8 hours with food) or naproxen (220-440mg twice daily) for 7-10 days to reduce inflammation and pain, as NSAIDs may be used to reduce pain and swelling 1.
- Gradually incorporate strengthening exercises such as calf raises, hamstring curls, or gentle squats, starting with 2 sets of 10 repetitions and slowly increasing, to improve muscle strength and function.
- Consider massage therapy or foam rolling to break up scar tissue and improve flexibility, although the evidence for these modalities is limited 1.
- Proper hydration and adequate protein intake support muscle healing and recovery. If pain persists or worsens after two weeks of this regimen, consult a healthcare provider as you may need physical therapy or further evaluation, and to assess for any underlying conditions that may be contributing to the persistent tightness.
- Persistent tightness after a month suggests the muscle may have healed with excessive scar tissue or developed compensatory patterns that require professional intervention to properly address, and a healthcare provider can help determine the best course of treatment. It is essential to note that immobilization should not be used in the treatment of a muscle strain, as it can lead to decreased muscle strength and function 1, and instead, functional support and exercise therapy should be prioritized.
- Additionally, surgery is only advised for patients that require quick recovery, such as professional athletes, or whose complaints are not resolved by conservative treatment 1, and is not typically recommended for the treatment of a pulled muscle in the leg.
From the FDA Drug Label
Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions Cyclobenzaprine hydrochloride tablets should be used only for short periods (up to two or three weeks) because adequate evidence of effectiveness for more prolonged use is not available
The treatment plan for a patient with persistent leg muscle strain and tightness one month post-injury may include:
- Rest
- Physical therapy However, the use of cyclobenzaprine for more than two or three weeks is not recommended due to lack of evidence for its effectiveness for prolonged use 2. Since the patient is one month post-injury, alternative treatments should be considered.
From the Research
Treatment Plan for Persistent Leg Muscle Strain
The treatment plan for a patient with persistent leg muscle strain and tightness one month post-injury may involve a combination of the following:
- Rest, ice, compression, and nonsteroidal anti-inflammatory drug therapy to reduce pain and swelling 3
- Physical therapy to restore flexibility and strength as pain and swelling subside 3
- Conservative approaches such as growth factor therapy and administration of autologous platelet-rich plasma during the early postinjury period 4
- Topical anti-inflammatory therapy to provide local analgesic and anti-inflammatory effects while minimizing systemic adverse events 4
- Surgical treatment for more serious injuries, although this is less common than conservative and topical therapies 4
Management of Chronic Muscle Tightness
For patients experiencing chronic muscle tightness, the following strategies may be used:
- Complementary therapies to manage symptoms 5
- Workarounds to manage daily life and restrictions caused by chronic muscle tightness 5
- Conservative therapy, although surgical options such as fasciotomy may be considered for chronic exertional compartment syndrome 6
- Platelet-rich plasma (PRP) injections, which have been shown to promote muscle recovery and potentially reduce pain, swelling, and time for return to play 7
Considerations for Treatment
When developing a treatment plan, considerations should include: