From the Research
Treatment Principles
The treatment of muscle strain injuries typically follows the RICE principle, which stands for Rest, Ice, Compression, and Elevation 1, 2, 3. This principle aims to stop the injury-induced bleeding into the muscle tissue and minimize the extent of the injury.
Initial Treatment
Initial treatment consists of rest, ice, compression, and nonsteroidal anti-inflammatory drug therapy 2. The "PRICE" principle, which includes protection, rest, ice, compression, and elevation, is also recommended to target the first inflammatory response 4.
Rehabilitation
As pain and swelling subside, physical therapy should be initiated to restore flexibility and strength 2. The rehabilitation programme should be built around progressive agility and trunk stabilisation exercises, as these exercises seem to yield better outcomes for injured skeletal muscle than programmes based exclusively on stretching and strengthening of the injured muscle 1.
Key Considerations
- Immobilization should be limited to a period sufficient to produce a scar of sufficient strength to bear the forces induced by remobilisation without re-rupture 1, 3.
- Early mobilization is required to invigorate adhesion, orientation of the regenerating muscle fibers, revascularization, and resorption of the connective tissue scar 3.
- Avoiding excessive fatigue and performing adequate warm-up before intense exercise may help to prevent muscle strain injury 2.
- The ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) should be regarded critically, as there is currently no hard evidence to support their use, although they are appropriate in exceptional cases 4.
Treatment Strategies
Some studies suggest that haematoma aspiration may be considered in the early stages after injury 4, while others propose that intramuscular injections are not of use in the treatment of muscle injuries 4. Additionally, several growth factors might promote the regeneration of injured skeletal muscle, and many novel treatments have involved enhancing complete functional recovery 5.
Treatment Outcomes
The long-term outcome after muscle strain injury is usually excellent, and complications are few 2. However, muscle injuries can result in the loss of ability to participate in training or competition, and there is a need for consensus to provide strategies and recommendations for the treatment of muscle injuries 4.