What is the treatment for muscle strain?

Treatment for Muscle Strain

The mainstay of treatment for muscle strain is rest and limiting the use of the injured extremity, followed by application of cold therapy, and gradual return to activity as pain allows. 1

Initial Management (First 24-72 Hours)

Rest and Activity Modification

• A person with a painful muscle strain that limits use should avoid activities that cause pain 1
• Complete immobilization should be avoided to prevent muscular atrophy and deconditioning 2
• The optimal length of relative rest depends on the grade of the injury and should not be longer than needed for adequate healing 2

Cold Therapy (Cryotherapy)

• Apply cold (ice and water surrounded by a damp cloth) to the strained muscle for pain and swelling reduction 1
• Cold application should be limited to 20-30 minutes per application, 3-4 times daily 1
• Ice should not be placed directly on the skin to avoid cold injury 1
• A mixture of ice and water is more effective in lowering tissue temperature in the injured area than ice alone 1

Compression

• Consider applying a compression wrap to promote comfort after an acute strain 1
• Ensure compression wrap does not compromise circulation by overtightening 1
• While compression wraps may provide comfort, evidence shows they do not significantly reduce swelling or improve recovery time 1

Elevation

• Elevate the injured area above heart level when possible to help reduce swelling 2, 3

Pain Management

• Nonsteroidal anti-inflammatory drugs (NSAIDs) can effectively relieve pain from muscle strains 1
• For patients with cardiovascular risk factors, consider acetaminophen as a first-line analgesic option 1
• A stepped care approach to pain management is recommended, starting with the safest options (acetaminophen, tramadol) before progressing to NSAIDs 1

Intermediate Management (After Acute Phase)

Progressive Movement

• Early mobilization is required to:
  • Promote proper orientation of regenerating muscle fibers 2
  • Minimize inactivity-induced atrophy 2
  • Prevent loss of strength and extensibility 2
• Begin gentle range of motion exercises as pain allows 3

Therapeutic Exercise

• Exercise therapy should be initiated as pain and swelling subside to restore flexibility and strength 3
• Gradually increase activity level as symptoms improve 1
• Consider coordination and balance training to prevent recurrent injury 1

Common Pitfalls and Caveats

• Avoid excessive cooling which may impair muscle regeneration 4
• The effectiveness of cooling may be reduced in deep muscle injuries or in patients with thicker adipose tissue 4
• Complete immobilization can lead to muscle atrophy and should be avoided 2
• Seek medical attention if:
  • Pain is severe or worsening
  • Function is significantly limited
  • There is uncertainty about whether the injury is a strain, sprain, or fracture 1

Special Considerations

• For athletes, exercise therapy should be incorporated into regular training activities as soon as possible 1
• Growth factors have shown promise in experimental settings for enhancing muscle regeneration after strain injuries, but are not yet standard clinical practice 5
• The long-term outcome after muscle strain injury is usually excellent with appropriate management 3