What are the signs and treatment for a patient presenting with a pulled muscle?

Signs and Treatment for a Pulled Muscle

The most effective treatment for a pulled muscle includes relative rest, ice therapy, compression, and NSAIDs for pain relief, followed by a progressive rehabilitation program focusing on stretching and eccentric strengthening exercises. 1

Clinical Signs of a Pulled Muscle

Pain Characteristics

• Sharp or stabbing pain in the affected muscle that increases with activity and may subside after a warm-up period 2
• Pain typically well-localized to the affected area with corresponding tenderness 2
• Pain that worsens with movement or contraction of the injured muscle 3

Visual and Physical Signs

• Possible swelling and ecchymosis (bruising) in the affected area 2
• Visible or palpable asymmetry compared to the uninjured side 2
• Reduced range of motion in the affected limb 4
• Pain reproduction with maneuvers that simulate muscle loading 2

Progression of Symptoms

• Early stage: Pain primarily during activity that may diminish after warming up 2
• Progressive stage: Pain increases in intensity and duration as the condition worsens 2
• Advanced stage: Pain may be present even at rest 2

Treatment Algorithm

Immediate Management (First 24-72 hours)

• Relative rest: Reduce activities that aggravate symptoms while maintaining some movement to prevent muscle atrophy 1
• Ice therapy: Apply ice through a wet towel for 10-minute periods to reduce pain and swelling 1
• Compression: Use elastic bandages to limit swelling and provide support 5
• Elevation: Keep the injured area elevated when possible to reduce swelling 5
• NSAIDs: Use for short-term pain relief and to reduce inflammation 1, 3
• Consider topical NSAIDs to minimize gastrointestinal side effects, especially in elderly patients 1, 4

Early Rehabilitation Phase (Days 3-14)

• Begin gentle range of motion exercises as pain allows 4
• Initiate light stretching exercises to prevent loss of flexibility 3
• Gradually introduce low-resistance strengthening exercises 4
• Continue ice therapy after activity if pain or swelling persists 4
• Maintain pain control with NSAIDs as needed 1

Progressive Rehabilitation Phase (Weeks 2-6)

• Implement eccentric strengthening exercises, which have proven beneficial in tendinopathies 1, 4
• Gradually increase resistance and intensity of exercises 4
• Focus on restoring normal flexibility and strength 3
• Begin functional exercises specific to daily activities or sport requirements 4
• Consider physical therapy for guidance with proper exercise technique 4

Advanced Rehabilitation (Week 6 onward)

• Progress to sport-specific or activity-specific training 3
• Implement preventive strategies including proper warm-up and avoiding excessive fatigue 3
• Gradually return to full activity when pain-free with full strength and range of motion 3

Special Considerations

Warning Signs Requiring Medical Attention

• Severe pain that does not improve with rest 2
• Inability to bear weight on the affected limb 2
• Persistent symptoms despite appropriate conservative measures 2
• Significant swelling, redness, or warmth suggesting possible infection 1

Adjunctive Therapies

• Therapeutic ultrasound may help decrease pain and increase collagen synthesis, though evidence for consistent benefit is limited 4
• Orthotics/braces may provide support during the healing process, though evidence for effectiveness is limited 4

Prevention Strategies

• Adequate warm-up before intense exercise 3
• Avoiding excessive fatigue during activity 3
• Progressive training to build muscle strength and endurance 3
• Proper technique during sports and exercise activities 3

Prognosis

• Most muscle strains have excellent long-term outcomes with appropriate treatment 3
• Complications are few when properly managed 3
• Return to full activity typically occurs within 2-6 weeks for mild to moderate strains 3