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Muscle strains, or pulled muscles, are a common orthopedic condition and can be caused by a variety of factors, including direct trauma, indirect insults, and degenerative diseases. When a muscle is strained, its fibres are stretched beyond their limit and tear apart, resulting in pain and reduced mobility. The good news is that most muscle strains are not severe and will heal on their own with time and rest. However, severe muscle tears may require medical intervention or even surgery. The healing process involves multiple steps, including inflammation, regeneration of muscle fibres, and remodelling with scar tissue formation. Early mobilisation and physical therapy play a crucial role in stimulating vascularisation and restoring muscle function. Strength training and good ergonomics are important strategies to prevent muscle strains and reduce the risk of musculoskeletal injuries.
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What You'll Learn
Muscle regeneration
Three main phases have been identified in the process of muscle regeneration: a destruction phase with an initial inflammatory response, a regeneration phase with activation and proliferation of satellite cells, and a remodelling phase with maturation of the regenerated myofibres. The inflammatory response plays a crucial role in bridging the initial muscle injury response and timely muscle injury repair.
The various types of immune cells and cytokines have crucial roles in the muscle regeneration process. Regulatory T cells (Treg) are important players in muscle regeneration, regulating the inflammatory infiltrate at the site of tissue damage. Treg cells also indirectly influence the behaviour of satellite cells, affecting the inflammatory milieu in regenerating muscles.
Satellite cells are tissue-resident muscle stem cells required for postnatal skeletal muscle growth and repair through the replacement of damaged myofibres. After injury, satellite cells become activated, proliferate and give rise to myogenic precursor cells, known as myoblasts. Myoblasts form new myotubes or fuse with damaged myofibres, ultimately maturing into functional myofibres.
Macrophages, infiltrating injured muscle, are key players in the healing process. M1 macrophages, defined as pro-inflammatory macrophages, act during the first few days after injury, contributing to cell lysis, removal of cellular debris, and stimulating myoblast proliferation. M2 macrophages, defined as anti-inflammatory macrophages, act 2 to 4 days after injury, attenuating the inflammatory response and favouring muscle repair by promoting myotube formation.
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Surgical repair
During muscle rupture surgery, sutures are used to repair the injured muscle. The surgical repair of skeletal muscle is generally easier if the injury is close to the MTJ (Musculotendinous Junction) rather than in the middle of the muscle belly. This is because the fascia overlying the muscle is stronger near the MTJ, allowing for more precise anatomical reconstruction. It is important to note that sutures may not always provide sufficient strength to reattach all ruptured muscle fibres, and there is a risk of creating gaps between the ruptured muscle stumps.
After surgical repair, the muscle should be supported with an elastic bandage to provide compression and relative immobility. Complete immobilization, such as casting, is usually not necessary. The surgical repair process aims to bring the retracted muscle stumps closer together to prevent the development of large scar tissue within the muscle. However, suturing the fascia does not prevent the contraction of ruptured muscle fibres or the formation of hematoma in the deep parts of the muscle.
While surgical intervention can be beneficial in specific cases, it is important to exercise caution when considering it as a treatment option for muscle injuries. Non-operative treatments should be explored first, as they often lead to successful outcomes.
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Anti-inflammatory medication
NSAIDs are meant to be used for the short-term and immediate treatment of muscle pain and injury. Long-term use of these medications is discouraged. Additionally, NSAIDs are not recommended for use before or during endurance sports. Several studies have found little actual performance benefit of taking ibuprofen and warn that it may mask pain, which can lead to an increased risk of injury. Other studies have cautioned that the use of NSAIDs during ultra-distance exercise is associated with an increased risk of exertional hyponatremia.
It is important to follow the proper dosage instructions for the medication and to speak with a doctor before trying any pain relief options, including complementary and alternative medicines. Side effects may develop if large doses of NSAIDs are taken or if they are taken for a long time. Some side effects are mild and go away, while others are more serious and require medical attention. The most frequently reported side effects of NSAIDs are gastrointestinal (stomach and gut) symptoms such as feeling bloated, stomach pain, nausea and vomiting, and constipation. Taking NSAIDs with food, milk, or antacids may reduce the risk of these gastrointestinal symptoms.
Acetaminophen (Tylenol) is a popular alternative to anti-inflammatory medications. It works to relieve pain and fever but does not reduce inflammation. To prevent stomach pain and ulcers as a result of taking NSAIDs, a doctor may prescribe misoprostol, proton pump inhibitors (PPIs), or double dose H2-receptor antagonists (H2RAs), which have been found to prevent gastric troubles caused by NSAIDs.
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Muscle strengthening
Types of Exercises:
- Muscle-strengthening activities can include exercises such as weightlifting, bodyweight exercises (e.g. push-ups, pull-ups, squats), and resistance band exercises.
- Aerobic exercises such as running, cycling, and swimming can also help build muscular endurance, which is the ability of a muscle to sustain repeated contractions against resistance over time.
- Other exercises that can improve muscular endurance include circuit training, long-distance running, and climbing hills.
Frequency and Duration:
- It is recommended to perform muscle-strengthening activities on 2 or more days per week, focusing on major muscle groups such as legs, hips, back, abdomen, chest, shoulders, and arms.
- A typical training session can be as short as 20 minutes, with 2-3 sets of 8-12 repetitions of each exercise.
- For general health, combine muscle-strengthening activities with at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week.
Safety and Technique:
- When starting a new exercise program, especially if you have injuries or medical concerns, it is important to start slowly and listen to your body.
- Use proper form and technique to ensure safe and effective workouts. Use steady, controlled movements, especially during heavy lifting.
- Allow for rest days between working different muscle groups, and take breaks during your workouts as needed.
- Be cautious when working out areas prone to pain or injury, such as the neck, shoulders, back, and joints. Avoid holding your breath during exercises to prevent a rise in blood pressure.
Nutrition and Recovery:
- While exercise is important, proper nutrition and recovery are also key components of muscle strengthening. Ensure you are consuming a balanced diet with sufficient protein to support muscle growth and repair.
- Allow for adequate recovery time between workouts to give your muscles time to heal and regenerate.
- Progressive functional physical therapy can also be beneficial in improving muscle strength and function, especially after an injury.
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Rest and recovery
It is important to give your muscles time to recover between workouts. This means getting enough sleep and taking rest days, as well as ensuring you have a healthy lifestyle, managing your nutrition, and staying hydrated. The American Council on Exercise (ACE) recommends scheduling at least one day of complete rest every 7-10 days to allow your body to recover and adapt.
Passive recovery is a complete cessation from exercise, giving your body time to rest and repair. How much passive recovery your body needs depends on factors including your current fitness level and the intensity of your workouts. Active recovery, on the other hand, involves low-intensity, low-impact exercise that promotes blood flow and tissue repair without causing further stress on the body.
During sleep, the body produces the majority of its growth factors and hormones that aid in daily muscle repair and recovery. Getting 7-9 hours of sleep per night allows those growth factors to do their work. Sleep deprivation may impair muscle recovery by hindering the body's inflammation reaction and the production of hormones that aid muscle growth.
Nutrition is also key to muscle recovery. Consuming protein after your workout can help give your body the raw material it needs to repair muscle damage. Research suggests that consuming roughly 1.4-2.0 grams of protein per kilogram of body weight per day is enough to build and maintain muscle mass.
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Frequently asked questions
A muscle strain is a tear in your muscle fibres, also known as a pulled muscle. They can be caused by a multitude of factors, including direct trauma, such as muscle lacerations and contusions, or indirect factors, such as strains and degenerative diseases.
The muscle repair process can be split into three phases: destruction, regeneration, and remodelling. The destruction phase involves the initial inflammatory response to the injury. The regeneration phase involves the activation and proliferation of satellite cells, which are tissue-resident muscle stem cells required for muscle repair. The remodelling phase is when the actual repair of the injured muscle takes place, with myofibres regenerating out of satellite cells and connective tissue scars forming in the gap between torn muscle fibres.
The healing time for a pulled muscle depends on the severity of the injury. A mild strain may only take a few weeks to heal, while a more severe injury could take several months. It is important to rest the injured muscle and gradually ease back into activity to avoid re-injury.
To prevent muscle strains, it is important to strengthen your muscles through activities such as weight lifting, yoga, or cycling. Good ergonomics at work can also help to reduce muscle strain by fitting the job to the person and reducing tired muscles.
