Many people participate in activities which will sometimes lead to muscle strains. The degree of muscle strain determines the severity and hence the time to fully recover. Physiotherapy helps to facilitate the healing process and achieve a good outcome.
A muscle strain involves injury to the muscle cells. There are three grades of muscle strains: Grade one is mild and associated with minimal swelling, and pain. Grade two involves a partial tear of the muscle and therefore patients will experience swelling, pain on activity, limited mobility, and a decrease in strength. A grade three muscle tear involves a complete tear of the muscle and may require surgery depending on the site of the tear and the muscle involved.
A muscle tear heals according to the natural healing process. There are three phases of healing. The acute phase involves inflammation and lasts about a week. Immediately after a tear there is often swelling, bruising (due to the damaged blood vessels), and the muscle fibers retract. In the first 24-48 hours, inflammation ensues and starts the healing process. Specific cells begin to clear away the debris and damaged tissue while other cells release chemicals which increase which blood flow to the area by dilating the blood vessels. During the second phase of healing, fibroblastic cells start to produce collagen a connective tissue. Collagen formation is important to bridge the defect in the muscle until new muscle cells regenerate. This newly formed scar tissue is not very strong until 4 weeks after the initial injury. Indeed, at 2 weeks the scar tissue is only at 50% of the tensile strength and can re-tear easily. Thus it is important not to return to sports too soon to avoid re-injury.
Physiotherapy helps guide the healing process. R.I.C.E. (rest, ice, compression, elevation) is used initially to reduce the inflammation. Taping and wrapping the injured muscle can help protect the muscle to prevent more tearing. Ultrasound and electrical modalities enhance the healing process. During the second phase of healing, physiotherapy tries to regain full mobility, and strength. It is important that the scar flexibility in the muscle tissue is good to avoid re-tearing. Patients are given specific stretching and strengthening exercises.
Return to sport must be gradual. A grade one muscle strain usually takes 3 weeks to heal while the grade two strain takes about 6 weeks.
Written by Susan Reive, Owner of Kilborn Physiotherapy Clinic