Muscle strain (thigh, groin, back): how to treat?

What is muscle strain?

Muscle strain is a type of injury in which the muscles or tendons that attach to the bones undergo such an effort that they cause the muscle fibers and blood vessels that irrigate these tissues to rupture.

It is common to hear, when a strain occurs, that the person has felt a “sting” in the region of the injury.

This distention is the response to an effort beyond the capacity of the tissues. Thus, the muscles are stretched to the point of breaking fibers, blood capillaries or muscle bundles.

As a consequence of the rupture, symptoms such as pain, swelling and bruising, accompanied by inflammation at the injury site, may appear. It is very common in athletes, especially in contact sports such as football, handball, basketball and in sports such as marathoners and cyclists.

In the strain, the rupture can be considered partial or total, dividing according to the severity of the injury.

Usually, treatment is performed with the use of ice, compress, rest and elevation of the injured area. However, monitoring by an orthopedist and physiotherapists may be necessary.

The recovery time can vary, which also depends a lot on the physical condition of the person who suffered the strain.

In more severe cases, where many fibers are broken, the recovery time is longer, and may extend for weeks or months.

The diagnosis of a sprain is something immediate, since this rupture causes instant pain, preventing the person or athlete from continuing to perform the exercise.

In ICD-10, the International Classification of Diseases, muscle strain can be found by the code M62 (other muscle disorders) and M62.6 (muscle strain).

Read on and find out how to prevent yourself!

Causes

Muscle strain is caused by overexertion of the muscles to perform some muscle contraction. It is common in races, football matches, volleyball and other competitive sports.

However, although it is more common in people with a more intense exercise load, it also occurs in ‘ordinary’ people.

Risk factors

The risk of muscle strain increases under some conditions. Some risk factors are associated with traumatic injuries, something that athletes are more susceptible to suffer.

In addition, overweight, infections, performing exercises without technique and with overload, lack of warm-up and stretching in training also increase the chances of the strain to happen. Other reasons considered to be at risk are:

Lack of physical conditioning

Poor physical conditioning can increase the chances of injury. The person in exercise will have less preparation than he would have practicing activities regularly.

This can result in fatigue , lack of technique and little awareness of the limits of the body itself, using overload or performing very intense activity.

Age

In older people, the risk of muscle strain increases due to the presence of several other risk factors, such as lack of physical conditioning and less muscle strength.

The decrease in the amount of collagen is also associated with loss of muscle elasticity, which can happen due to aging, increasing the chances of injury.

Little warm-up before training

The strain can be considered cold and hot. When it happens in people without previous heating, it is the cold distension.

It receives this name because the muscle is not yet prepared for physical activity. When it comes to a hot sprain, the muscle is already fatigued.

Muscle fatigue

Muscle fatigue is the failure to maintain the expected strength. It is a condition where the body has been subjected to extreme wear and therefore the person is no longer able to perform the exercises perfectly.

Some symptoms of muscle fatigue include loss of concentration, changes in neuromuscular transmission, low tolerance to activity and a much greater risk of suffering an injury.

Incomplete rehabilitation

Returning to physical exercise without being fully recovered is one of the risk factors for muscle strain, as the athlete’s body is not yet ready to return to the rhythm of before.

Types

There are two main types of muscle strain, acute strain and chronic strain.

Acute distention occurs when the muscles and tendons need to undergo a sudden and strong contraction.

It is more frequent in athletes or people who practice physical exercises more frequently, because the muscles and tendons are more exposed to repetitive and prolonged movements.

It can also happen when we perform some movements such as lifting heavy objects from the floor or using too much force against resistance.

Chronic muscle strain occurs as a consequence of acute strain, where the muscles are always under repetitive and prolonged movements.

Usually, chronic distension is the most common in marathon runners, cyclists and competitive sports, due to the high load of training and competitions.

Within these two types a classification according to the degree of the injury:

Light distension

Where there is a small stretch of some muscle fibers, in which there is no hematoma or edema . The athlete usually feels only pain at the time of stretching.

In mild strain, or grade 1 injury , the athlete is expected to recover within a few days. In some cases, the athlete is able to continue the activity, as the injury does not prevent him from continuing.

Moderate distension

In moderate strain, or level 2 injury , the damage is more severe than in mild strain. In this lesion, greater damage occurs to muscle fibers and in greater amounts. Symptoms such as swelling and bruising are more frequent.

The pain is also more severe, which takes the patient a longer time of rest, needing 1 to 3 weeks to fully recover.

Severe distension

Severe, or level 3 , distension is the complete breakdown of the muscle. The athlete has pain, bruising and swelling. It is necessary to have a longer rest period or even remain immobilized until you have completely recovered.

What happens to the injured muscles?

When our body suffers an injury, such as muscle strain, our body has several responses to repair this damage as quickly as possible.

The distension causes a destabilization in the fiber structures, which ends up resulting in a process of necrosis (cell death), inflammation, repair and fibrosis.

Thus, at the same time that our organism tries to regenerate the broken tissues, it goes through a healing process.

The first phase after the injury occurs through the immediate inflammatory process, where the signs and symptoms appear. From injury to recovery, some phases are covered:

Inflammation and degeneration stage

After suffering a rupture in the distension, the sarcolemma of the muscle fiber loses its integrity. Sarcolema is the thin layer of connective tissue that surrounds muscle fiber. When damaged, it undergoes the process of cell necrosis.

In sequence, mononuclear cells, macrophages and lymphocytes migrate to the affected tissue. One of the functions of these cells is to enable the secretion of cell growth factors that specifically assist in the inflammatory process.

Interleukins (IL-8, IL-6, IL-1), proteins produced by these cells, together with tumor necrosis factors act by increasing the permeability of the injured area, accelerating the inflammatory response and the athlete’s recovery.

Thereafter, the exposure of tissue collagen causes a greater release of chemotactics and mitogens in the injured site. Thus, the clotting process begins and the leukocytes (white blood cells) destroy the necrotic cells.

Muscle regeneration

The muscle regeneration phase occurs 24 hours after muscle strain has occurred. The main characteristic of this phase is the action of myogenic regulatory factors and some growth factors (such as IGF).

They are responsible for the activation of satellite cells, essential for muscle regeneration and the formation of new fibers.

Healing

The healing phase lasts between three to six days. In this process, TGF-β1 is released, a growth factor that stimulates fibroblasts to produce proteins and proteoglycans.

These proteins will be responsible for the healing and repair of the broken tissue. Fibroplasia, that is, complete regeneration of the fibers, can last between four and six weeks.

Remodeling

In the remodeling phase, there is the maturation of the regenerated muscle, contraction of the collagen fibers and the reorganization of the scar tissue. This phase can last a very long time, from 15 to 60 days.

After three weeks, the healing of the injured muscle is considered more resistant, strong, firm and poorly vascularized.

Most cases of muscle strain tend to terminate in the first week, but in more severe cases it can happen after weeks of the injury that has occurred.

Which muscles are most affected?

Any muscle can undergo muscle strain, but some are more likely, as they are often required. Are they:

  • Internal thigh musculature;
  • Calf muscles;
  • Anterior thigh muscles (quadriceps);
  • Thigh hindquarters.

The regions of the muscular belly, part of which are contracted muscle fibers, and the muscle-tendon junction are most affected.

The muscles of the groin, back, buttocks and arms can also be affected, but less frequently when compared to the lower limbs.

In athletes, the lower limbs are the most affected by muscle strain, with hamstring muscles being the most affected.

The hamstring muscles are, in fact, the 3 muscles located in the posterior part of the thigh, being the semimembranaceous, semitendinosus and the biceps femoris muscle.

This set of muscles receives the name hamstrings because they originate in the ischium and present as tibia and fibula leg bones as a distal insertion.

Symptoms

Symptoms of muscle strain include:

  • Immediate pain at the injury site;
  • Weakness;
  • Hematoma, resulting from the rupture of capillary veins;
  • Edema (swelling);
  • Ecchymosis (blood infiltration into muscle tissues);
  • Bleeding;
  • Deformity;
  • Difficulty moving the injured muscle.

Pain at the site is the main symptom of muscle strain. In the case of acute distension, the patient may feel a “pinch” or stitches in the area, which will prevent him from continuing in the activity.

In the most severe cases of muscle strain, when feeling the region of the lesion, it is possible to feel the rupture of the fibers.

In chronic distension, the pain is not as severe. They are felt when the person repeats the movement of the injury or makes a movement that affects, in some way, the area where the distension occurred.

Bruises, however, are not a symptom present in all types of muscle strain.

Bleeding varies according to the amount of fibers injured, as well as the severity of the injury and the vessels nearby. It manifests itself in the formation of hematomas, intramuscularly or subcutaneously and between fascicles.

Diagnosis

The diagnosis of muscle strain is made by analyzing the symptoms. However, depending on the type of the lesion, in order to have a more accurate diagnosis, complementary exams can be done, such as a blood test that checks the levels of the enzyme CPK (creatinophosphokinase).

The doctor may also order a soft tissue ultrasound, where it is possible to more accurately observe the bruises caused by the injury.

Other imaging tests such as radiography, MRI and electromyography can be done for a differential diagnosis and to follow up on the most appropriate treatment for the patient.

Is there a cure?

Yes , muscle strain can be cured. It is considered a common lesion, with easy diagnosis and treatment. Usually, the patient recovers in a few days. In more severe cases, treatments such as physiotherapy, acupuncture and massage may be needed to help complete recovery.

Treatment

The treatment of muscle strain is performed by an orthopedic doctor or by a physiotherapist , who must accompany the athlete until he is recovered from the injury and can return to daily training and exercises.

What usually happens is a reaction by the body itself to repair the disruptions that the injury has caused. It is able to repair fibers, absorb clots and control, by the action of the immune system, the presence of inflammation.

The most serious injuries require a medical evaluation and more specific treatment, as it may be necessary to exclude the possibility of a fracture. It is also important to check the possibility of the injury leaving sequelae in the patient and preventing him from making any movement, for example.

Some measures that are used for treatment include basic care, such as the RICE method (Rest, Ice, Compression, Elevation). According to this model, the patient must:

  • Remain at rest;
  • Put ice on the injured area, for compression;
  • Use bands to compress the injured region;
  • Elevate the limb where the injury occurred.

Other treatments that may be needed include physical therapy and the use of medications, such as pain relievers and anti-inflammatories to help relieve pain and inflammation.

Ice

Applying ice to the lesion soon after it occurs helps to reduce the chances of swelling. In addition, the cold decreases the sensitivity to pain, internal bleeding and the inflammatory process.

Ice packs can be done every 2 hours until symptoms are reduced or disappear.

However, it is important to be careful with the ice, not putting it directly in contact with the body. The ideal is to use a thermal bag or improvise using a cloth or any plastic, so as not to burn your skin.

Range

One of the recommendations after suffering a muscle strain is to bandage the injured area, causing a compression of the site. Like ice, it helps to stop swelling and internal bleeding.

Remain with the injured muscle at rest

Resting is also part of recovery, so it is not recommended that the patient practice activities in which the injured muscle may be required, as the pain may increase and end up worsening the condition.

However, it is important to perform activities and put the body in motion, even if it is gradually.

What should be considered is the athlete’s common sense in perceiving the limits of his body. When you feel pain or swelling, it is a sign of reducing exercise a little or stopping.

Stay with the injured muscle elevated

This is the fourth step of the RICE method and consists of the patient leaving the injured limb elevated above the level of the heart.

The elevation of the injured limb helps to reduce swelling and contributes to better blood circulation, as it increases the venous return of blood to the systemic stream. It also helps to decrease pain, throbbing and bruising.

For example, if the patient has suffered a muscle strain in the leg, it is best to leave it supported on pillows when sitting or lying down.

Massage

Massage at the injury site can help reduce swelling and make the muscles less tense, also reducing pain.

Acupuncture

Acupuncture is a practice of traditional Chinese medicine that uses the insertion of needles in specific points on the patient’s body as a technique. It aims to relieve pain and other health problems.

Bandage and splint

The use of a bandage or splint is recommended for patients who have to remain with the injury site immobilized.

Physiotherapy

Physiotherapy is one of the most beneficial treatments for athletes in recovering from an injury such as muscle strain. The exercises help in the total recovery of the movements and in the muscular strengthening.

Before starting physical therapy, it is necessary to undergo an assessment by the physiotherapist. Thus, he will know the patient’s needs and the periodicity of the exercises.

Sessions can be done daily or at intervals, which facilitates a faster recovery.

Exercises and the total duration of physical therapy treatment may vary according to the degree of the injury.

Surgical treatment

Surgical treatment for muscle strain is rarely recommended, as in most cases, the problem is resolved with other less invasive treatments. Usually, the broken muscles or tendons recover with the support of clinical and physiotherapeutic treatment.

The surgery, when done, is restricted to competition athletes, usually when the recovery with other treatments is longer than the time that the athlete has until the next competition and that cannot be postponed, as in cases of Olympic Games and World Cup example.

It is also indicated in cases where the injury causes great damage to the patient, preventing its functionality.

Medicines

Usually, the drugs used to help in the treatment are analgesics and anti-inflammatory drugs , as they help to relieve pain and swelling. In some cases, the use of some ointments may be recommended to massage the area and help reduce these symptoms.

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Prognosis

In most cases, when it comes to mild muscle strain, people return to their activities in a short time, within two to three days.

In moderate-grade injuries, the recovery time is slightly longer, and may extend to 7 days. In severe cases, consequently, the recovery time is longer, as the body needs a longer time to heal and regenerate the broken tissue.

In these cases, treatments with a physiotherapist may be necessary to be able to rescue muscle strength and range of motion.

In extremes, where the patient had to undergo some surgery, greater care and the monitoring of a physiotherapist are indispensable.

In general, even after two weeks of the accident, if the patient still has symptoms, he should seek medical help, as prolonged pain and difficulty in moving the joints can indicate another problem.

Complications

Muscle distension can present some complications, such as persistent pain at the site or when performing the same movement as the injury. Patients may also experience difficulty in healing, reduced muscle strength and range of motion in the affected area.

These complications are considered harmful, especially for athletes of high competition, who may need to leave the sport because of the injury, and their career is, in a way, impaired.

In more rare cases, muscle strain can cause the Achilles tendon to rupture, and may be total or partial. In such cases, surgical intervention is usually necessary.

How to prevent muscle strain?

It is not always possible to prevent this type of injury, but in some cases, they occur due to lack of physical and technical preparation when performing the exercises. In these situations, it is possible to maintain some care routines to prevent muscle strain from happening.

The main skills that must be worked on involve movements to strengthen the muscles and provide greater resistance.

Heating

One way to prevent muscle strain is to warm up before training or physical activity to be practiced.

Be careful with external factors

When it comes to practicing physical activities it is important to be careful also with external factors, such as the floor slippery by ice, snow or rain.

On rainy days, be more cautious about outdoor sports. If you are running, take a few steps to avoid falls, for example.

It is important to invest in suitable, comfortable shoes that help in situations like this.

Practice exercises regularly

Regular and moderate physical activity is more beneficial than intense and aggressive activities once or twice a week.

This attempt to compensate for days off can impair the quality of physical activity and, thus, the athlete ends up getting hurt.

As seen, one of the risk factors for muscle strain is fatigue and poor physical fitness. Maintaining a healthy exercise rhythm can help reduce the chances of this type of injury.

Use good equipment

If you use equipment for your series of exercises or in the sport you practice, observe their quality.

Sloppy, worn or poorly adjusted equipment is not able to provide the necessary support for the athlete and this ends up hurting him.

In gyms, for example, observe the quality of equipment and see if this is a concern of the establishment. Just as the athlete’s posture influences the result of the movement, so does the device.

Take breaks

Staying in the same position for a long time can put pressure on the muscles. Therefore, sitting, standing or performing repetitive movements for a long period is not recommended.

To prevent injury, it is important to take a few breaks to stretch and rest your muscles for a while.

Common questions

Here are some of the most frequently asked questions about this type of injury:

What is the difference between stretch and muscle strain?

Typically, these two types of injury are synonymous, however, there are differences.

Muscle stretching is the disruption of red muscle fibers, located in the middle of the muscle. Muscle strain is the disruption that occurs at the muscle-tendon junction.

Both types of injury have the same mechanism and classification, as they are divided into 3 degrees.

What is the difference between muscle contracture and muscle strain?

Muscular contracture is a less severe type of injury than distention, as it does not break muscle fibers.

This type of injury occurs due to poor functioning in the movement of muscle contraction and relaxation, so the muscle ends up contracting, but does not relax again.

The treatment is done with muscle relaxants, massage, application of heat to the injured area and rest.

It is possible to prevent muscle contracture with the same care taken for stretching.

Read more: What is it and what is muscle relaxant for?

I suffered a muscle strain. What should I do?

If you suspect you have a muscle strain, stop the activity you are doing and use an ice pack on the spot. It is essential to seek help from a doctor to receive the correct diagnosis of the injury.

After the guidance of a specialist, seek to practice the recommendations on rest, use of ice at the site of the injury, elevation of the area and the correct use of the prescribed medications.

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