Muscle strains

A muscle strain is an injury to a muscle or tendon caused by overstretching or tearing of the muscle fibres or the fibrous tendon tissue that attaches the muscle to bone. Unlike a sprain (which affects ligaments connecting bone to bone), a strain involves the musculotendinous unit itself.

Strains range in severity: - **Grade I (mild):** microscopic tears; tenderness and mild pain, but full range of motion maintained; no loss of strength - **Grade II (moderate):** partial tear; more significant pain, swelling, and bruising; some loss of strength and range of motion - **Grade III (severe):** complete rupture of the muscle or tendon; significant pain, swelling, and bruising; marked weakness or inability to use the muscle

**Common locations:** - Lower back (lumbar strains) — one of the most common musculoskeletal injuries - Hamstrings (back of the thigh) — common in sprinting and jumping sports - Calf (gastrocnemius or soleus) - Quadriceps (front of the thigh) - Groin (hip adductors) - Shoulder (rotator cuff or biceps) - Elbow (common flexor or extensor tendons)

**Causes:** - *Acute:* a single forceful event — heavy lifting with poor mechanics, sprinting, sudden acceleration or deceleration, an awkward fall - *Chronic (overuse):* repetitive low-grade stress on the same muscle group — running, rowing, typing, assembly line work

**Risk factors:** poor warm-up before exercise, muscle fatigue, previous strain in the same muscle (most important predictor of re-injury), muscle imbalance, inadequate conditioning, cold weather, and direct contact sports.

**Acute management — RICE:** - **Rest:** avoid activities that reproduce the pain; gentle movement is encouraged to prevent stiffness - **Ice:** 15–20 minutes every 2–3 hours during the first 48–72 hours to reduce swelling and pain - **Compression:** elastic bandage to limit swelling - **Elevation:** keep the injured area above heart level when possible

After the acute phase, a structured physiotherapy rehabilitation programme is essential for full recovery — addressing muscle flexibility, strength, neuromuscular control, and sport-specific movement patterns. Returning to activity too early is the main cause of re-injury.

For strains that fail to respond to conservative management, targeted interventions (prolotherapy, ozone, pulsed radiofrequency) address chronic inflammation and impaired tendon healing. Complete tendon ruptures (e.g., Achilles or quadriceps) require surgical repair.