What is a ‘strain’?
A muscle strain is an injury to a muscle.
The word strain could be used interchangeably with the word ‘tear’.
Strain seems to fit better as a descriptor of low grade/minor muscle injuries, with tear perhaps more appropriate when describing higher grade/severe muscle injuries.
Essentially, it describes damage or injury to a muscle resulting in pain, weakness, loss of range of motion and ultimately, reduced function.
Grading of muscle strains
There have been multiple grading systems proposed for describing muscle strains with no singular grading system proving superior and/or providing accurate prognostic value (Grassi et al., 2016).
The most common system which most people will have heard used is
- Grade 1
- Grade 2
- Grade 3
This system’s simplicity is the main reason for it’s popularity and widespread use.
Grade 1 Strain – Mild
- Less than 10% muscle fibre disruption
- Less than 10 degrees loss of range of motion
- Minimal pain on palpation and contraction
- Minimal loss of strength
- Minimal loss of function
- Can continue playing
Grade 2 Strain – Moderate
- 10-50% muscle fibre disruption
- 10-25 degrees loss of range of motion
- Considerable pain on palpation and contraction
- Considerable loss of strength
- Considerable loss of function
- Inability to continue playing or ‘limping’
Grade 3 Strain – Severe
- 50-100% muscle fibre disruption
- Complete tear
- More than 25 degrees loss of range of motion
- Severe pain on palpation and contraction
- Near complete loss of strength
- Near complete loss of function
- Athlete collapses or cannot weight bear
Other grading systems
- Ultrasound based grading systems
- MRI based grading systems
- The Munich Classification
- The British Athletic Classification
So how do I manage my muscle strain?
There are a number of proposed ways to manage acute muscle injuries, mostly represented by acronyms such as ICE, RICE, RICER, PRICER, POLICE and more recently, PEACE + LOVE.
The PEACE + LOVE approach is our preference due to acknowledging the subacute and chronic stages of healing better than the other aforementioned acronym based approaches, however a few of these points are probably still up for debate so please discuss this with your physiotherapist.
P = protection
E = elevation
A = avoid anti-inflammatories
C = compression
E = education
+
L = load
O = optimism
V = vascularisation
E = exercise
(Dubois & Esculier, 2020)
Your physiotherapist will be able to explain these components in more detail and discuss the best management for your individual presentation.
How long will my muscle strain take to heal?
Every injury will be different with a myriad of factors combining to determine tissue healing.
A rough estimate would be:
- Grade 1 muscle strain = approximately 0-2 weeks
- Grade 2 muscle strain = approximately 2-8 weeks
- Grade 3 muscle strain = approximately 6 weeks – 6 months
There is also a difference in timeframes between recovery to the point of returning to activity, and complete tissue healing.
Hence, even though a grade 2 muscle strain might take 6 weeks to heal, you can usually return to lower level activity well before complete tissue healing.
You physiotherapist will guide you through the rehabilitation progress and advise you on what level activity is safe and appropriate throughout your recovery.
You can read more here:
References
Dubois B & Esculier J-F. (2020). Br J Sports Med
2020;54:72–73.
Grassi, A., Quaglia, A., Canata, G. L., & Zaffagnini, S. (2016). An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems. Joints, 4(1), 39–46. https://doi.org/10.11138/jts/2016.4.1.039
Pollock N, James S, Lee JC, et al. (2014). British athletics muscle injury classification: a new grading system. Br J Sports Med. 2014;48:1347–1351.