• Muscle Strain

    (Pulled Muscle; Strain, Muscle)


    A muscle strain is an injury that damages the internal structure of the muscle. It may be small, or severe enough to cause internal bleeding and lengthening of muscle fibers. If the damaged parts of the muscle pull away from each other, it is called a muscle rupture.
    Muscles of the Back
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    A muscle strain is caused by tension or stress applied to the muscle that it cannot withstand. There are several ways that this can happen:
    • Muscle may not be ready for sudden stress
    • Tension may be too much for the muscle to bear, such as lifting a weight that is too heavy for you
    • Muscle is used too much on a certain day
    Certain areas have muscles that are more likely to be strained than others, including:
    Muscles that cross two joints are at the greatest risk.

    Risk Factors

    Factors that increase your chances of getting a muscle strain include:
    • Athletic activities, especially those with running, lifting, and jumping
    • Tight muscles
    • Fatigue
    • Overexertion
    • Cold weather


    Symptoms depend on how you strained the muscle.

    Strain While Performing an Athletic or Physical Activity

    You feel immediate soreness or pain in the affected muscle. If you try to use that muscle, it hurts even more. The area becomes tender and swollen. In the most severe cases, there may be a skin bruise because of bleeding underneath. Moving the nearby joints causes pain. Running and lifting are common activities that cause this type of muscle strain.

    Strain from an Accumulation of Stress

    When you do an activity that your body is not used to doing, the muscles are not in shape for that kind of activity. You may not feel pain during the activity, but the next day a muscle or set of muscles may be very sore. The muscle will be tender, and using it causes pain or discomfort.


    The doctor will ask about your symptoms, your recent physical activity, and how the injury occurred. The injured area will be examined for:
    • Tenderness directly over the muscle
    • Pain when contracting the muscle, particularly against resistance
    • Pain when stretching the affected muscle
    Images may be taken of structures inside your body. This can be done with:


    Treatment depends on the severity of the strain and the muscle involved.

    Acute Care

    Your muscle will need time to heal. Avoid activities that place extra stress on the affected area. In general:
    • Do not do activities that cause pain.
    • If normal walking hurts, shorten your stride.
    • Do not play sports until your doctor has said it is safe to do so.
    Apply an ice or a cold pack to the area for 15-20 minutes, four times a day, for several days after the injury. Do not apply the ice directly to your skin. Wrap the ice or cold pack in a towel.
    Pain Relief Medications
    To manage pain, your doctor may recommend:
    • Over-the-counter medication, such as aspirin, ibuprofen, or acetaminophen
    • Topical pain medication—creams or patches that are applied to the skin
    • Prescription pain relievers
    Compression can help prevent more swelling. Your doctor may recommend an elastic compression bandage around the affected muscle. Be careful not to wrap the bandage too tight.
    Elevation can also help keep swelling down. If possible, keep the affected muscle higher than your heart as much as possible for the first 24 hours or so. A couple of days of elevation might be recommended for severe strains.

    Recovery Steps

    Rehabilitation with a physical therapist may be required.
    Use heat only when you are returning to physical activity. Heat may be used before stretching or getting ready to play sports to help loosen the muscle.
    Begin stretching exercises for your muscles as recommended.


    To reduce your chance of straining a muscle:
    • Keep your muscles strong so they can absorb the energy of sudden stressful activities.
    • After a short warm-up period, stretch out tight muscles, especially previously injured ones.
    • Learn the proper technique for athletic activities to decrease muscle stress.
    • Stop when you are tired. Tired muscles do not function well. They do not react properly to sudden stress.


    American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

    OrthoInfo.org - American Academy of Orthopaedic Surgeons http://orthoinfo.org


    Health Canada http://www.hc-sc.gc.ca

    Public Health Agency of Canada http://www.phac-aspc.gc.ca


    Counsel P, Breidahl W. Muscle injuries of the lower leg. Semin Musculoskelet Radiol. 2010 Jun;14(2):162-175.

    Muscle strain. Johns Hopkins Medicine website. Available at: http://www.hopkinsortho.org/muscle%5Fstrain.html. Accessed May 13, 2014.

    Orchard J, Best TM, et al. Return to play following muscle strains. Clinical Journal of Sport Medicine. 2005 Nov;15(6):436-41.

    Sprains, strains, and other soft-tissue injuries. American Academy of Orthopaedics website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00304. Updated July 2007. Accessed May 13, 2014.

    Zeni A, Morfe EG. Frontera: Essentials of Physical Medicine and Rehabilitation. 1st ed. Philadelphia, PA: Hanley and Belfus; 2002; chap 62.

    1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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