Source Predisposing Factors to Muscle Strains
a muscle that has been previously injured and has neither properly nor completely rehabilitated;
using a muscle that has been previously injured and healed with contracted scar tissue, thus not permitting normal muscle excursion; a sudden force can reinjure the scar tissue and recreate the symptoms of a muscle strain;
unusual tightness within a muscle group that does not permit normal excursion in the muscle-tendon unit;
improper or incomplete stretching and warming up prior to exercise or competition;
overexertion;
overexposure to cold temperatures for extended periods of time.
Treatment
Phase 1 immobilizes the muscle strain and uses RICE for 24-72 hours.
Phase 2 assures maximum, normal lengthening and contracting of the muscle. Grade I or mild Grade II strains may take as little as a few days. Grade III strains could require from 10 days up to many weeks for complete recovery. Start with limited ROM exercises. For severe strains, ROM exercises may be started in water (i.e., aquatherapy for strengthening and rehab).
Phase 3 begins after normal excursion returns. Progressive resistance exercises are started. At times, it is ideal to begin with machine type exercises rather than free weights and cables.
Phase 4 brings return to the types of activities used in the particular sport or activity in which these muscles were disrupted. Do this phase slowly.
Phase 5 is reconditioning for the particular sport or activity. In the conditioning phase, it is important, as always, to include plenty of stretching and strengthening exercises.
Heat and Cold
In general, patients should use whichever of the two gives them the most relief. Cold application leads to vasoconstriction and is recommended in acute injury. Heat is often more beneficial in muscular pain and may help in muscle relaxation. The contrast between cold and heat therapy is a technique that sometimes gives more relief than either modality used alone.
Moist heat seems to have a better effect than dry heat. Local application of heat is contraindicated in patients with decreased sensation or circulatory impairment. It is also contraindicated over areas of malignancy and not advisable in acute injury. Usual application is about 20 minutes, not more than 30 minutes.
Cold (ice in most cases) should not be used for more than 15-20 minutes per session with an hour break between sessions. In acute injuries such as sprains, ice packs can be applied for the first 24-72 hours. In muscular pain such as in the neck or back, contrast therapy often feels good. The use of cryotherapy (cold) is contraindicated over areas of decreased sensation or vascular compromise. It is also not advisable for patients with vasculitis or open wounds.
I would like to point out that some of this information is paraphrased from books that have been written over 15 years ago. It is just like an old saying: "The more things change, the more things stay the same."
References
Birnmaum JS. The Musculoskeletal Manual, 1982; pp 17-19.
Southmayd W, Hoffman M. Sports Health: The Complete Book of Athletic Injuries, pp. 77-80.
Michael J. Leone, BA, BS, MBA, DC. Strength coach, fitness trainer and nutrition consultant.
Mick Leone, DC
