How to Treat Muscle Strains and Tears? A Physiotherapist’s Guide!

Tear or Strain: What’s the Difference?

A muscle strain (also called an elongation) occurs when a muscle is stretched beyond its normal capacity, causing micro-tears within the muscle fibers.

When there are “many” ruptured or torn muscle fibers, it is referred to as a muscle tear rather than a strain.

Therefore, what differentiates a strain from a tear is the “severity” of the injury.

Generally, more muscle fibers are damaged in a tear than in a strain, even though there are no very objective criteria to differentiate between these two muscle injuries.

Among the dozens of proposed classifications for muscle injuries, one categorizes them into three grades [SantAnna 2022].

Mild Strains and Contusions: Grade I

Damage to only a few muscle fibers, with a small edema and discomfort, accompanied by little or no loss of strength and minimal restriction of movement.

It is not possible to palpate a muscle defect during muscle contraction.

Although the pain does not cause significant functional impairment, it is not recommended to keep the athlete active due to the high risk of worsening the injury.

Moderate Strains, Tears, and Contusions: Grade II

There is more significant muscle damage, with an evident loss of function (contraction ability).

A small muscle defect or gap can be palpated at the injury site, and a slight local hematoma, possibly with bruising, occurs within 2 to 3 days.

The tear is partial: not across the entire width of the muscle.

Severe Contusions or Tears: Grade III

An injury extending across the entire transverse section of the muscle, causing near-total loss of muscle function and intense pain: complete tear or rupture.

The structural failure of the muscle is evident, and the bruising is usually extensive, often distant from the rupture site.

How to Be Sure It’s a Tear and Not Something Else?

Tears and strains usually occur after a sudden movement, often while playing sports. They can also occur during a coughing fit, particularly for tears in the back or ribs.

The commonly observed symptoms are:

• Intense and sudden pain that remains present for several days in a less intense form, both at rest and when using the injured limb;
• Pain localized more in the middle of a muscle or body segment, rather than near a joint;
• A popping sound at the moment of a sudden movement: “pop!”;
• A hematoma or swelling in the injured area.

If you consult a doctor or physiotherapist for this problem, a differential diagnosis will be performed to rule out other causes with similar symptoms: a sprain, tendon rupture, fracture, simple contusion, tendinopathy, etc.

Generally, the diagnosis is made simply by examining you and asking questions. In case of doubt, imaging such as an ultrasound, X-ray, or MRI may be prescribed, but they are not essential for making the diagnosis.

The Most Common Locations for Muscle Tears Are:

• The triceps surae, in the calf: especially in athletics and racket sports;
• The quadriceps and hamstrings, in the front and back of the thigh: especially in football, rugby, or athletics;
• The biceps, in the arm;
• The rotator cuff, in the shoulder: especially in tennis, baseball, or weightlifting;
• The adductors, inside the thigh: in sports involving quick direction changes or lateral movements, such as soccer or ice hockey.

More than 90% of all sports-related injuries are contusions or strains/tears [SantAnna 2022].

What is the Healing Time?

The healing of skeletal muscles follows a consistent order, without major changes depending on the cause (contusion, strain/tear, or laceration).

Three phases have been identified in this process: destruction, repair, and remodeling. The last two phases (repair and remodeling) overlap and are closely linked.

Phase 1: Destruction

This phase is characterized by the rupture and necrosis (death) of damaged muscle fibers, the formation of hematomas in the space created between the ruptured muscles, and the proliferation of inflammatory cells.

Phase 2: Repair and Remodeling

This phase involves the removal of dead cells, the regeneration of new muscle fibers (myofibers), and the production of connective scar tissue along with new blood vessels and nerve endings.

Phase 3: Remodeling

The more numerous and significant the injuries, the longer these three phases take.

For a Grade II strain or tear, the time for new fiber regeneration is often 2 to 3 weeks. It is usually possible to resume physical activity slowly and gradually after about a month.

For a Grade III tear, healing can take up to 3 or 4 months. Pain may persist for several weeks.

Source: SantAnna 2022

What to Do to Treat This Muscle Tear?

Time is a key factor in healing, and whatever you implement, there is an unavoidable time required for the damaged muscle fibers to heal.

They heal and regenerate on their own, without any external intervention! Our body is very capable of repairing itself in this context, as long as the process is not hindered.

In the hours following the injury, applying ice, wearing compression (sock or sleeve for the arm), and elevating the injured limb (PRICE protocol) is recommended.

Rest

The main treatment strategy is complete or partial rest of the body part affected by the strain or muscle tear.

For example, if the affected muscle is the calf:

• Running will not be possible for a few weeks;
• Walking will be possible in a limited manner, on flat terrain and at low intensity, with crutches for 3 to 7 days initially if necessary;
• Jumping should be avoided absolutely;
• Core exercises, arm strengthening, and muscle strengthening exercises involving only the uninjured lower limb can be continued.

Physiotherapy?

Physiotherapy sessions are often prescribed in cases of strain or tear, especially if you are very active in sports.

One of the roles of physiotherapists is precisely to help you identify what you can and cannot do in your specific context.

Depending on the specific injury you have, as well as your lifestyle, goals, and perspective: do you lean towards caution, or are you very eager to resume sports even if it means taking risks?

In some cases, progressive muscle strengthening may also be recommended, as well as gradually performing stretches targeting the torn muscle.

Some physiotherapists also use physiotherapy treatments for this type of muscle injury: extracorporeal shock wave therapy, therapeutic ultrasound, electrotherapy, cryotherapy, etc. Although there is no strong empirical evidence of faster recovery when these methods are implemented.

Medications?

Some low-quality and poorly replicated studies show a potential benefit of taking anti-inflammatory drugs (NSAIDs) in the first few days [SantAnna 2022].

Surgery?

Surgery is very rarely proposed [SantAnna 2022]:

• When more than half of the muscle is torn and there is a significant muscle hematoma;
• In case of persistent pain during stretching 4 to 6 months after the injury.

The surgery also requires strict rest for at least 4 to 6 weeks for the muscle fibers to heal.

Home Remedies?

Given the lack of quality evidence supporting more tested treatments based on stronger theoretical foundations, I doubt there is any real benefit to the home remedies sometimes suggested for muscle tears: consumption of foods such as ginger, pumpkin seeds, balms for application, etc.

When to Resume Sports?

Here are the average times observed before resuming sports in professional football players who have had a strain or tear [Parlermi 2023]:

The average times before resuming sports are:

• 24 days for a quadriceps tear;
• 22 days for hamstring tears;
• 21 days for a calf tear.

Note that these are professional athletes who are accustomed to heavy training loads. Depending on the sport you practice and your physical condition, the recovery times may vary.

This is why it is important to discuss with your doctor or physiotherapist if you want an external opinion from someone experienced in supervising this type of rehabilitation!

How to Avoid Another Muscle Tear?

Recurrent muscle injuries are more common among amateur athletes (48.4%) than professionals (16.2%).

A recurrence is when a new injury occurs in the same muscle 2 months to 1 year after the first injury. This happens to 1 in 10 to 4 in 10 people, depending on the sports and muscles involved.

The most commonly affected muscles are:

• The hamstrings (biceps femoris, back of the thigh),
• The rectus femoris (front of the thigh, quadriceps),
• The medial gastrocnemius (calf).

Preventing a tear or recurrence primarily relies on proper strength training for a given muscle group. Eccentric exercises have the strongest evidence for preventing recurrences.

Training with a workload appropriate to one’s capacities and increasing it progressively is key to minimizing the risk of injury.

Finding the right balance is an art! This is the role of coaches, physical trainers, physiotherapists, doctors, and also the athletes.

Ideally, the intensity, frequency, and duration of training should be individualized based on each person’s characteristics.

This is something rarely seen in amateur sports clubs, especially in youth categories, where consistent attendance at training sessions is not always present, making it difficult for coaches to individually monitor each athlete’s training load.

Source: Palermi 2023