Pulling a muscle sucks, and figuring out if it's an actual strain that needs attention sucks even more. We've all experienced strains, cramps, soreness and general tightness, but it doesn't help that these all seem to cause varying degrees of similar pain. Here's how to tell if it's really a pulled muscle and what you can do about it. Illustration by Fruzsina Kuhari.
Sharp pain in general is a pretty fair indicator of something nasty, but it's also very complex. You'd probably be busy worrying about whether you can or should continue working out, either a bit later or in the days after. So, it's important to determine that you do have a pulled muscle and not some other type of pain, like our good friend delayed-onset muscle soreness (DOMS). It's a very simple but common mistake. Luckily, there are a couple of things to look out for.
Is It Really A Pulled Muscle?
First of all, a pulled muscle is the colloquial term for a muscle strain. A strain, then, is essentially a traumatic tearing of muscle tissue, although I've seen "pulled muscle" used to signify relatively minor (but still painful) instances -- they all still mean a tear of some sort. The more muscle fibres you tear, the more serious the strain and the more pain you'll likely feel (though sometimes the pain can come slowly). There are rarer cases where the muscle is totally ripped apart, in which case you've got a muscle rupture, AKA a real doozy.
When you pull a muscle, it usually happens suddenly, and you'll know something's gone horribly wrong in that instant. Because a pulled muscle can be easily confused with other types of injuries like sprains or hernias, a major differentiator, according to Paul Ingraham, science writer at PainScience.com, is that a muscle strain makes just one muscle (or muscle group) feel weak and the muscle contraction painful.
Basically, you'd feel more pain during the lengthening (eccentric) portion of the movement and during resistance tests, says Justin Kobbe Solace, a board certified massage therapist and pain management specialist at Hybrid Health. In more severe cases, there'll be signs of inflammation, like swelling, redness and warmth on the skin, and possible bruising. At that point, don't try to play it cool; get some medical help.
How Pulled Muscles Happen
The bummer about pulling a muscle is that you don't have to be doing anything badarse. True story: a relative of mine strained his back from picking up his dog. Strains can just happen when you force your muscles to do more than they are used to doing, perhaps from overly aggressive stretching, making really abrupt movements (such as slipping and falling) or lifting something heavy (like a 27kg Golden Retriever in my cousin's case) in an awkward manner.
While you can pull virtually any muscle in your body, strains are way more common in bigger muscles, such as in your hamstrings, calves, quads, biceps and back muscles. Certain sports like basketball, football and track are notorious for a higher probability of a strain. I know I've definitely had or seen a fair share of pulled hamstrings from my track and field days.
Basically, all those really explosive movements -- the quick cuts, the sprints from a dead-stop, or the jumps to reach a 3m basket -- make it likely to overstretch and tear muscles, especially if your muscles aren't properly warmed up, if you have weak muscles in general, or you're fatigued. But pulled muscles can also happen because of repetitive motions or overuse of the muscle (think rowing, golfing, running or factory work in an assembly line), and those things can lead to gradual wear... and eventually tear.
On the other hand, if you woke up feeling like some places are stiff and painful, then you're probably just sore. Sure, it might be a miserable for a day or two, but just be glad your muscles could be growing instead.
Stretching Does More Harm Than Good
Your first instinct might be to stretch a pulled muscle, but think about it for a second: if a pulled muscle is a result of overstretching, then stretching it further to its full range of motion won't help. Instead, your safest bet is to simply avoid anything that would agitate the injured muscle and give it as many days as it needs to calm down.
The universally recommended initial treatment for pulled muscles is R.I.C.E., which stands for rest, ice, compression and elevation. No surprise there, as it seems to be the framework for many other soft-tissue injuries as well. Interestingly, though, the authors of this paper in the Journal of the American Academy of Orthopaedic Surgeons and this one in the Journal of Athletic Training mention that the efficacy of I.C.E. in R.I.C.E. for muscle strains in particular haven't been fully studied. Still, "their employment is generally recommended."
That's to say that icing, compression and elevation probably don't treat the actual strain, but icing and compression can help numb the pain at least.
If you grit your teeth and exercise through the pain too soon, you might end up making the injury worse, which could eventually lead to re-injury or chronic injury, says Solace. If it's a minor strain, do what you can as far as gently moving your muscle through its range of motion after a couple of days of rest. Stop if or when it's painful. Solace adds that this way, you encourage blood flow to aid in the healing process.
Many minor strains and injuries can resolve with time and proper rest, but if the pain gets worse or you don't see any improvements after a reasonable number of days, then it's time to get medical help. The ideal doctor to help is someone trained in musculoskeletal medicine, but not all family doctors (yes, including yours) are well-suited to properly diagnose muscular injuries.
Check with your insurance provider or your physician to refer you to a specialist in muscular or sports-related injuries. If you're still unsure if you pulled a muscle, you can look for a doctor or physical therapist who specialises in that particular region of the body where you're experiencing pain. For example, if you hurt your low back, check with a spine specialist.
How to Prevent Future Muscle Strains
You've probably heard the advice to stretch and generally keep yourself "flexible", and you won't strain your muscles. However, a review of the research into the topic shows that regular stretching doesn't help keep you from pulling a muscle (or preventing injuries in general). So, what does work? A good warm-up, but keep in mind an effective warm-up doesn't necessarily include static stretching.
Instead, focus on moving your muscles and joints through a <full range of motion with "dynamic stretching", and prepare for your workout by doing less intense versions of your actual exercise. For example, if you're warming up for squats, try bodyweight squats and work your way up to your real "working set". If you're working out in cold weather, put in a little extra time to warm up. Here are a few other things to keep in mind:
- Know when you're ready to go again: Going back to your regular workouts should be based on the return of your strength and range of motion, rather than by a set recovery period. Of course, this will vary depending on the severity of the strain, but the key is to keep things pain-free. When you do get back to it, slowly ramp up the intensity week-by-week according to how your injury feels.
- Minimise intense activity when you're really tired: You are much more prone to any sort of injury when you're tired or fatigued, so don't try to push through workouts, especially if your form, alertness, and technique start to fall off.
- Start slow: If you're starting a new program, exercise, or sport, it's important to ease yourself into it so you can learn to recognise when you should push or back off.
The good news is that our bodies are amazingly resilient, and we can make them stronger. Of course, it will take effort. In the case of rehabilitation from a serious injury, professional supervision by a physical therapist, trainer or doctor is necessary to make sure you're doing your exercises and stretches correctly to strengthen and keep an injured muscle healthy.