The pain of muscle strains

Most people follow a commonsense approach to soothing sore muscles: take it easy and maybe pop an over-the-counter pain remedy. In a day or so, the pain usually goes away. But what if it doesn't improve? Or if the pain becomes quite severe and affects mobility? Or if other symptoms appear? If so, then you may have a muscle strain, sometimes called a pulled muscle, which requires special attention.

Stretched to the limit

A muscle strain occurs when muscle fibers are stretched beyond their limits or forced to contract too strongly. They often strike the shoulders, neck, abdominal area, back, hips, and legs.

"Strains often occur when muscles are fatigued, overused, or not properly warmed up," says Dr. Robert Shmerling, former clinical chief at Harvard-affiliated Beth Israel Deaconess Medical Center's Division of Rheumatology. "An imbalance between weak and strong muscles can also cause a strain."

The risk of muscle strains is high during sports activities with quick start-and-stop motions, like tennis or basketball. But they can also happen from a single movement (such as using a too-heavy dumbbell), repeated motion (like the back-and-forth movement of raking leaves), or something as ordinary as stepping off a curb.

Soreness or strain?

You can tell the difference between regular muscle soreness and a strain by pain location and healing time. For instance, pain in a large area, such as your entire back, is likely caused by sore muscles. Pain in one specific area of your back could be a strain. If the pain eases after a few days, you probably have sore muscles. However, if the pain has not improved after several days — or if it has worsened — that's likely a sign of a significant muscle strain.

Muscle strains can have a spectrum of symptoms. Besides increasing pain, they can include severe soreness, swelling, throbbing, weakness, tenderness, and bruising. There are three grades of muscle strains, based on their severity:

Grade 1 (mild). Only a few muscle fibers are stretched or torn. Although the injured muscle is tender and painful, it has normal strength.

Grade 2 (moderate). This strain has more injured fibers and more severe muscle pain and tenderness. There is also mild swelling, noticeable loss of strength, and sometimes a bruise.

Grade 3 (severe). This strain tears the muscle all the way through, sometimes causing a "pop" sensation as the muscle rips into two separate pieces or shears away from its tendon. Grade 3 strains are serious injuries that cause significant loss of muscle function and considerable pain, swelling, tenderness, and discoloration. Because grade 3 strains usually cause a sharp break in the normal outline of the muscle, there may be a noticeable dent or gap under the skin where the pieces of muscle have separated.

Home treatments

You can treat most mild to moderate strains with home remedies. Begin with the RICE method (rest, ice, compression, and elevation), which also can be speed up the healing of regular sore muscles.

Rest. Rest the injured muscle (and take a temporary break from exercise and sports activities).

Ice. Apply an ice bag or gel pack wrapped in a cloth to the affected area for 15 to 20 minutes three or four times a day at least two hours apart. Don't apply ice directly to the skin; instead, put the ice in a towel or plastic bag before placing it on the sore area. Ice helps reduce swelling and inflammation. After a day or so, alternate between ice and heat.

Compression. Wrap the area in an elastic bandage. Make sure the pressure is snug but not too tight.

Elevation. For leg or arm muscle soreness, raise the affected limb to a level above your heart.

"Take over-the-counter pain relievers as needed, unless you've been advised by your doctors to avoid them," says Dr. Shmerling. The usual choice is a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve). Acetaminophen (Tylenol) eases pain but does not help with inflammation; people commonly take it when they want to avoid the side effect of an upset stomach common with NSAIDs.

Only take the recommended dose, and check with your doctor if you need more pain relief, especially if you have a history of heart, liver, stomach, or kidney disease. People also can try drugstore pain relief gels or creams. "There is no strong evidence to explain how they work, but they're thought to alter the body's pain perception," says Dr. Shmerling. Other remedies for mild to moderate strains include these:

Stretching. Gentle stretching promotes healing by re-establishing the normal length of the muscles.

Massage. Gently massage the injured muscle for 30 seconds at a time using your hands, a foam roller, or a tennis ball. This promotes the normal breakdown and repair of muscle tissue.

Hydration. Drink plenty of water throughout the day. Water can aid recovery by helping cells flush out waste products.

If symptoms don't improve after a week or if they become more severe, seek medical attention, as you may have a grade 3 strain or another problem.

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