Muscle Strain | Muscle Tear - Symptoms and More Information About Common Muscle Injuries

In a muscle strain (distension), the muscle fibers are stretched excessively beyond their elastic limits. This leads to irritation and inflammation in the muscle tissue, which gradually increases. Unlike a muscle fiber tear, however, there is no actual tear in the muscle fibers—only severe overstretching.

Since the tissue of the affected muscle remains intact, there is usually no bleeding. Typically, however, the inflammatory response causes swelling of the muscle tissue, which can vary in severity depending on the extent of the injury.

The video shows how muscle fibers are structured:

The most common cause of a muscle strain is improper loading, in which the tense muscles are suddenly overstretched. This often happens during sports, especially when accelerating abruptly—such as during a quick start or a final sprint.

Rapid transitions between accelerating and decelerating or changes in direction—such as in tennis or soccer—are also typical causes of muscle strains. Athletes who haven’t warmed up are particularly at risk, as their muscles are significantly more susceptible to injury. Muscles that have been stretched during a warm-up are significantly less prone to overstretching and muscle strains.

Overuse of a muscle due to a forceful, frequently repeated movement during sports or work can also trigger such an injury. Muscle strains are therefore not just an issue for athletes. Almost everyone who does physically demanding work has to deal with an unpleasant muscle strain from time to time.

A muscle strain can affect any muscle. However, there are muscle groups that are particularly susceptible to this. These include, in particular, the leg muscles—especially the thigh and calf muscles. Groin strains (adductor strains) are also well-known and dreaded. 

The muscles of the upper extremities—specifically the shoulder and arm—are affected less frequently. This is partly because the muscles in the legs are generally much stronger and more developed than those in the arms. The chest and back muscles can also be strained, though this is significantly less common than strains of the leg muscles. 

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A muscle strain causes pain that often intensifies at first and reaches its peak after about 48 hours. This is due to increasing inflammation of the tissue and the resulting swelling. In addition, the injured muscle stiffens, and if the strain continues, those affected experience cramp-like, pulling pains. Even stretching exercises and shaking the affected area have no effect and do not alleviate the symptoms. The symptoms usually subside with rest, which is why people typically voluntarily refrain from physical activities and sports training until they are pain-free again.

A muscle strain can usually be diagnosed based solely on the circumstances of the injury and the symptoms described. Patients typically report

• unfamiliar, athletic exertion,
• starting a new job that places excessive strain on specific muscle groups, or
• a “strange” movement (e.g., lunge, stumbling, slipping) during training or competition.

During the physical examination, a tender spot in the area of the affected muscle is almost always palpable. Relatively soon after the injury, discoloration often develops due to an increasing bruise. Swelling of the affected muscle and redness of the overlying skin are also frequently observed.

An ultrasound examination also provides a simple and reliable way to visualize the injured muscle. This usually reveals swelling and a bruise in the affected muscle.

If an injury to the bony attachment structures (tendons) is suspected, or in cases of very prolonged and severe illness, an MRI scan may well be ordered to rule out other conditions such as a muscle tear or other issues. This imaging method provides an even more reliable and detailed view of the tissue than ultrasound. If a bone injury is suspected, an X-ray is recommended. 

Staying calm is particularly important when treating a muscle strain: so stop exercising or engaging in strenuous activity immediately! The affected area now needs rest.

In acute cases, the RICE rule is the recommended immediate measure:

• P - REST
• E - ICE
• C - Compression
• H - Elevation

Cooling the area as quickly as possible helps—for example, using ice packs, cold water compresses, or by immersing the injured body part (including taking a bath) in cool water. However, ice should never be applied directly to the skin; it should be wrapped in a protective cloth. 

Heat is contraindicated during the acute phase (the phase immediately following the accident), which means you should absolutely avoid applying heat. Applying heat actually promotes the inflammatory process and increases both swelling and pain. Therefore, do not apply heat under any circumstances during the acute phase!

After initial cooling, it is recommended to consistently rest the strained muscle. This is best achieved by immobilizing it with a supportive and protective elastic bandage (compression bandage). Bandages have also proven very effective. Special shoes or rigid casts (e.g., plaster casts) are not necessary.

However, elevating the affected area can be very helpful and quickly relieve pain. The reduced blood flow also often significantly reduces swelling, and bruising occurs rarely or much more slowly. Elevation also allows the body to more easily drain the fluid that has leaked into the surrounding tissue. Swelling is a major cause of pain in muscle strains, so elevation is usually found to be very comfortable.

Massage is also very helpful and supportive of the healing process. It promotes recovery of the injured muscles and reduces existing swelling. In addition, massage therapy is generally very pleasant for the patient. 

Once the acute symptoms have subsided, heat therapy can also be helpful, though it should be used in moderation and depending on whether and how well the patient tolerates it. Ointments that promote blood circulation and provide warmth can also be used for this purpose. 

A healthy diet rich in magnesium and protein, along with adequate fluid intake, helps the body regenerate the damaged muscles and more easily flush out the fluid that has leaked into the tissue as a result of the inflammatory process. 

The duration of the rest period for a muscle strain depends on the type and severity of the strain. It also depends on which muscle is affected. If a muscle strain does not show significant improvement within a few days, medical attention should be sought. What appears to be a muscle strain may actually be a torn muscle fiber or an injury to tendons or bones. For this reason, a prolonged course of symptoms and increasing pain should be taken very seriously and require a medical examination. 

Often, a visit to your primary care physician is sufficient; they will then decide whether a referral to a specialist (in trauma surgery, orthopedics, or sports medicine) is necessary. The specialist may then order further tests and determine how long the recovery period should be. However, it is always necessary to balance the need for muscle recovery against the disadvantages of a prolonged break from training. For this reason, highly motivated professional athletes in particular will want to keep the recovery period as short as possible. Nevertheless, resuming training too soon can have long-term negative consequences, which for professional athletes can lead to a decline in performance or even the end of their athletic career. Experience shows that a rest period of 5–7 days is sufficient for a muscle strain to heal.

What is the difference between a muscle strain and a muscle tear?

A muscle strain occurs when muscle fibers are overstretched without actually tearing. A muscle fiber tear, on the other hand, involves a partial or complete tear of the muscle fibers. Accordingly, a muscle fiber tear is usually more painful and takes significantly longer to heal.

How do you know if you have a muscle strain?

Typical symptoms of a muscle strain include a pulling pain, muscle stiffness, tenderness, and limited range of motion. The pain often increases within the first 48 hours and subsides with rest.

What is the best way to treat a muscle strain during the acute phase?

During the acute phase, the RICE method should be followed: Rest, Ice, Compression, and Elevation. Cooling and rest relieve pain and prevent swelling. After the acute phase, gentle movement, heat, or ointments that promote blood circulation aid in recovery.

How long does it take for a muscle strain to heal?

Depending on the severity, a muscle strain usually heals within 5–7 days. If symptoms persist or worsen, you should see a doctor to rule out a torn muscle fiber or other injuries.