This document and all of SaveYourself.ca was, for many years, created in my so-called “spare time” and with a lot of assistance from family and friends. Undying thanks to my wife, Kimberly, for countless indulgences large and small, and for being my “editor girlfriend”; to my parents for (possibly blind) faith in me, and much copyediting; and to Mike Gobbi, buddy and digital mentor, for many of the nifty features of this document (hidden and obvious). And thanks to all of the above, and many others, for many (many) answers to “what do you think of this?” emails.

Thanks finally to every reader, client, customer, and big tipper for your curiosity, your faith, and your feedback and suggestions and stores. Without you, all of this would be pointless.

And a few thanks to some health professionals who have been particularly inspiring to me: Dr. Steven Novella, Sam Homola, DC, Dr. Harriet Hall, Simon Singh, and Dr. Stephen Barrett.

Here is what some readers have said about the muscle strain and pain tutorial over the years. Feedback is always welcome. I focus on the positive in this section, but I want to acknowledge that I certainly do receive some criticisms as well. In many cases I respond by making improvements to the tutorial. However, the vast majority of feedback is enthusiastic. Thanks, everyone!

The internet is a dicey place to spend money ... so many scams. I wanted to let you know how appreciative I am of your eBook on muscle strains. When I got to the stop sign, I had to reflect and realized that the style and quality of what you had written was worth a gamble. Well, paying the twenty bucks and learning what I wanted to learn — and more — was worth every penny. I am now rehabbing my level 1 calf strain with full confidence and feel very well informed moving ahead. Good luck and keep writing — we need all the help we can get out here!

— Craig Adkins, tennis player and professional skiing cameraman, Portland, Oregon

Enjoyed your web site and found the advice extremely helpful having just strained my thigh muscle.

— Paul Farley, West Sussex, England

My strained thigh muscle felt like a broken bone at first, but I'm using your icing method and it’s responding brilliantly.

— Paul Farley, West Sussex, England

I found this article when I was researching how to heal my pulled muscle. I love the mobilization exercises at the end — great for a ‘desk jockey’ like me!

— Juanita Vannay

I read your article on muscle strains, and I was very impressed. You seem to really know your stuff. I wish there was one of you in every state!

— Robin

One more special comment. In the Spring of 2009, I received an incredible endorsement from Jonathon Tomlinson, a GP in Hackney, East London, praising the whole website and every tutorial:

I'm writing to congratulate and thank you for your impressive ongoing review of musculoskeletal research. I teach a course, Medicine in Society, at St. Leonards Hospital in Hoxton. I originally stumbled across your website whilst looking for information about pain for my medical students, and have recommended your tutorials to them. Your work deserves special mention for its transparency, evidence base, clear presentation, educational content, regular documented updates, and lack of any commercial promotional material.

— Dr. Jonathon Tomlinson, MBBS, DRCOG, MRCGP, MA, The Lawson Practice, London

High praise indeed! Thank you, Dr. Tomlinson — testimonials just don’t get much better than that.

Here are several additional articles of interest:

• SY Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
• SY Eccentric Contraction — A peculiar phenomenon in muscle physiology
• SY Do Epsom Salts Work? — There is (still) no good reason to believe that Epsom salt baths aid recovery from muscle pain, soreness or injury
• SY Save Yourself from Neck Pain! — All your treatment and self-help options for a crick in the neck explained and reviewed
• SY You Can’t Beat Muscle Soreness — The myth of prevention or treatment for muscle fever, nature’s little tax on exercise

And here are the articles recommended for those of you who may have muscle knots, as opposed to a muscle strain:

• SY Save Yourself from Trigger Points & Myofascial Pain Syndrome! — Trigger points (also known as muscle knots) & myofascial pain syndrome, explained and discussed in great detail, including every imaginable self-treatment and therapy option for difficult cases
• SY Dance of the Sarcomeres — A mental picture of muscle knot physiology explains four familiar features of muscle pain
• SY Stretching for Trigger Points — Is muscle knot release a good reason to stretch?
• SY Basic Self-Massage Tips for Myofascial Trigger Points — Learn how to massage your own trigger points (muscle knots)

A major feature of my tutorials is that I actively update them as new science and information becomes available. Unlike regular books, and even ebooks — which can be obsolete by the time they are published, and can go years between editions — this tutorial is updated at least once every three months and often much more. I also log updates, making it easy for readers to see what’s changed. This tutorial has gotten 11 major and minor updates worth logging since I started logging carefully in late 2009, and countless more minor tweaks and touch-ups.

New section (Mar 30 '12, section #4.17) — No notes. Just a new section. See section #4.17, Prevention: will water and electrolytes make a difference?

Update (Nov 2 '11, section #4.9) — Rewritten and expanded with important evidence about how stretching does not prevent strain injuries. See section #4.9, What about stretching? Can it treat or prevent strains?

Minor update (Jul 14 '11, section #2.2) — Added a (very) funny clip from the TV show Glee. See section #2.2, True muscle strain checklist.

Major update (Jun 21 '11, section #2.2) — Major improvements to the table of contents, and the display of information about updates like this one. Sections now have numbers for easier reference and bookmarking. The structure of the document has really be cleaned up in general, paving the way for efficient conversion to other formats (Kindle, Apple’s iBookstore, etc). Best of all, it is now significantly easier for me to update the tutorial — which will translate into more good content for readers. Care for more detail? Really? Here’s the full announcement. See section #2.2, True muscle strain checklist.

New artwork (Jun 8 '11, section #3.3) — Added a nice new diagram of strain severity. See section #3.3, What’s the worst case scenario for your muscle strain?

New section (Mar 12 '11, section #2.1) — No notes. Just a new section. See section #2.1, Cramp versus strain example: Multi-muscle cramping catastrophe on a hot summer night.

New section (Jan 18 '11, section #3.4) — Some useful new information about how to estimate healing time more accurately. See section #3.4, Healing time is hard to predict.

New section (Oct 5 '10, section #4.13) — Another new section and yet more good new evidence about prevention. See section #4.13, Prevention: Warmups work.

New section (Sep 15 '10, section #4.16) — New section based on solid new evidence about prevention. See section #4.16, Prevention: can you prevent muscle strains by upgrading your muscle balance?

New cover (Aug 6 '10, section #4.16) — At last! This e-book finally has a “cover.” SHOW See section #4.16, Prevention: can you prevent muscle strains by upgrading your muscle balance?

New section (Apr 9 '10, section #4.18) — No notes. Just a new section. See section #4.18, Is there anything to the platelet-rich plasma injection hype?

Older updates — Listed in a separate document, for anyone who cares to take a look.

1. Simons in The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, from the foreword. “Muscle is an orphan organ. No medical speciality claims it. As a consequence, no medical specialty is concerned with promoting funded research into the muscular causes of pain.” BACK TO TEXT
2. You can get a rough measure of how well-studied a subject is by doing a search for it on PubMed, a large database of citations to medical research. Searching for muscle strain is a bit tricky, because “muscle strain” is mentioned in lots of papers that aren’t really about muscle strain. But if you cleverly search for the terms “muscle strain” only in titles, you will get, as of 4/14/07, only 61 search results, even less than iliotibial band syndrome (another under-studied condition). Compare that to, say, 3000 for adhesive capsulitis (frozen shoulder), or 5900 for carpal tunnel syndrome. BACK TO TEXT

3. Most doctors are well aware that there are serious shortcomings in the medical management of most musculoskeletal problems, especially chronic pain cases. Dr. Jonathon Tomlinson, an instructor at St. Leonards Hospital in Hoxton, explains that “undergraduate training is focused on hospital orthopedics (broken bones and anything else that’s amenable to surgery) or rheumatology (nasty inflammatory diseases) which comprise a minority of the aches/pains/strains and injuries that people actually suffer from.”

   Medical researchers have done many studies showing that most doctors do not understand aches and pains or heed expert recommendations. A good recent example is a paper in the Archives of Internal Medicine showing that family doctors frequently ignore guidelines for the care of low back pain — see Williams et al.

   More generally, the Journal of Bone and Joint Surgery, and the Journal of the American Osteopathic Association, have both published papers recently showing that physicians simply do not have an adequate understanding of musculoskeletal medicine. In 2002, Freedman et al felt that “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” Then again in 2005 in JBJS, Matzkin et al concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.” Most recently, in 2006, Stockard et al wrote “82% of allopathic graduates ... failed to demonstrate basic competency in musculoskeletal medicine.”

   BACK TO TEXT
4. A torn ligament is always called a sprain, whereas a torn muscle is always called a strain. BACK TO TEXT
5. Was it really the electrolytes? No. That’s what I thought at the time, but a nice myth-busting 2011 experiment comparing crampy runners with their uncramped comrades showed clearly that dehydration was not the culprit. Fun science. See Schwellnus et al. BACK TO TEXT

There are 30 more footnotes in the full version of this book.
I like footnotes, and I try to have fun with them.

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