Riiiiiip!
Muscle strains strike most often in the big muscles of the body. But sometimes the pain is not what it seems …
Save Yourself from
Muscle Strain!
AN ADVANCED TUTORIAL FOR PATIENTS AND PROFESSIONALS
Muscle strain (pulled muscle) and muscle pain explained and discussed in great detail, plus every imaginable treatment option
by Paul Ingraham, Vancouver, Canada (qualifications)
Welcome to the most detailed information about muscle strain and pain available anywhere, especially for tough and stubborn cases. This is more than just a web page: it’s bigger than it looks, a pair of online books — many dozens of chapters and over 70,000 words — for both patients and professionals that explores every myth and controversy, and every possible way of reducing pain coming from muscle. It is more scientifically current than any competitive information source, yet also more user-friendly and readable.
What is muscle injury? Is your muscle actually injured? What works? What doesn’t? Muscle strain and pain are usually woven together. Somewhere in your body, something hurts and you think it’s got to be a muscle strain or a muscle spasm or … well, something to do with a muscle anyway. If you’re like most people with muscle pain, you’re not sure exactly what the problem is, and you’re looking for some answers.
Attention physicians & therapists
This tutorial is written for both patients and professionals. It includes detailed analysis of recent research that you won’t find in any textbook, and the document is crafted to suit any skill level. For instance, user-friendly footnotes add an optional layer of detail. See my reading guide for professionals.
Muscle strain and pain myths and misconceptions
Believe it or not, muscle pain is a subject of great scientific mystery and many myths and misconceptions. A torn muscle is arguably among the most medically neglected of all common injuries.12 Odds are good that your family doctor is not competent to assess and treat musculoskeletal problems, including muscle strains.3
And so, although most muscle pain is relatively simple to diagnose and self-treat, an incredible number of people end up in my office who either have muscle strains that have been misdiagnosed as something else, or they have “something else” that’s been misdiagnosed as a muscle strain. Strain, pain, spasm, contracture, scar tissue, tone and tension are all poorly understood and routinely confused. They are not only surprisingly complex topics scientifically, but clinicians are not generally aware of the research that has been done.
It would be nice, for once, if someone came to my office with a muscle pain that had been accurately diagnosed … but it almost never happens! So I wrote this tutorial, because clearly there is a need for it. The world obviously needs more and better information about muscle pain. And if you’ve read this far, then so do you!
An incredible number of people end up in my office who either have muscle strains that have been misdiagnosed as something else … or vice versa!
What would Adam & Jamie do? You know, if they were doctors?
How can you trust this information about muscle strain and pain?
I’m inspired by the MythBusters approach: I question everything and I have fun doing it. (No explosions, alas.) I assume that anything that sounds too good to be true probably is. I make no big promises, I do not claim to know the one true cause of anything, and I am not selling a treatment system or my own services. I say “I don’t know” when I don’t know and I say “I’m guessing” when I’m guessing. I actually read scientific journals, I clearly explain the science behind every key point (there are more than 30 footnotes here), and I link to the original sources so you can check them yourself. I hang out with doctors. I study harder than I ever did in school. Much harder.
Some of my favourite sources
I spend a lot of time on PubMed, and I cite from the best sources whenever possible, like The Cochrane Collaboration and The New England Journal of Medicine and PLoS Medicine.
So all the science and all the options for muscle strain treatment are here. If you’ve been struggling with pulled muscle injury, I think this tutorial will feel like a “good find” to you!
You are going to know all about muscle strain by the time you get to the end of this document. In fact, you’re going to know more about muscle pain — and how to treat it — than all your friends and neighbours, and probably more about it than your family doctor or your physiotherapist!
As with all the tutorials on SaveYourself.ca, I’ve worked hard to provide you with the best information available anywhere — not just better researched and referenced, but also regularly updated, and presented in a clear, friendly style that’s just like coming to my office and having a nice long conversation about it, where all your questions get answered.
So what is a muscle strain?
Actually, it's simple: any torn muscle is called a muscle strain (and this is the same as a “pulled muscle”).
(A torn muscle is never called a “sprain.” Sprains always refer to torn ligaments. There’s actually no such thing as a “muscle sprain” — it’s a contradiction in terms.4).
Although you might have problems that make you vulnerable to a muscle strain, the direct cause of every muscle strain is traumatic ripping of the muscle tissue — arg! — usually at the point where the muscle meets its tendon. Muscle will tear under the force of your own muscular contraction, or excessive stretch.
The more muscle fibres are torn, the worse the strain. In the case of a serious strain, the entire muscle may completely rupture — literally ripped in half! Double arg!
Muscle strains are particularly common in the thigh and groin in soccer, ultimate, hockey and other fast-moving team sports.
Sometimes an impact or a laceration damages muscle fibres in such a way that the injury is basically like a muscle strain. We won’t discuss this scenario much, because there’s not much medical mystery involved if you were gouged by a hockey skate. We also won’t discuss full muscle ruptures in much detail, because they are so extreme that they are easy to diagnose — even doctors can do it! 
If you have a doctor who can’t help you with lacerations and contusions, you really need a new doctor.
The more muscle fibres are torn, the worse the strain.
There will be much (much) more detail below about exactly what a muscle strain is, and its complications, and how to treat it, and so on. But before we get into that, it’s important to determine whether or not you actually have a muscle strain, or some other kind of muscle pain.
How do you know that you’ve got a muscle strain?
Muscle strains and especially muscle ruptures are actually surprisingly rare, compared to other causes of muscle pain. Funny thing about this tutorial: most people who find this document, like most people who think they have strained a muscle, have actually not done any such thing — or (just as common) they strained a muscle once upon a time, but the strain healed long ago and has since become an entirely different problem.
This could be you!
Most people who think they have strained a muscle have actually not done any such thing.
Some of the things that get confused with muscle strains are (and these will all be covered in more detail below):
- Spasms, cramps, and charlie horses are whole muscle contractions, ranging from uncomfortable to those howling, awful attacks that usually afflict the calves and feet.
- Nasty muscle knots, technically known as trigger points, are small patches of localized muscle spasm and involve no actual damage to the muscle.
- Delayed onset muscle soreness, a.k.a. DOMS or PEMS, is that savage muscle soreness we all get after an unfamiliar workout … but it always (really) fades after about three days, guaranteed.
- Low back pain is a complex phenomenon which routinely gets attributed to muscle strain, when in fact it is very rarely caused by muscle strain. Just about the only time low back pain is ever caused by muscle strain is when you have a sudden, severe onset of pain while trying to move a hide-a-bed down some stairs … or something like that. If you have low back pain, I recommend that you stop reading this article right now and head on over to Save Yourself from Low Back Pain!)
True muscle strain checklist
Here’s a checklist of the signs and symptoms of a true pulled muscle. If you can say, “Yeah, that’s me,” to all of these, then congratulations: you probably have an actual, certifiable, card-carrying Muscle Strain®.
Did it hit you suddenly during strong stretching or an moment of athletic intensity? In other words, did you have an “oh, shit” moment?
Is the injury fairly recent? A few weeks old at the most?
Do you have just one muscle (or muscle group) that’s both weak and painful to use?
Is there a spot in the muscle that’s especially sensitive? (It may even be little bit deformed — is there a bump or a depression?)
If you “woke up with it,” or the pain came on slowly over several days, or if it’s six months old, or if the pain isn’t consistently in one particular place … then we’ll be talking about other possibilities.
The “oh shit” moment: the most essential sign of muscle strain
Muscle strain cannot occur without an “oh shit” moment. (It’s fun to explain oh-shit moments to my patients — it always gets a laugh!) In other words, it hits suddenly: you know that something nasty has happened
End of free introduction to this tutorial
Full access to the rest of this tutorial, including a complete second book about muscle knots, is available immediately for USD$1995. Click the “Buy Now” button to purchase access, and then continue reading this document immediately.
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Yes! The store is digitally secure and safer than a bank machine. My store is managed by a great little company, eSellerate, in Nebraska. I talk to folks there often.
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The store uses a secure (SSL) server, which means that all information you send to the store is encrypted so that it’s virtually impossible for hackers to read. Hackers rarely try to crack this kind of encryption — it’s not worth their effort.
Why do you ask for personal contact information?
I have to — it’s required by law to prevent fraud. However, Big Brother is not watching my customer database, and I have no use for your personal information. If you want, just fill in fake contact information. People do it all the time! I do need a real email address, or you won’t get a receipt.
For more information, see Security, Privacy & Refund Policies.
- What do you get, exactly? It’s not a physical book! You buy online access to the tutorial for 90 days.DETAILSYou can also print it, or save it. The full strain tutorial is about 10,000 words — about the length of a long feature article in a magazine — plus another 85,000 words in the companion book about muscle knots.
What am I buying? Is there a physical book?
No, there is no actual book. I sell online access to pages on SaveYourself.ca, just as scientific journals sell access to their articles — this is known as a “document-access” business model. You buy the right to visit the tutorial online for 90 days. Until you pay, it’s impossible to get to. While you have access, you can read the tutorial online. To preserve your purchase, you can print the tutorial, or save it as a webarchive file (instructions available to customers).
I’d rather read a book. Will you be publishing a book?
Almost certainly, but not for a while yet. For now I prefer to sell access to webpages. They are simply a better product: cheaper to produce, update, and deliver.
Do I have to download anything? Is there a PDF?
No, there is no file to download and store. There are several issues with PDFs: they are hard to update, glitchy and unreliable, difficult for some beginners to use, and more. Tutorials in the form of webpages are the superior product.
- Buy more and save 50%! Buy an “eBoxed set” of all eight SaveYourself.ca eBooks for great savings.DETAILS
What is the “eBoxed” set, and how does it save you 50%?
An eBoxed set is a bundle of all eight eBooks about pain problems for sale on this website, ideal for professionals, keen patients and anyone who wants more for less. Purchased individually, they would run you about $160, but the set is only $79.50 — a savings of $80.
Benefits include the savings, a full-year subscription, and inexpensive renewal forever.
Want only 5 tutorials? No problem. Just let me know which ones you’d like.
| Company | Regeneration Training |
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| Owner | Paul Ingraham |
| Location | 888 Pacific St Vancouver, Canada V6Z2S6 |
| Service | 778-968-0930 support@SaveYourself.ca |
| Guarantee | 100% money-back |
| Read More | company policies |
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Plus …
- Free second tutorial! When you buy this tutorial, you will also get Save Yourself from Trigger Points and Myofascial Pain Syndrome! — a $1995 value. Muscle strain (injury) and muscle pain (knots) are so intertwined and confused that most readers need information about both. I supply both for the price of one: a 2-volume set. You automatically get both when you purchase here.
Volume I Contents
Here’s a sneak peak of the Table of Contents for the muscle strain and pain tutorial…
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To get access to all 33 sections, purchase the tutorial for $19.95. You’ll receive the full version right away.
 90 days access print or save 100% money-back guarantee exhaustively researched constantly updated reader questions answered 10,000 words 33 sections 26 footnotes all myths & controversies all diagnostic issues all treatment options
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Volume II Contents
And here’s a sneak peak of the Table of Contents for the trigger points tutorial, which is delivered automatically with the muscle pain tutorial (yes, it’s much bigger)…
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To get access to all 129 sections, purchase the pair of tutorials for $19.95. You’ll receive the full version right away.
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Testimonials
Here are some of the nicest things that readers have said about my muscle strain and pain tutorial over the years. 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
Paul Farley, West Sussex, England
Paul Farley, West Sussex, England
Juanita Vannay
Robin
One more special testimonial. 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:
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.
What’s New In the Muscle Strain And Pain Tutorial?
Thursday, October 1, 2009 — Added a section on anti-inflammatory medications, and included Voltaren® Gel, an excellent treatment option for muscle strain that only recently got into my radar. You can read about Voltaren in a free article as well as here in the tutorial, but the tutorial covers the topic specifically as it relates to muscle strain.
Wednesday, July 1, 2009 — Major bibliography update. The SaveYourself.ca bibliography has long been the largest of its kind. It contains an incredible amount of surprisingly readable information about musculoskeletal health science, and it is now possible for visitors to search and sort the bibliography with powerful new features. For instance, every source about muscle strain and pain referenced in this tutorial can now easily be displayed in a single search, with a variety of options. See the front page for the announcement of the new features, or visit the bibliography itself.
Wednesday, April 8, 2009 — Added an intriguing new section about a new treatment for muscle strains, a drug called “suramin,” that may be slightly miraculous. For a little while, you can read about this for free on the front page of SaveYourself.ca.Wednesday, April 1, 2009 — The visual design of the site was upgraded over the past several days. Although this is not an update to the content of this tutorial, it is nevertheless a significant upgrade for all of them — like publishing new editions of books with better typesetting and layout. The new design is even cleaner and reader-friendly; it now looks that good in most web browsers; and pages load as much as 50% faster. Many under-the-hood improvements will make it much easier for me to improve tutorial content. The tutorials are now well-oiled machines of digital publishing goodness, vastly superior to the low-production values of most eBooks. More information about the upgrade is published on the front page.
Tuesday, February 3, 2009 — Added a small new section about Traumeel, a popular but questionable remedy that I often get asked about. See the section, “Don’t bother with Traumeel either,” or the free article, Does Traumeel Work?.
Thursday, December 4, 2008 — It’s been a long time since the last update to this tutorial! It doesn’t get much love, because muscle strain is actually pretty straightforward compared to the other subjects I write about. Most of the complexity of treating muscle strain concerns its interactions with trigger points, and that is what this update is about! I recently published a (free) article about a serious shoulder injury I suffered (not a strain, but same difference) which became even more seriously complicated by the formation of trigger points. I’ve integrated some of these ideas, and a nice new graph, into the muscle strain tutorial in the section, “Muscle strains that don’t heal have usually been hijacked by trigger points”. You can also read the story of my own injury, Into the Fire: Trigger point pain as a major injury complication, and how I finally “miraculously” healed from a serious and stubborn shoulder injury by untying the muscle knots.
Wednesday, January 16, 2008 — Introduced special offer: all muscle strain and pain tutorial customers now receive a second, companion tutorial at no charge, Save Yourself from Trigger Points & Myofascial Pain Syndrome! This is a really great deal, and a valuable extension to this tutorial.
Wednesday, November 21, 2007 — This tutorial has been around for quite a while (2 or 3 years I think), but I just started tracking changes! I made a bunch of improvements to the introductory sections so that it’s clearer who the tutorial is for. Also beefed up descriptions of conditions that get mistaken for muscle strain.
Further Reading
Here are several additional articles of interest:
- SYSave Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
- SYEccentric Contraction — A peculiar phenomenon in muscle physiology
- SYDo Epsom Salts Work? — There is (still) no good reason to believe that Epsom salt baths aid recovery from muscle pain, soreness or injury
- SYSave Yourself from Neck Pain! — Many chronic neck pain treatment options explained and discussed in detail, supported by clearly explained scientific research
- SYYou Can’t Beat DOMS! — The myth of treatment for nature’s little tax on exercise, delayed onset muscle soreness (DOMS)
And here are the articles recommended for those of you who may have muscle knots, as opposed to a muscle strain:
- SYSave Yourself from Trigger Points & Myofascial Pain Syndrome! — Trigger points (also known as muscle knots) and myofascial pain syndrome, explained and discussed in great detail, including every imaginable self-treatment and therapy option for difficult cases
- SYDance of the Sarcomeres — A mental picture of muscle knot physiology explains four familiar features of muscle pain
- SYStretching for Trigger Points — Is muscle knot release a good reason to stretch?
- SYBasic Self-Massage Tips for Myofascial Trigger Points — Learn how to massage your own trigger points (muscle knots)
Acknowledgements
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.
Notes
- 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.” Return to text.
- 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. Return to text.
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 numerous studies showing that most doctors do not understand aches and pains. 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 felt that “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” Then again in 2005 in JBJS, Matzkin concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.” Most recently, in 2006, Stockard wrote “82% of allopathic graduates ... failed to demonstrate basic competency in musculoskeletal medicine.”
Return to text.- A torn ligament is always called a sprain, whereas a torn muscle is always called a strain. Return to text.
