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!

What would Adam & Jamie do? You know, if they were doctors?

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, and I do not claim to know the “one true cause” of muscle strain and pain. When I don’t know something, I admit it. I actually read scientific journals, I clearly explain the science behind every key point (there are more than 40 footnotes here), and I always link to the original sources.

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.

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.

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.

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.

In 2007, I was enjoying my athletic peak and managing, just barely, not to embarrass myself while playing quite a bit with some younger and more talented athletes. One hot night I was running low on electrolytes: too much sweating, not enough salt intake. (Actually, that’s a surprising myth.5) I was playing “goaltie,” a variant of ultimate: a hard-running Frisbee sport with the same intensity and speed as soccer, but with more jumping.

Both calves spasmed on a jump, bringing me down hard. That was nasty, but it was just the start: as soon as I hit the ground, both sets of hamstrings went off as well, and all that was more than enough to make for a good cramping story … but then my abdominals joined the fray, and that gave me an anecdote I’ll be sharing for the rest of my life.

The cramping all hurt, a lot, but I was too surprised and busy to focus on the pain. If you’ve ever had a strong spasm, you know that there’s a powerful instinct and need to elongate the muscles. Stretching is your only hope of relief. But I had a puzzle to solve: just try to stretch the backs of your legs and your abdominal muscles at the same time. It’s an anatomical impossibility.

ZOOM

That’s me in the air at the back. Check out that vertical! It was that kind of jump that triggered a massive wave of spasms …

I jackknifed back and forth so violently that the other players wondered if I was having a seizure, but I was simply on my impossible mission to stretch both sides of my body. If I stretched the legs, the abdominals would bunch up; if I stretched them, the leg muscles tried to kill me. After about three tries each way, I realized it couldn’t be done and that my only hope was compromise: to find the least awful position somewhere between the extremes. It meant that neither muscle group would really be stretched at all — but neither would be allowed to fully contract either. I gasped “cramps! lots of cramps!” so everyone knew I wasn’t actually having a seizure … and then waited it out.

Without the power of stretch, the cramps took a long time to fade. It was a long time to endure extremely powerful contractions.

A spasm is capable of injuring muscle. In this case, I was wrenching back and forth, my own muscles in a tug-of-war with each other. These were perfect conditions for injury. Something had to give, and it did — I had mild strains of all the affected muscles, resulting in not just days of soreness but severe soreness for weeks, and a vulnerability to re-injury that was still a problem a full year later.

The spasm here was the strong involuntary contraction of the muscles. The strain was the injury caused by the forces on the muscles.

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 a moment of athletic intensity? Were you lifting something way too danged heavy and/or awkward? In other words, did you have an “oh, shit” moment?
• Is the injury fairly recent? A few weeks old at the most? If it’s been a long time, it’s probably not a muscle strain any more — certainly not an acute one!
• 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?)
• Is the skin flushed and hot? Does it look puffy?

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. If your real problem is actually a painful “muscle knot,” for instance, you might want to take your knots for a nice massage — but massage is mostly pointless for a 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