Muscle Strain (Pulled Muscle)

Muscle strain vs sprain

See ligament sprain for joint injuries.

Causes and risk factors

• Sudden acceleration, sprinting or jumping
• Lifting heavy objects with poor technique
• Overstretching
• Overuse or repetitive movements
• Inadequate warm-up
• Muscle fatigue
• Tight or weak muscles, or imbalance between muscle groups
• Previous strain of the same muscle (the biggest risk factor)
• Cold weather
• Older age

Grades of muscle strain

Common muscle strains

• Hamstring: sudden pain at the back of the thigh during sprinting, often with a pop
• Calf (gastrocnemius): sharp pain in the calf when pushing off, sometimes called "tennis leg"
• Groin (adductors): pain in the inner thigh with kicking or changing direction
• Quadriceps: front of the thigh, from kicking or sprinting
• Lower back: pain and spasm after lifting or twisting. See low back pain
• Neck: after awkward sleeping, posture or whiplash. See neck strain
• Chest wall and intercostal muscles: from coughing or twisting
• Rotator cuff and biceps: from lifting or throwing

Symptoms

• Sudden pain during activity
• Tenderness over the injured muscle
• Swelling and bruising, which may appear over 1 to 2 days and track downward
• Muscle spasm
• Weakness or difficulty using the muscle
• Pain when stretching or contracting the muscle
• A visible gap or lump in severe tears

Diagnosis

Most strains are diagnosed by examination: where it hurts, how much strength is lost, and what movements cause pain. Imaging is used when a severe tear or tendon injury is suspected or recovery is slow:

• Ultrasound shows muscle tears and fluid
• MRI grades the injury and checks tendon involvement, especially in athletes
• X-ray if a bone injury or avulsion fracture is possible

Treatment

First 48 to 72 hours

• Protect the muscle from further injury
• Relative rest: avoid activities that cause pain, but avoid complete immobility
• Ice for 15 to 20 minutes every 2 to 3 hours, with a cloth between ice and skin
• Compression with an elastic bandage to limit swelling
• Elevation above heart level when possible
• Pain relief: acetaminophen (paracetamol). Some guidance suggests avoiding NSAIDs for the first 48 hours because they may affect early healing; after that, ibuprofen at the label dose can help. Avoid NSAIDs with stomach ulcers, kidney disease or blood thinners

After the first few days

• Gentle movement and stretching within a pain-free range
• Progressive strengthening, including eccentric exercises such as Nordic hamstring curls for hamstring injuries
• Heat before exercise to loosen stiff muscles
• Gradual return to activity: build up over days to weeks, and return to sport only when strength and flexibility are near normal and running or jumping is pain-free

Physical therapy

A physical therapist guides rehabilitation, which reduces the risk of re-injury, especially for hamstring and calf strains in athletes.

Surgery

Surgery is usually only needed for complete tendon ruptures, such as some proximal hamstring avulsions, Achilles ruptures or distal biceps tears. See tendon rupture.

Healing time

• Grade 1: about 1 to 3 weeks
• Grade 2: about 3 to 8 weeks
• Grade 3: several months, often with surgery
• Hamstring strains involving the tendon may take longer and recur more often

Prevention

• Warm up before exercise
• Build training load gradually
• Include strength training, especially eccentric hamstring and calf exercises
• Stretch regularly
• Use proper lifting technique: bend the knees and keep loads close
• Rest when fatigued
• Fully rehabilitate previous strains before returning to sport

Frequently asked questions

How do I know if I pulled a muscle?

A pulled muscle causes sudden pain during activity, tenderness over the muscle, swelling or bruising, spasm and weakness. Pain worsens when you stretch or contract the muscle. A pop, a visible gap or inability to use the muscle suggests a more severe tear.

How long does a muscle strain take to heal?

Mild strains usually heal in 1 to 3 weeks. Moderate strains with partial tears take about 3 to 8 weeks. Complete tears can take months and may need surgery. Following a rehabilitation program helps prevent re-injury.

Should I use ice or heat for a pulled muscle?

Use ice for the first 48 to 72 hours to reduce pain and swelling. After that, heat can relax stiff muscles before gentle stretching and exercise. Do not apply heat to a fresh injury with swelling.

What is the difference between a strain and a sprain?

A strain injures a muscle or tendon, which connects muscle to bone. A sprain injures a ligament, which connects bones at a joint. Strains are common in the hamstrings and back; sprains are common in the ankle and knee.

When should I see a doctor for a muscle strain?

See a doctor if you heard a pop and cannot use the muscle, there is a visible gap or deformity, swelling or bruising is severe, numbness or pale skin develops, urine turns dark, or pain does not improve after 1 to 2 weeks.