That Painful Pull
A pulled or torn muscle can be a real challenge to heal
More than 300 individual muscles enable your limbs to work and give your body shape and definition. If you spend time properly stretching and strengthening them, you're rewarded with strength, power and flexibility.
On the other hand, if your muscles are improperly trained or injured, you may end up with significant problems. Many of us have seen the serious consequences of an abrupt muscle tear: A sprinter rounding the turn suddenly drops, clutching a torn hamstring.
A muscle tear may be partial or complete and caused either by a direct blow or by overexertion. There are three degrees of muscle ruptures. A first-degree strain involves less than 5 percent of the muscle. You may notice only mild pain and not lose much strength or range of motion. We sometimes refer to these mild tears as pulled muscles.
A second-degree tear is a greater rupture that stops short of a complete tear. Any contraction of the torn muscle will cause pain. With either a first- or second-degree tear, you may feel a defect of the muscle - a bump or an indentation - at the site of the most pain. You should be able to partially contract the muscle, but you may not be able to walk or stand without pain or a limp.
A third-degree rupture is a complete tear across the width of the muscle. You will be unable to contract the muscle. This is what happens when someone suddenly drops while sprinting. The torn end of the muscle may ball up and form a large lump under the skin, and a great deal of internal bleeding occurs. Severely torn muscles may require surgery to heal properly.
Keeping Your Muscles Healthy
You're more likely to tear a muscle if you're not adequately trained or properly warmed up. So it's important to lay the proper groundwork with pre-season conditioning and to gradually build up to peak condition.
Pushing yourself too hard also can contribute to a muscle tear. This seems like common sense, but what happens to the muscle tissue to cause this?
The buildup of lactic acid in anaerobic and extended aerobic exercise decreases muscle strength and coordination. A muscle that is fatigued and overstrained is more likely to tear.
Lack of flexibility can also contribute to muscle tears. Limber muscles perform better under strain than tight muscles. A prior injury may limit the full range of motion in a joint, which, in turn, can contribute to a loss of flexibility in the muscle and subsequent injury. Whether or not you've been injured, consider regular stretching an essential part of your exercise program.
To reduce your risk of tearing a muscle, always take a day off between weight-lifting sessions. Never increase both the number of repetitions and the amount of weight in the same strength-training session. Always warm up and stretch before your workout, and stretch and cool down after.
When at rest, muscles are 15 percent saturated with blood; when you're exercising, the saturation level may increase up to 72 percent. A good warm-up means gradually increasing the blood flow to your muscles. Jog in place, jump rope or ride a stationary bike until you break a sweat. At this point, you know your body has redistributed blood flow to your muscles, and they're ready to stretch.
Stretches should be a slow and steady hold - no bouncing. A slow and steady stretch slightly lengthens the muscle and prepares it for action. Now you're ready to work out.
Severe Tears
A severely torn muscle can be as painful as a broken bone and in some instances more difficult to heal. The tear occurs when the fibers of the muscle are ripped apart and bleed into the muscle compartment. All of a sudden you feel pain and lose muscle function. The blood in the muscle can inhibit healing and cause the formation of scar tissue.
You can tear a muscle anywhere along its length, including where the tendons attach muscle to bone. You may experience a tear during a sudden change of direction or a quick burst of speed in aerobics class.
These tears are called distraction ruptures and occur when the demand made upon a muscle exceeds its innate strength. Distraction ruptures occur in sports such as tennis, weight lifting, sprinting and aerobics.
Compression ruptures occur as a direct result of impact - such as when one woman's knee collides with another woman's thigh in a soccer game. The impact bruises and tears muscle tissue and can cause severe spasms commonly referred to as a charley horse.
Any time you have a bruise along the muscle mass resulting from an impact, you have some degree of muscle tear.
Both types of ruptures are very painful and can be serious because of the bleeding involved. How quickly you recover depends on the severity of your injury, the amount of bleeding and the amount of scar tissue formed.
It's important to recognize that a tear has occurred and to control the bleeding as quickly as possible.
The First 72 Hours
As soon as you injure a muscle, stop exercising. Begin treatment immediately and see your physician for an accurate diagnosis of the severity of your injury.
Continuing to exercise will increase bleeding and damage, making recovery more difficult. The sooner you stop exercising, the less pressure and bleeding will occur at the site of the injury.
Immediately apply ice to the injured area for 20 minutes. This will further decrease the blood flow to the damaged muscle.
Do not apply heat or massage the muscle. Heat will increase blood flow to the area, further damaging the muscle. Massage causes additional trauma and interferes with the healing process.
Wrap the injured area with an Ace bandage for support and compression. Keep it elevated at a level above your heart. Sleep with the injured limb elevated on a pillow.
Although your body starts to heal almost immediately, the process can easily be disrupted by impact, muscular contraction or weight bearing. Protect the area well at least until the healing process is secure.
If the injury is severe, use crutches or a splint to relieve the strain and protect your muscle from additional damage.
After 72 Hours
Maintain support and protection with the Ace bandage. Continue to apply ice for 15 minutes at a time three or four times a day. After three days, you can begin alternating ice with heat treatments.
The injury will heal with scar tissue, which is not as flexible as muscle and doesn't perform as well. Scar tissue in the middle of the muscle may predispose you to reinjury and potentially leave the muscle weaker than it was before the injury.
A previously injured muscle is more likely to tear again, particularly if it was not fully rehabilitated. Physical therapy is very important to help you strengthen a damaged muscle. Special machines can measure the progress of your muscular strength, so you can know when it is safe to return to activity. A monitored program also can help you return to full strength so that reinjury will be less likely to occur.
Be especially careful during the rehab period to get your muscular strength, flexibility, and biomechanics back in balance. During this time you may be more likely to suffer a secondary injury, hurting yourself in another area.
Good luck!
About the authors: Carol L. Otis, M.D., is Chief Medical Advisor to the Sanex WTA and UCLA student health physician. Roger Goldingay is a former professional soccer player. They are married and the co-authors of The Athletic Woman's Survival Guide.