Managing a strained muscle
Probably one of the most frequent things I get asked about are muscle strains – especially “minor” ones. When we look at strains we have a grading system of 1-3: 1 being minimal muscle tearing, 2 being a wide range of muscle tearing (more than minimal, but not complete), and 3 being a complete tear. If you’re someone who challenges yourself in the gym (or any sporting endeavor) you are bound to experience some kind of minor muscle strain (grade 1 and lower end of the grade 2s).
Whether it be my time at the gym, clinical work, or just in consulting with people, I often get asked about what someone should do for (insert name of muscle you hurt here) pull. Usually these people were doing some sort of exercise (running, lifting, basketball, etc) and felt a pull/tear feeling in the muscle and are now worried.
Before I go further, if you have experienced a severe strain and are in a lot of pain - a bad grade 2 or a grade 3 – go get checked out immediately! This can be a serious injury that needs to be examined. If you have blood in the area, bruising, extreme pain, then go and get it looked at.
In contrast to the above, a lot of the time the people asking have mild pain, a bit of swelling, and its tender to touch. In these cases, my recommendations follow this pattern:
1. Calm shit down
2. Let it recover
3. Slowly build it back up
(Thanks Greg Lehman for the verbage)
1. Calm shit down
In simplest terms, you’ve pissed off a lot of stuff and until it has calmed down, we are limited in what we can do. The most important thing in order to calm shit down is don’t do anything that is going to aggravate it. This is an area where people commonly make a lot of excuses like – “well if I warm up then it doesn’t really bother it much.” I’m sorry but any stress to that region is generally negative at this stage of healing, the less we bother it the better. We all have this internal battle, but you've got to ask yourself if you want to train around this long term, or address it in the short term.
Now the whole world of ice/heat/RICE is constantly a hot topic that people debate far too much (pun intended). To keep it simple, if the injury is recent (less than 3 days old) ice is usually a good option. It will help to reduce the general swelling and decrease pain in the area – both good things. Once we’ve exceeded that 3 day mark, ice gets a bit more questionable. However, if you experienced a minor strain, you shouldn’t need to ice much after 3 days. Additionally, utilizing elevation and compression whenever possible is helpful. Obviously if you hurt your pec this isn’t too easy, but for calves, hamstrings, etc. this can be done relatively easy. The goal with elevation is to have the location of the injury be higher than your heart - laying down is the most helpful position.
2. Let it recover
In contrast, heat is more beneficial after that 3 day mark. In the first three days there is going to be an excess of fluid trying to get into the area and through the use of cold, compression, and elevation we can minimize it. After that point, we are shifting over to the proliferation phase of healing and starting to get the tissue better. Heat can assist in bringing in good nutrients at this point.
Medication such as ibuprofen (brand name: Advil) can be of benefit, but we want to limit it during that first window of time. Those first three days are primarily the inflammatory phase of healing where WE WANT inflammation. Once that time has passed, inflammation isn’t really desired and utilizing something such as ibuprofen will act as an anti-inflammatory.
Additionally, you just need to give it the required time. In most cases of minor muscle strains we just need to not get in the way of healing and things will get better. The exact time frame will depend on the severity of the injury. In general, we are looking at some sort of time frame of 1-2 weeks, up to 8 weeks.
3. Build it back up slowly
Once we reach this point in the healing process, the damage has basically been managed and the injury is “healed.” However, the new tissue is not quite as strong as the prior tissue (yet) and thus shouldn’t just get loaded like the old muscle.
I’m not sure what people screw up more, the second phase or this one. Once people get to feeling pain free and moving decently well, they often jump back in very aggressively and screw up the process. Instead, taking an extra couple of weeks to slowly ramp back up would be the better option.
Now for a real world example – low back injury
I recently managed to strain my lower back and it was to the point of not being able to squat my bodyweight without quite a bit of pain. Knowing this was just a muscle strain I followed the plan outlined above.
1. Rested for the first few days doing as minimal as possible, having some cold showers and icing my back on the regular.
2. Once I got through that first three days, I still couldn’t do much without pain but knew I was ready to start doing something. I began just training my upper body and lower body in isolated fashion for anything that didn’t cause pain (DB bench press, lat pulldown, leg extension). I progressed to doing some easy “core” work (deadbugs, short side planks, bird dogs) and began doing activities that required a bit more activation of my back (split squats, lunges) over the next couple of weeks.
After about 3 weeks I could start squatting without any pain and felt sufficiently back to moving alright.
3. The first day I squatted I used the bar for 3 sets of 15 and went very slow. Over the next week I squatted 3 more times and slowly added weight and kept the reps moderate. By the time I got to my fourth squat workout, a little over a week after the first day, I did 225 for 6 (45%) with some additional lighter sets. I started to add in more “low back” exercises (back raises) and by two weeks later I was able to sufficiently handle normal training.
From start to finish, this protocol took me 5 weeks to get back to feel all good. However, I was in a hypertrophy block not using very heavy weight, so I only need to get back up to 70%ish.
Adjust the timeline for yourself but don’t rush back, get better.
Move well, lift heavy, get strong
The Strength Therapist