Muscle strains are the most common soft tissue injury during sports or exercise. Muscle strain or “muscle pull” refers to the damage that occurs in the muscle fibers or tendon as a result of overstretching. While the muscle is able to contract and relax, causing motion of the joint, there is a limit on the amount of stress that it can take. Once the muscle is overloaded and reaches its breaking point, a tear in the muscle fibers occurs.
Muscular strains are classified into Grades I to III, with Grade I involving a disruption of a small area of muscle fibers, Grade II involving a partial tearing of fibers, and Grade III indicating a complete tear of the muscle.
Youth athletes may experience the following common injuries depending on the sport:
Adductor (groin) muscles - commonly injured during football or soccer due to stress during turning activities.
Hip flexor muscles - muscles at front of hip used for kicking motion
Quadriceps muscles - this muscle group is responsible for extending the knee and used while running, kicking and jumping
Hamstring muscles - located in the back of the thigh and most active while running, specifically sprinting.
Muscle strain symptoms can range from mild pain with minimal loss of strength, to significant strength loss with limited range of motion and high level of pain. Some swelling and bruising may occur with more severe strain.
If an athlete experiences a lower-body muscle strain and is unable to walk normally, that would be an indication to remove from participation. By not allowing the body to heal, the process is prolonged and can easily worsen.
Muscle Strains vs. DOMS
As fall sports seasons heat up, many athletes will be increasing their training and putting excess stress on their bodies. Some athletes will likely experience soreness after workouts or practices, known as Delayed On-set Muscle Soreness or “DOMS” for short. While this is a form of many micro-tears in the muscle, it is not to be confused with a muscle strain injury.
Healing Process and Treatment
The human body immediately starts to heal after a muscle strain, beginning with an inflammatory response that increases blood flow to the affected area so the body can repair itself. After the inflammatory response, the body begins to lay new tissue, followed by scar formation, and eventually leads to breakdown of the scar tissue to return to normal.
To maximize healing, muscle strains should initially be treated with RICE:
Rest: This can be the most difficult for a young athlete, who feels he or she can continue to participate in activity.
Ice: Recommended for the first 48 to 72 hours, applying three to five times daily for 20 minutes at a time and avoiding direct contact to skin.
Compression: Apply by using a bandage wrap to the affected muscle.
Elevation: Keep the muscle elevated so gravity can assist with removal of excess inflammation.
For a young athlete, the time needed to heal varies, but it could be as soon as one to two days for a minor Grade I, while a Grade II could take three to four weeks, and Grade III could be as long as six to 12 weeks.
Return to Activity
When it comes to returning to sports for an athlete, progression is key. If the athlete is unable to perform daily activities, he/she is not ready. It is recommended to start light exertion, such as walking. Then progress to light jogging, followed by sports specific motions at slower speeds. Eventually work up to cutting or agility, and finally practice at full speed. Athletes and parents should heed the advice of coaches and trainers to ensure they do not risk further injury by returning to play too early.
Reducing the Risk of Future Strains
The best practice is injury prevention:
Warm up prior to physical activity. The best way to prepare the body for motion is to increase the heart rate and move multiple joints through a full range of motion. Dynamic stretching, performed through muscle movements, is currently recommended when preparing for exercise, while static stretching has been shown to have little to no benefit prior to activity
Maintain good muscle strength and flexibility. Muscular strength is associated with increased coordination and muscle memory. Body weight exercises such as squats, push-ups and pull-ups are great for increasing strength. Tight muscles can reduce the range of motion of a joint, increasing the risk of muscular strains. To improve one’s flexibility, proper warm-up and stretching prior to activity, as well as at completion of an event/game, are essential.
Diet is also key. An athlete’s diet should include an increase in water and carbohydrates 48 hours prior to competition to provide an adequate level of energy. Good sources of carbohydrates include whole grain pastas, starchy vegetables (potatoes) and green vegetables. If the body becomes low on fuel, fatigue sets in and the risk of injury increases.
Following competition, there should be an increase in protein intake. While carbohydrates are necessary to fuel an athlete during competition, the normal damage that occurs to the muscles requires nutrients to recover or heal. Proteins such beef, chicken, eggs and peanut butter are good sources to aid in the recovery process.
Patrick Pinkerton, MS, ATC, LAT, is a certified athletic trainer at the Children’s Health Andrews Institute for Orthopaedics & Sports Medicine in Plano, Texas. A native of Oklahoma City, he began playing ice hockey at age 13. After playing three years of juniors, he attended Eastern Michigan University, where he played college hockey and graduated with a bachelor’s degree in sports medicine/exercise science. He also holds a master’s in athletic training from the University of Central Oklahoma, where he worked with high school and collegiate athletic departments. In his professional career, he has worked as a performance specialist at Athletes Compound and Athletic Republic, head athletic trainer for the Arizona Sundogs minor-league professional hockey team, and in a private orthopedic practice before joining the Children’s Health Andrews Institute in 2016.