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1st Aug

2013

Exercise to Heal Muscle Strains

Muscle strains or tears are common in sports.  The most commonly used approach after an injury is the RICE method, or rest, ice, compression and elevation.  However, unless applied appropriately, this can delay healing.

Rest must be interpreted in relative terms.  Complete and prolonged soft tissue immobilization leads to a slower rate of healing and weakening of the muscle and connective tissue.  Although the muscle at first needs to be rested during normal activities, some light motions can usually be started within 24-48 hours, even if it means just lightly contracting only neighboring muscles.

Ice applied together with compression within the first 15 minutes of injury can reduce the amount of bleeding and swelling that takes place, and shorten the overall recovery time.  However, after the first few hours, prolonged compression and ice only reduces the amount of oxygen which can reach the injured muscle, thereby slowing down the healing.  Elevation with the limb at least 2′ above the heart allows gravity to assist in returning excess fluid from the area, in particular if performed with some movement.

During the first hour or two following the injury, ice applications together with compression and elevation repeated in 15-20 minute intervals is recommended. After that, the best first-aid approach is typically to apply ice and compression only for 5-10 minutes at a time, interspersed with repetitive motion with minimal or no tension, repeated many times a day.  It is important not to apply any tension which stretches the muscle, which could easily restrain the muscle.

The severity of the injury determines how long this acute care regimen should be continued.  Often within a few days the muscle can be lightly contracted, avoiding putting stretch on the muscle.  For a calf strain, this could e.g. be sitting with the knee slightly bent and the foot pointing down slightly, then gently and slowly lifting the heel, repeated at least 25-30 times.

As the healing progresses, the muscle can be contracted a little more within pain free limits, however without stretch.  A common mistake is sports and health care is to start adding muscle stretching at this stage, which can only weaken or even compromise the healing tissue.  It is much safer to instead progress the exercise resistance and speed to where the muscle eventually can contract with fast movements through its full length, which promotes both a more elastic and stronger tissue, which can handle forces with less chance of re-injury.  Treated correctly this way, even severe muscle strains can typically heal well within 4-6 weeks, and less severe injuries often in 3-4 weeks.  Passive stretching on a warmed up muscle may be appropriate towards the end of this period.

Best wishes,

Gunnar

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