Several symptoms can indicate that you have incurred a muscle strain but the symptoms you feel will depend on the grade of strain you have incurred:
- sudden onset of pain, or pain/soreness that comes on the next day related to a specific event
- pain on touching the injured area
- mild, moderate, or severely limited range of movement, or an extreme abnormal range of motion
- decreased strength in the injured muscle
- bruising or discoloration in the area or at a distal location to the strain
- a “knotted up” feeling
- a local divot or bump in the affected area due to the torn muscle fibers
- muscle spasm in the area
- stiffness in the area
How do health care professionals diagnose the problem?
Your physiotherapist at ProActive Rehab & Sport Injury Centre will ask a number of questions to determine if you have strained your muscle and to determine how severe the damage is. They will want to know exactly when you injured yourself and if you injured the muscle from one specific event or if a repetitive injury caused your pain. They will want to know what you felt immediately after the injury and whether or not you feel that you have lost any strength or range of motion. Your therapist will also want to know if there has been any swelling or bruising around the area or anywhere down one of your limbs. They will also want to know what sort of things are aggravating your pain or if you have been able to do anything to make your pain feel better. They will inquire about any medications you are taking and whether or not you have ever injured this muscle in the past.
After a thorough history your physiotherapist will do a physical examination. Firstly they will observe how you are holding your affected limb or your neck or back, if this is the area in question. Next they will examine the area to determine if there is any swelling or bruising present. They will palpate (feel) your muscle to find out which area is most sore. They will also check to see if there are any divots or unusual bumps in the area, which would be the result of a section of torn muscle fibers; this would indicate a more severe strain. Finally, they will ask you to move your muscle in order to determine how much you can move it and whether or not moving it causes you pain. In order to help determine the severity of the strain your physiotherapist will also assess how much they can passively stretch your injured muscle, and will check how much strength against resistance you can generate with your muscle. If you are able to they may ask you to push, pull, bend, stand, sit, or jump in order to help assess your strain. Lastly, they will check the integrity of the joints that are closest to your injured muscle to ensure that you haven’t also injured them.
After a thorough history and physical examination your physiotherapist will determine the grade of your muscle strain. If they determine that your strain is severe (severe grade II or a grade III) they may send you to your physician for a review as further investigations are possibly required, and medication may be needed to control some of your symptoms. If you have a severe strain to one of your lower extremity muscles you may require the use of crutches in order to get around; your physiotherapist can teach you how to use them. The general rule regarding when to use crutches is such that if you are limping when walking without crutches you should use crutches until your strain heals enough so that you are able to walk without limping when not using crutches.
What will my doctor do when I see them?
In the case of a severe strain (severe grade II or a grade III), a physician’s review may be necessary. When you see your physician, they may prescribe anti-inflammatory or pain medications to help control the swelling and assist with the pain.
Your physician will determine if a diagnostic investigation is required to further assess your muscle strain. In most cases an X-ray is not necessary unless your physician is concerned that you may have also fractured the bone, in which they will order an X-ray to rule this out. Diagnostic ultrasound is a timely way to image muscle groups to determine strain severity. In cases of severe strains, a magnetic imaging resonance (MRI) test may be ordered to confirm the muscle that has been injured, and to determine the exact amount of damage to the muscle, particularly if it looks severe enough to warrant surgical consideration. An MRI has the benefit of confirming the exact severity of the muscle strain. Grade I or grade II strains that are mild to moderate do not generally require any investigative reviews but may benefit from the use of pain or anti-inflammatory medications.