A pull or strain occurs when a muscle is overloaded or overstretched, creating tears in some of the muscle’s fibers. The pain associated with this injury is usually straightforward: a sharp pulling sensation followed by an immediate recoil to protect the injured area. Strains often occur in long muscles, which need to coordinate many moving parts at once. This means you’re most likely to pull a muscle in your shoulder, thigh or calf.
Did you lift something that was too heavy, and have to react quickly to avoid dropping it? That’s a common cause of shoulder strains.
Did you break into a sprint, but then had to stop suddenly? A sharp pain in the back of the thigh could signal a pulled hamstring.
Maybe you wanted to get back into shape, and thought running was the way to go. The only problem? You hadn’t run in months, but still thought you could jump back in at full speed. That’s a great way to strain a calf!
Even though muscles have pretty good healing capabilities, it can take up to six weeks for the tissue to sufficiently repair itself. The first week is usually the worst; that’s when the muscle feels its most tender and weak, and is unable to respond as quickly as you need it to.
It’s getting hot in here
Think of a sudden muscle injury like a house on fire on a busy street. There’s a lot of heat—and a lot of commotion in the surrounding neighborhood for fear of collateral damage. A swell of helpers (useful for not) rush to the scene. Debris starts falling. Traffic is backed up for miles.
In a situation like this, we need an action plan. Without one, the fire may spread and harm other nearby homes.
When you pull a muscle, you may think your best bet is just to wait it out. But that’s a big mistake! Just like a house fire, muscle healing can quickly become complicated. And complications slow things down.
So, what’s your plan?
The magic word: RICE
When you think you’ve pulled a muscle, remember this word. “RICE” is a first aid protocol for acute muscle and joint injuries. The letters stand for:
Individually, each component of RICE can be useful (as we will see below). But when used in harmony, they form a powerful protocol for overcoming the obstacles that can slow down recovery.
Rest limits any additional damage to the injured muscle fibers.
Ice is a great pain reliever and helps lower the heat of the injury, protecting nearby muscles.
Compression keeps circulation flowing smoothly and properly.
Elevation helps limit swelling and shuttle tissue debris way from the muscle.
Just like a well-orchestrated fire response team, RICE is your emergency action plan when you strain a muscle. Remember: the faster the fire is controlled, the sooner rebuilding can begin.
How to employ RICE
Begin RICE as soon as possible after the injury, and maintain the protocol for at least three days.
Aggressively reduce repetitions of any offending activities by 75 percent. Take a day off if you can, and avoid any forceful muscle stretching or foam rolling that might disrupt the initial repair process. Rest does not mean “do nothing,” however. Any exercise or activity that is low impact and slow in speed can help to maintain conditioning and prevent stiffness. For a lower body injury, this could include peddling on a stationary bike. For an upper body injury, take an easy, unloaded hike. Aim for at least 30 minutes of low-intensity and slow-paced activity per day for the first week.
Apply a bag of crushed ice or frozen veggies, wrapped in a damp cloth, to the injured area for 15-20 minutes, three times per day. After three days, if the area is stable and swelling has subsided, decrease your ice regimen to once or twice per day as needed for pain relief (such as after activity) up to the seven-day mark.
Alternatively, you can submerge the injured area in a cold tub, using a 1:3 or 1:4 water-to-ice ratio, for 10 minutes. The temperature should be between 50 and 60 degrees Fahrenheit. To estimate the right temperature, the ice should melt in the tub. Move the limb regularly to circulate the water.
Wear an elastic bandage around the limb with moderate tension. Making sure to start wrapping below the site of the injury, and finish wrapping above it. Increased pain or tingling is a sign that the wrap is applied incorrectly. Wear the wrap continuously (if possible) for the first three days, reapplying when necessary to eliminate wrinkles. After that period, as long as the area isn’t continuing to swell, you can wear the wrap during daily and/or strenuous activities to support any lingering weakness.
Elevate the injured area above the heart for at least five minutes at a time as often as you can throughout the day. This will help prevent additional swelling and encourage proper circulation. At a minimum, prop the area up during ice pack treatments. Lower body injuries can be elevated by propping the ankle up on a chair while lying down, and upper body injuries can be elevated by lying on the opposite side of the body. The first three days are the priority period for elevation, but you may find that these positions offer helpful relief throughout the first week.
But I’ve heard that RICE will delay healing. Is that true?
When an injury occurs, the body’s emergency response—known as inflammation—kicks in. Inflammation is a good thing, as it means the body is mounting an attack against something it perceives as a threat. Unfortunately, the response can get a little too aggressive, causing damage to the surrounding (healthy) tissues. Since ice can calm down inflammation, it’s the part of RICE that tends to get a bad rap.
Remember the burning house? When an emergency like that occurs, a large influx of first responders (along with a cascade of observers and well-meaning volunteers) flood to the area. They can easily overwhelm the site.
This is also true of the human body immediately following an injury. Our bodies are great at sensing danger, but not very good at being able to tell the difference between an internal (sterile) injury and a foreign invader. (Reference)
So, when using Ice for an injury, the small amount of surface area and the short amount of time you apply the ice will not delay healing. It’s just not powerful enough to work against the amazing emergency crew you have inside your body. A little help to calm the situation can be a good thing.
RICE will not cure an injury. But it can reduce downtime, which means you’ll get back into action a lot faster. It can also help prevent long-term complications. We’ve seen many post-deployment clients who were unable to receive injury treatment at the time of the trauma. Those who were able to implement RICE—even if imperfectly—typically have a faster recovery. They tend to maintain better flexibility and have less scar tissue when the opportunity to fully recover finally comes along.
When you should seek professional help:
- If the muscle doesn’t work properly after the injury, or is visibly deformed, you may be dealing with a large tear. In the upper body, this could mean that you’re unable to flex your elbow or raise your arm overhead, even though there’s nothing blocking the motion. In the lower body, it could mean that you can’t actively bend or straighten your knee, or walk without limping. Keep in mind that a loss of muscle function that is painless is actually an indicator of a more severe injury.
- If you’re experiencing a significant amount of pain that persists even with rest, there may be other injuries involved that need attention.
- If bruising starts to develop over the next few days, despite the absence of skin lesions or additional trauma, considering getting checked out. This can signal a more severe injury that may cause problems down the road, such as scar tissue and/or persistent weakness.
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