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Different Types of Muscle Strains

Uncovering the Facts of Different Types of Muscle Strains

Have you ever experienced a muscle strain?  What is a muscle strain, anyway?

A muscle strain is an uncomfortable injury or trauma to the belly of a muscle.  Minor strains often result in a stretch to the muscle, like pulling a rubber band.  More severe strains can overstretch the muscle to the point where the muscle can have a partial or even complete tear.  Strains often occur in the low back or hamstring muscles1, but any muscle in the body is vulnerable to a strain injury! 

Strain injuries do not discriminate.  Many athletes, active lifestyle, and sedentary individuals suffer from muscular strains.  They can occur in various scenarios ranging from repetitive or overuse injuries like running or throwing a baseball, or sudden onset situations such as lifting a heavy box while moving.  Many people often describe a muscle strain as feeling like a “pulled” muscle, and they are not wrong – a muscle strain often results from a muscle being pulled too hard by outside forces2!

While strains occur to muscles, they have a cousin you may know as well: the sprain.  Sprains have a similar stretching mechanism of injury, but sprains happen to ligaments instead of muscles.  For the sake of this article, we will keep it simple and discuss muscular strains; however, an injury is sometimes also considered a sprain/strain because there may be a strain to the muscle and a concurrent sprain of ligaments at the joint.

Muscular strains can be put into two categories: chronic overuse, and acute traumatic strains.  

An overuse strain can be confusing at first because there is no single “event” that can be pinpointed that resulted in pain or injury.  A traumatic strain injury, on the other hand, often has a single and significant event results in injury; think of lifting a TV and suddenly, your low back goes into spasm!  Ouch!

Over-Use Strain (Chronic)

The Cumulative Injury Cycle

The Cumulative Injury Cycle3 represents the process in which over-use injuries and pain may occur.  This cycle is not limited to a particular activity, but anything you do repetitively!

The chronic cycle begins with Overwork, such as the long duration of sitting or longer-distance running.  Yes, even long periods of sitting can overwork muscle groups in addition to increasing your chances of developing deep vein thromboses, diabetes, and undoing the benefits of exercise.3  The engagement of muscle groups in the same activity – day in, day out – may lead to muscular imbalances and Weak, Tight, and Tense soft tissues, like muscle.2,3

These weak and/or tight muscles lead to excessive Friction, Pressure and Tension to the local muscles, ligaments, tendons, and fascia2.

In turn, this results in Decreased Circulation and Swelling and Hypoxia (lack of oxygen) to the area.  The lack of proper oxygenation to our soft tissues results in the formation of Adhesions and/or Scar Tissue to the area, which decreases the function of the local structures.  

Think of these adhesions like a tube of superglue that leaks out and gets into the carpet.  The nice fibers of the carpet are no longer smooth, and the carpet is not as effective in cushioning your feet due to gluing the synthetic fibers together.

Overworked, weakened muscles, coupled with excessive friction and tension and decreased circulation, result in a vicious cycle that both weakens and tenses muscles and soft tissue.  The cycle keeps on churning until the body sends off the alarm system that something is wrong.

At some point in your life, you probably stepped on something painful.  You may not have known it was even on the ground, waiting to ambush the bottom of your foot, until you stepped directly on it.  Our bodies can act very similarly.  We do not know something isn’t working correctly us until our internal alarm system goes off.  That alarm system comes in the form of pain!

Now that we know how chronic and repetitive injuries can occur with strains, what about severe episodes?

Acute Strain

The dreaded acute or traumatic strain.  It is a sudden onset of extreme discomfort or pain, and it can be life-altering for a stretch of time depending on the “grade” of your strain.  Strains can come at different levels, known as Grades4; in particular, Grades I, II, and III.  Read on to learn more about the different grades or levels of injuries for strains:

Grade I Muscle Strain

In a Grade I muscle strain, the muscle or tendon is overstretched and may have small tears to the muscle, like papercuts.  You may have mild pain with or without swelling.  Grade I strain is also called mild muscle strain.  For Grade I muscle strain, simple home remedies, such as applying RICE (rest, ice, compression, elevation) therapy may be just enough to manage symptoms.  These are usually self-resolving in a small time frame, although can be uncomfortable during the healing process.

Grade II Muscle Strain

Also called moderate muscle strain, Grade II strain occurs when the muscle or its tendon is overstretched with more of the fibers torn.  Symptoms may include marked pain with swelling.  The area of injury is tender and uncomfortable to the touch and may include bruising.  Movement can be difficult to perform because of the level of discomfort and muscle involvement.

Grade III Muscle Strain

Grade III strain, or severe muscle strain, is the most serious among the three grades of muscle strains. Most of the muscle fibers are torn!  In some cases, the muscle is completely torn or ruptured, resulting in a potential loss of function.  Pain, swelling, tenderness, and bruising are usually present.  Movement is usually difficult.

Moderate and severe muscle strains should be seen by a qualified health care provider, such as a chiropractor, for a thorough evaluation!

Now that you know about the different levels of muscle strains, what can be done to help prevent this kind of injury in the first place?

Preventative Measures

Here are some corrective strategies to decrease the chances of the over-use strain or acute traumatic strain injuries.

Keep in mind, even if everything is as perfectly as possible, you still may end up with strains and sprains if your sport or activity is strenuous in nature.  Even the best preparation cannot fully prevent injury, but it certainly can cut down on the chances of it happening!  Some things we can do are:

Corrective exercises: This will help combat against muscular imbalances that cause biomechanical issues and increased strain on the body.

Micro-breaks: Break up the repetitions of your activity or sport.

Ergonomics: Well-fitted sporting equipment, changes in exercise gear, or alterations to a work environment may be necessary to reduce the likelihood of injury.

Proper Technique: Less strain on the body from optimal efficiency and performance.

Rest and Recovery: Helps get the body back to a steady state and prevents excessive fatigue.

Equipment: Key to performance, efficiency, and reduction of strain on the body.

Should injury occur regardless of these factors, there are things you can do to ensure your body heals.  Anyone can get a strained muscle, and the amount of time you need to fully heal depends on the individual and the type of injury.5

Treatment Options

If a strain injury does occur, there are many treatment options one can consider in addition to the afore mentioned PRICE1,4,6 methods.  In our office, we typically utilize traditional therapeutic modalities such as electrical muscle stimulation, taping, ice, etc.

In addition, we provide 3 key treatment options that not all clinics do, and they are as follows. You can click on each one for more detailed information on our treatment interventions:

  1. Types of soft tissue treatment
    1. Active Release Tech.
    2. Graston
    3. Deep Tissue massage
    4. Ultra sound and IFC (Electrical Stimulation)
    5. Active stretching’s

It is important to see a doctor if you have a painful sprain or strain to get the appropriate evaluation and treatment.  Your knowledgeable chiropractor may also suggest changes to your exercise routine, sport habits, computer or desk setup, or other lifestyle factors to help improve your recovery.

References     

  1. Muscle strains. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/muscle-strains/symptoms-causes/syc-20450507. Accessed October 2020.
  2. Walls R.M., et al. General principles of orthopedic injuries. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed October 2020.
  3. Leahy, P.M. Cumulative trauma disorder defined. Retrieved from http://www.sportdc.com/art/leahy_art.shtml. Accessed October 2020.
  4. Mangusan, D. “Back muscle strains.” Retrieved from http://www.physiotherapynotes.com. Accessed October 2020.
  5. “Sprains and strains.” National Institute of Arthritis and and Musculoskeletal and Skin Diseases. Retrieved October 2020 from: https://www.niams.nih.gov/health-topics/sprains-and-strains
  6. Sprains, strains and other soft-tissue injuries. American Academy of Orthopaedic Surgeons. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries. Accessed October 2020.

Running Injury Prevention Strategies Part 2

Having good running form is another way to prevent running injuries. There are many nuances to running form. We’ll discuss the big three. They are Cadence, Posture and Foot placement.

Cadence (Stride Length)

The amateur runner may not put much thought into their running beyond putting one foot in front of the other, however, if you are finding yourself with consistent pain in your shins or recurring lower leg injuries the way you run may be playing a role. New research has demonstrated that when you take a longer stride as you run, the ground reaction force on your legs will be increased. This increased force can lead to more injuries and micro traumas that can lead to chronic injuries and discomfort.

With Cadence think quick feet. A faster stride will reduce the amount of time you spend on the ground and decreased ground-reaction force. This reduces the impact on your body gets hitting the ground.

 If you think that this may be affecting your ability to run pain-free, try taking some shorter runs and actively think about taking shorter steps while running. Your legs will have to move faster to maintain the same pace as before. It will take some time to retrain your brain to alter your running pattern, but with some regular training, you should be able to make the transition.

Photo by sasint–3639875
See how long her stride is? If the foot is landing far in front of you, your cadence is most likely low.

Posture

Good posture will help you run with less pain and prevent injuries. Basically good posture will create good running posture. Your head should be over your ribcage and your rib cage should be over you pelvis and pelvis over your feet. This posture will let you run using less energy. If your posture is good it will be easier to fill your lungs with air. Next is to engage your core and build midline stabilization.

Foot Placement

Stand with your feet shoulder width apart. This is a very stable position. Now stand with one foot in front (heel to toe). That’s harder right? Standing this way or running this way takes a lot of balance and energy. We’ll call this cross over gait. When we run we should land with our foot under our knee and our knee under our hip. This will support your center of mass better. Think leaning tower of Pisa, the top is not over the bottom making it unstable.

Photo by John-Silver–3202135
The base would be the foot and the hip would be the top.
Take a look at this runner. His foot is on the midline of the body. The leg is not stacked The hip is not stacked over knee or foot. Can you see the pelvis dropping on the left side as well?

Photo by Andrea Piacquadio
Can you see the cross over gait? The foot is midline, the hip once again is not stacked over the knee and foot. Look at her stomach muscles. Can you see the twisting? Here’s an example of the core not being engage and lack of midline stabilization.

If you are new to running or experienced and need help we are here! Please call the office to set up an appointment.

Running Shoes part III: The latest Research

Part 3: Running shoes

What happens if you don’t have pain or you are a casual runner that is just looking for a new pair of running shoes?

The research shows that selecting running shoes based on comfort is the best.

The best way to know if they are comfortable is by trying them on and run at least a quarter-mile.  If the shoe feels good then that is the right shoe for you! That’s it, pretty easy, right?  If the sneaker feels good, that’s the one to buy.

Keep it simple! Your body knows what it needs.

Below is a nice summary of shoe research.

Research on running shoes

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If you missed my other posts on running shoes click here! And if you need help with shoes or running in general please give us a call!

More research showing chiropractic is safe

A systematic review of 47 randomized trials found that cervical manipulation is safe and effective:

  • An effect in favor of thrust manipulation plus exercise compared to an exercise regimen alone for a reduction in pain and disability.
  • Of the 25 studies (that evaluated adverse events), either no or minor events occurred.
  • According to the published trials reviewed, manipulation and mobilization appear safe.  

Coulter ID et al. Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician. 2019 Mar;22(2):E55-E70.

Why does my back hurt in the morning?

People that come into our chiropractic clinic for treatment after lumbar disc herniation or disc bulging frequently have a history of pain which is worse in the morning and then improves after they’ve been up moving around for a bit.

Often they have some questions about what exercises and stretches they can do in the morning to make them feel better. We learned more about morning back pain in a disc – injured patient after the research of Michael Adams in the 1980s.(1,2) Adams referred to the “diurnal behavior of the disc” which mostly refers to the tendency for the discs to absorb moisture from the tissues around them overnight.

The discs soak up the fluids from the tissues around them while a person is recumbent in bed overnight. So in the morning when they wake up the outer layers of the disc are under a bit more tension, which we refer to as hydrostatic pressure.

In turn, the disc becomes a bit more plump, adding pressure to nerves and surrounding structors.

So what should you do? Once you get out of bed you should not bend over right away. Try to keep your back straight or try stretching backward .

Next, use your hips to bend over the sink to brush your teeth.

A straight back using my hips to bend over.
Bending at the lumbar spine causing lots of pressure on the lumbar discs

The above picture is a great way to cause sharp shooting pain in the morning.

Try to sit up straight or use a back support in the small of your back like in the picture above.

Sitting with a more normal curve in the lumbar spine helps take the pressure off of the lumbar discs and helps decrease pain.

A wrong way to sit

Sitting like this cause more disc pressure causing disc irritation. It can cause the disc to bulge more.

Discs are fatter in the morning because the absorb fluid overnight. So think of a jelly doughnut if the doughnut has more jelly its more likely to shoot out if you put pressure on it.

So remember back straight, stomach tight will help prevent lower back pain and help you heal if you have pain.

Impaired Core Stability as a Risk Factor for the Development of Lower Extremity Overuse Injuries: A Prospective Cohort Study

A weak core can increase your chances for lower extremity injury during exercise!

The core is important for your lower back and neck health for sure. It’s also very important for extremity health. If you have been dealing with an arm or leg injury (extremity) that has not been getting better with treatment, it might be good to add in some core exercise to improve outcomes.

Take Home Message from the study: A college freshman with dynamic postural control limb imbalances, decreased hip extension strength, or decreased core muscle endurance during bridging exercises is more likely to develop a lower extremity overuse injury.

What type of running shoe I get part 2

Part 2:

Ok, we’ve worked on any muscle imbalances, fixed any joints that needed fixing and now we’re working on running form. What’s next is everyone’s favorite: running shoes

Let’s talk about running shoes!

When I’m looking for a running shoe these are the things I look for:

  1. Heel to toe drop:

This a zero drop shoe.  That means the heel and toe are at the same level.

IMG_0939

Here’s a large heel drop.

IMG_0949

Now which one to choose?

You can not use a zero drop shoe if you were using a running shoe (with a large heel drop) like the one above your whole life. Doing that you would destroy your Achilles tendon and calves. 

I would suggest using the lowest heel to toe drop you can tolerate. better to error on a bigger drop then lesser drop.  You can always go lower the next shoe.  This will lower your chance of soreness.  Remember change can take time, don’t rush things

2.  Where the shoe bends:

I like the shoe to bend where my big toe bends which is the “knuckle” part of the big toe.  It only makes sense that the shoe bends where the body bends.

IMG_0944

3.  The toe box:

The toe box is the space around the toes.  Take your foot out of the shoe or sneaker and take a  look.  I bet it does not look like your shoe.  Most people don’t have elf shaped feet.

A big toe box gives more room for your foot and toes. The second picture is an insert( black one) from a shoe with a big toe box.  My foot does not spill over the insert(green one) like the first picture.  

IMG_0945IMG_0946

If you have any question please call the office! Or you could bring your shoe in and we can go over it in person.

What type of running shoe should I get part 1

I’m going to do a multi-part blog on running and running shoes! Running and advice on the proper shoe are topics often brought up in my clinic so why not share for easy reference?

Starting with part one:

Here one question I get often:  I’m going to start to run to get in shape, so what brand (x) of running shoe?

There so many variables that go into the question.  Your biomechanic faults/deficiencies, anatomical variants,  the current level of your strength, the current level of fitness, what is your running form/style. Plus add in what you do for a living.  A construction worker has different stress on the body then a person who sits at a desk all day.

In my opinion, it’s better to start with yourself.  First, improve your body and then work on your running mechanics.   After, try to find the best style of running shoe based on comfort.

I like to take a “ground-up” approach.   The first thing to do is to make your foot and lower extremity better.  Fixing any joint dysfunction and then working on making your body stronger and more flexible is a great start.

Next is to improve your running form. I would video record the person running and make any necessary correction.  RUNNING is a SKILL and will need to be practiced.  

After doing all of the above, the patient will be less likely to get injured.  Plus it will be easy to find the right running shoe.