Muscular Strain

Symptoms | Tests for Diagnosis | Treatment | Prognosis

A muscle strain is also called muscle spasm, muscle cramp, -pulled" muscle, or tight muscle. It is associated with neck and shoulder pain as well as lower back pain. A muscle strain is an indirect injury to a muscle, usually from muscle fatigue and overuse. It can occur during any type of physical exertion running, climbing, extreme reaching with the arms, or turning/twisting of the head, neck, or back are common types of physical activity that may result in muscle strain and pain of the back, neck, and shoulder. An entire field of medical study, called ergonomics, has grown from medical problems, including muscle strains, arising in work-related settings. (see Home and Office Modifications)

In a muscle strain, tension or extreme stretching occurs that causes muscles to cramp or tear during physical exertion. Efforts to move are then replaced by painful and limited movement. The pain of muscle strain or spasms are from the sustained contraction of the muscle fibers (as well as from possible tearing of the fibers. The examining physician or therapist may feel a hard -knot" in the strained muscle. Minor muscle strains, such as if you wake up in the morning with -a crick" in your neck cause no permanent damage. However, more serious muscle strains, such as second-degree muscle strains, result in torn muscle fibers and third-degree strains have complete disruption of muscle fibers; these injuries require a thorough evaluation, treatment, and follow-up for optimal recovery.

Muscle strain without obvious or unusual physical exertion can be a work-related injury. Examples include holding your neck or back in an abnormal position while sitting at your desk or computer for long periods of time without taking breaks. Bad posture can also create chronic muscle strain in the neck, back, and shoulder areas, increasing the probability of long-term structural damage in soft tissues and joints of the spine.

Muscle strain should not be confused with muscle contusions, which are caused by direct blows or trauma to the muscle and often occur during contact sports.

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With muscle strain and cramps, there is typically pain and soreness on movement, sometimes a feeling of .twitchingê in muscles, or a hard knot that is tender on palpation of the area. A limited range of neck motion due to pain is also a common symptom. Second degree strains may include stiffness and weakness and a -black and blue" mark. In third degree strains where there is a tear within the muscle, the muscle fibers may bunch up and be able to be felt. There may also be more visible bruising from bleeding within the muscle.

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Tests for Diagnosis

When a muscle strain is the suspected injury, your doctor may ask questions about your general lifestyle, both at home and work, and will want to know when you first noticed any symptoms, if they occur now, and what types of regular or unusual physical activity you have recently been doing. Other questions may be related to the possibility of dehydration as a cause of muscle cramps: Have you experienced any excessive sweating, diarrhea, or vomiting?

The initial evaluation should include a detailed physical examination including a neurological examination; if necessary, further diagnostic tests such as an X-ray or scan may be ordered. Routine laboratory tests may be done to rule out metabolic causes.

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Immediate treatment for muscle strain can include rest, ice (first 48 hours), heat (alternated with ice after first 48 hours), compression, and medication (for pain and inflammation). A short period of brace immobilization may be recommended. Light stretching may be advised following a day of rest, if the strain is mild. These treatments are often followed by a period of rehabilitation if the pain or muscle damage continue to interfere with regular physical activities or for second and third degree strains. Exercises might include strengthening or stretching exercises for the shoulder and upper and/or lower back muscles, rotation and side-bending exercises for the neck, and even chin exercises to improve posture. Strength training of the quadriceps muscles, may also be part of your physical therapy to prevent future injury as these thigh muscles, when strong, can unburden the entire spine of overwhelming stress during the lifting of objects. Guidance and instruction in improving and maintaining overall correct posture while standing, sitting, and walking by staff of the HJD Spine Center can also protect you from future muscle injuries. Biofeedback, where patients learn to voluntarily relax their back muscles has proven a useful therapeutic modality for some patients.

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The prognosis for recovery from muscle strains is excellent. Complete relief from pain and the duration of time to normal activity or active sports depends on the initial degree of severity of the injury and the cooperation of the patient to adhere to the treatment regimen, physical therapy, and follow-up visits.

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