Acute Muscle Strain Rehabilitation
By Mike Libruk with Premier Athlete Training
Edited by Halee Olson
Muscle strain occurs because the ability of a muscle to produce or resist force is exceeded by the amount of force applied to the tissue. In the case that you experience an acute pain from muscle strain, here is a step-by-step guide to recovery.
1. Don’t Freak Out
During the initial time of injury, it is critical to remain calm and positive about the
severity of the injury. As long as there is not any bruising or physical deformity, the injury rehab process can begin almost immediately and pain symptoms should reduce rapidly. Catastrophizing the incident will only lead to increased pain experience, rehab time and distress. Additionally, hyper focus to the site of pain in a negative manner will reduce a person’s self-efficacy when it comes to the rehab process. The goal of remaining calm serves to reduce the psychological component of pain.
It is critical to remember that if the force that caused the pain is removed, no
further injury will occur. As long as nothing has to be repaired surgically, the body will naturally heal the afflicted tissue. Emotional attachments and psychological influence serve to protect the body from what it perceives as a threat; unfortunately, this often causes pain even after the tissue has completely healed. The pain will go away as the healing process occurs– once you know that you are not doing further damage to the afflicted area.
It is important to understand that movement increases muscle tolerance over
time. Staying active during the rehab process is crucial to limit the time it will take to return to sports and will also decrease the likelihood of future injury. Complete bed rest should be avoided at all costs. It is also critical to understand that experiencing pain has an emotional and neurological component as well as a physical and biological one. Our thoughts, beliefs and attitudes have a strong influence on the pain that we experience.
Biophysical Pain Model
Societal influences such as fear mongering like “Squats are bad for knees," “Deadlifts
are bad for the back” and “Bench presses are bad for shoulders."
Thoughts and beliefs about pain such as “This is serious," “You can’t do any activity or lift anything heavy," “I need to rest completely or I risk re-injuring" and “I’m injury-prone now.”
3. Increase Range of Motion
In some instances of injury, a full range of motion will be limited by pain; however, there will be a certain range of motion you can perform unweighted movement in with little-to-no pain. The first step is to perform unweighted movement through this range of motion for a few sets, two to three times a day. As pain allows, you should work to increase the range of motion slowly as you move. The goal of this phase is to increase to a full range of motion before a heavier load is introduced.
These sessions can be performed multiple times a day as they are easy to recover from. These movements are low in stress, so recovery and adaptation to them occurs rapidly; therefore performing these movements frequently will reduce the time it takes to return to a full range of motion. They are also so low in stress compared to the original stressor that caused the injury that they will not cause any further muscle damage. During this step, returning to full range of motion occurs in as little as one to three days.
4. Increase Strength
Once you’ve established a full range of motion through the afflicted muscle actions, it is now
time to increase strength by slowly increasing load as pain allows. For some, this could simply be an unloaded 45-pound bar as a start. The goal is to increase load through resistance exercises that utilize the recovering musculature. For example, this could be the introduction of lying hamstring curls and Romanian deadlifts in the case of a hamstring strain, or cable flies and bench presses in the case of a pectoral strain. It is important to understand that after a full, pain-free range of motion has been established, the afflicted area can tolerate a small load with no threat to injury.
The goal of this phase is to increase load to improve the recovering tissues' ability to withstand force again. Loading of these resistance exercises should be increased gradually and frequently until they are within range of previous strength levels. These exercises should be performed with a slower eccentric phase. This phase can be performed daily until the loads used begin to rival the previous load used before the injury. Once you have returned to a similar load, frequency of these exercises can be dropped back to a normal amount consistent with your strength program. Progression through this step can occur as quickly as one week as you increase the load back to weights used pre-strain.
5. Increase Power
Now that the recovering tissues can tolerate regular loading and produce normal amounts of
force, it is time to increase power as we prepare for return to sports. If the muscle strain occurred during resistance exercise, this will be the final step of the recovery programing. The goal of this phase is to reduce the accentuated eccentrics of the previous stage as loading continues to increase. For example, say you strained your pectoral muscle performing a bench press. As you progress through this phase, return to a normal eccentric speed and improve bar speed on the concentric phase of the lift. Mentally, cue here for maximum intended bar speed upon the concentric phase of the lift and fast controlled eccentrics. Here you can also introduce ballistic movements, such as explosive push-ups or kettle bell swings to further increase power production. Increasing power should be done gradually over the course of the next week or so you feel you are ready for further progression.
6. Return to Sport
The final step is to return to the activity that caused the acute muscle strain with reduced
intensity. Say you strained your hamstring during a maximal sprint, during this phase work to return to sprinting with a much reduced intensity. On a week-to-week basis, gradually increase intensity as you go about performing normal workouts sub maximally. When the afflicted area feels good, increase the intensity slightly the following week. This process is ongoing as the goal is to reach the previous levels of performance and to eventually surpass it injury free.
Below is a sample progression dealing with a hamstring strain during sprint competition or training. This is the exact format a Premier team member recently used to recover from a hamstring strain.
Day 0: Injury occurs midday, initial self-assessment working to remain calm and positive, keeping in mind that moving more will make the pain during walking and basic movement go away faster than if the individual rests completely. Perform partial range of motion hamstring curls with no resistance as legs lay off the end of the bed working through moderate to severe pain.
Day 1: Partial range of motion hamstring curls and body weight Romanian dead lifts (RDL’s) performed three times a day. Range of motion improves slightly during each session as pain decreases.
Day 2: Repeating day 1, full pain free range of motion occurs on third session before bed during hamstring curls and RDL’s.
Day 3: Add load by performing lying hamstring curl machine with 10 pounds of resistance and 45-pound RDL’s and back squat.
Day 4: Five sets of five back squats at 135 lbs, three sets of eight RDL with 65 lbs, three sets of 15 hamstring curl at 20 lbs.
Day 5: Five sets of five back squats at 185 lbs, three sets of eight RDL with 85 lbs, three sets of 15 hamstring curl at 30 lbs.
Day 6: Five sets of five back squats at 225 lbs, three sets of eight RDL with 105 lbs, three sets of 15 hamstring curl at 40 lbs.
Day 7: Four sets of five back squat at 275 lbs, five reps at 315 lbs, three sets of eight RDL with 125 lbs, three sets of 15 hamstring curl at 50 lbs.
Day 8: Five reps at 365 lbs, three reps at 405 lbs on back squats, three sets of eight RDL with 145 lbs, three sets of 15 hamstring curls at 60 lbs, 3x 30 second kettle bell swings. 405 for three is within a few reps of normal working sets for this individual. They followed these aggressive weight jumps because relative to their normal squat strength, the weights over the previous weeks were extremely sub maximal.
Day 9: Rest
Day 10: Return to normal programming and introduce normal sprint training at 50 percent of previous intensity.
Increase intensity ten percent each week until back to normal.
Remember: When in doubt, consult with a professional at Premier Athlete Training. Every body is different, and the staff at Premier can help create a rehab plan that is right for you.