You might be eager to start working out after an injury such as a pulled muscle. But, it's not always easy to know when it's safe to do so. These injuries vary widely in severity, which affects recovery time. A mild injury might start to feel better in the first week, while a more serious muscle strain can take a few months to heal.
The amount of time it takes to return to exercise after a muscle strain depends on the severity of your injury. Full recovery could be as soon as one week, or it might take several months.
Read more: Pulled Muscle from Overstretching
Types of Muscle Strain
Muscle strains are graded 1, 2 and 3, in order of severity. Grade 1 and 2 muscle strains often respond well to home remedies such as rest and ice. Exercises often begin after a few days, once your pain and inflammation have started to decrease. A grade 1 strain causes injury to a few of a muscle's fibers, and although painful, it does not typically affect your ability to move the body part.
Grade 2 strains cause injury to more than a few muscle fibers. These injuries are more painful and usually sore to the touch. You might also notice swelling, bruising and weakness of the affected muscle.
A complete muscle tear is classified as grade 3. With this injury, you will be unable to move the extremity and surgery is typically required for repair, according to a 2015 study published by Current Reviews in Musculoskeletal Medicine. Exercise after a muscle tear is dictated by your surgeon and physical therapist.
Read more: How to Test for a Muscle Tear
Rest Is Key
The first few days after injury are called the acute phase. The first step in treating a grade 1 or 2 muscle strain in the acute phase is use of the R.I.C.E. method — rest, ice compression and elevation. Rest does not equal zero physical activity; however, exercise requiring the injured body part or daily tasks that increase pain should be avoided for the first few days after a muscle strain.
Rest might also include a period of immobilization for your injured body part. For example, you might wear a sling for a shoulder injury, a brace on your wrist or use crutches to relieve pressure on a strained leg muscle.
Symptoms of a mild pulled muscle should begin to improve with rest, within the first week after injury. According to Orlando Health, you should consult a doctor if your pain lasts longer than a week or you continue to have difficulty moving the injured body part. Numbness and persistent swelling or bruising should also be evaluated by a doctor as these symptoms can indicate a more severe muscle injury.
Ice, Compress and Elevate
You can apply ice to your pulled muscle for 15 to 20 minutes at time, every two to three hours for the first few days after injury. Wrapping the injured area with a compression bandage will help decrease swelling and provide support. Elevate the injured area above the level of your heart when resting to assist gravity in decreasing swelling.
Stretching for Strains
Once the acute phase is over, begin gentle stretches to improve flexibility and help prevent stiffness that can occur as your muscle heals. According to Rocky Mountain Therapy Services, you should feel a gentle stretch, but no pain with these stretches. Too much too soon can cause further damage to your muscle.
For example, the single knee to chest stretch can be performed for a pulled muscle in the back.
HOW TO DO IT: Lie on your back. Bring one knee up toward your chest and wrap your hands around your leg below your knee. Gently pull the leg closer to your chest until you feel a stretch in your lower back. Hold for 20 to 30 seconds, and repeat three times on each leg.
Read more: Stretches to Improve Low Back Flexibility
Active Range of Motion
Active range of motion (AROM) exercises help improve your ability to move your injured body part against gravity. For example, if you've pulled a neck muscle, you can do the following AROM exercise: Slowly lift your head up toward the ceiling; then bring your chin to your chest. Return to the starting position (looking straight ahead) and rotate your neck to each side; then tilt each ear toward your shoulders.
Perform active range of motion during the subacute phase — three to seven days after injury for mild strains, or per your doctor's instructions for more severe injuries. Initially, you might need some help when moving the injured muscle. With a shoulder injury, this could include joining your hands and using the uninjured arm to help lift the injured one.
Strengthen with Isometrics
Strengthening an injured muscle often begins with isometrics. These exercises cause your muscle to contract, without movement of your body part. Begin isometrics in the subacute phase after injury, but only if you can do them without pain.
For example, to target isometric elbow flexion after a biceps strain, bend the injured elbow to 90 degrees. Place the opposite hand on top of your forearm. As you attempt to bend your injured elbow, press down with the opposite hand to meet the resistance.
Hold isometrics for a few seconds in the beginning, for 10 repetitions. As strength improves, you can progress to three sets of 10 reps in a row.
Add Some Weight
Once you can perform isometrics without pain and have full range of motion, begin strengthening exercises with resistance bands, dumbbells or weight machines. Initially, focus on single-plane, open-chain movements, where your foot or hand is not in a weight-bearing position.
For example, perform an open-chain extension after knee muscle strain. Sit on a chair and slowly straighten the injured leg as far as possible and then lower back down. Repeat 10 times, working up to three sets in a row. Add ankle weights to make this exercise more difficult.
Once these exercises are pain-free, gradually resume your regular workout routine. Start with less weight and lower repetitions than where you left off, and use pain as your guide. It is normal to have some post-workout soreness, but sharp pain usually indicates injury.
Include Some Eccentrics
Most muscle injuries occur in the eccentric, or lengthening, phase of a muscle contraction, according to a 2015 article published by Translational Medicine @ UniSa. Eccentric training is an important component of exercise after a muscle strain, particularly when the injury affects your tendon — the structure that connects the muscle to bone. Begin eccentrics once your isometrics and single-plane exercises are pain-free.
Eccentric movement occurs when you are returning to the start position of an exercise — such as straightening your elbow after a biceps curl. These exercises are sometimes referred to as "negatives." According to a 2015 article published by Journal of Orthopaedic & Sports Physical Therapy, eccentric exercises have been shown to decrease pain and improve strength of injured tendons in the ankle and knee.
However, eccentric exercises should be progressed slowly. According to the American College of Sports Medicine, eccentric strengthening can lead to delayed onset muscle soreness, or DOMS, which can set you back in your recovery after a muscle strain.
Read more: Eccentric Exercises for Patellar Tendonitis
Consider Physical Therapy
Returning to exercise after a muscle strain is not an exact science, and your chance of re-injury is high if you do too much, too soon. Physical therapy is an effective method of treatment for these injuries.
A physical therapist can provide you with an individualized exercise program to safely help you return to your prior level of function after injury. Physical therapy modalities such as ultrasound, electrical stimulation and cold laser can help speed healing by decreasing inflammation and pain.
Manual techniques performed by a physical therapist, such as joint mobilization, massage and passive stretching, can decrease the amount of time required to regain range of motion and strength after a muscle strain.
Is This an Emergency?
- Mayo Clinic: Muscle Strains
- Rocky Mountain Therapy Services: Muscle Strains
- Harvard Health Publishing: Muscle Strain
- Orthopaedic Specialists of North Carolina: Lumbar Flexion Exercises
- Journal of Orthopaedic & Sports Physical Therapy: Eccentric or Concentric Exercises for the Treatment of Tendinopathies?
- American College of Sports Medicine: Delayed Onset Muscle Soreness (DOMS)
- Current Reviews in Musculoskeletal Medicine: Surgical Treatment for Muscle Injuries
- Orlando Health: My Muscle Hurts, Should I Go to the Doctor?
- Translational Medicine @ UniSa: Muscle Injuries: A Brief Guide to Classification and Management