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January 03, 2020 5 min read

Muscle injuries are extremely common in athletes and represent approximately 10% to 55% of all injuries in sports (Järvinen et al., 2005). The most severe types often produce chronic pain, dysfunction, and the inability to return to practice or competition. An understanding of the types of injuries is needed, since appropriate management may determine the difference between an early return to sport, delayed return, or complete withdrawal from participation in a specific event.

This blog summarizes the most common muscle injuries encountered in athletes and provides guidelines on some treatment protocols.

In general, muscle injuries are classified as acute or chronic:

  • Acute muscle injuries result from a single traumatic event, causing trauma to the muscle. It commonly occurs in contact sports, such as football and basketball.
  • Overuse or chronic injuries are a result of cumulative or repetitive trauma to the muscle.

Muscle Strain

A strain is to a muscle, while a sprain is to ligaments. A strain happens when forceful contraction of the muscle occurs, mostly due to powerful lengthening contraction (contraction-induced), known as eccentric contraction, or when the muscle is over-stretched (stretched-related), causing microtears in the muscle fibers due to extensive mechanical stress. It is often seen in non-contact sports that involve dynamic movements, such as sprinting and jumping.

Muscle strain is categorized based on severity and the amount of tearing evident in the muscle fibers.

  • Grade I (Mild): minimal tearing of the muscle fibers with preservation of strength and range of motion. Localized pain and tenderness are present but often delayed.
  • Grade II (Moderate): a considerable amount of muscle tearing, resulting in significant pain with swelling. The strength and range of motion become limited due to pain.
  • Grade III (Severe): complete tear of the muscle. Significant swelling and pain with complete loss of muscle function.

Muscle Contusion

Contusion, or simply bruise, is a result of a direct blow to the muscle either from an opponent or direct contact with a blunt object and is commonly encountered in contact sports, such as football and basketball. The injury causes internal bleeding due to the damage to the blood vessels, causing blood to leak into the surrounding area, which sometimes forms a lump, known as a hematoma. Contusions result in swelling with associated pain and limitation of motions. A bluish discoloration in the skin is also seen due to torn blood vessels.

Muscle Cramp

Muscle cramps are sudden, involuntary muscle contractions of one or more muscle groups. It often occurs during long periods of strenuous activities, and usually seen in the calves and thighs. Muscle cramps cause sudden, sharp pain with an occasional lump of muscle tissue just beneath the skin.

Muscle Soreness

Delayed onset muscle soreness (DOMS) is common after engaging in strenuous and unaccustomed physical activity and is classified as a grade 1 muscle strain. It is characterized by localized tenderness with soreness that peaks in 1 to 3 days after the exercise and disappears after 5 to 7 days. The exact cause of the DOMS is not yet fully understood but is seen to involve an inflammatory process. Pain associated with DOMS is commonly believed to be due to the accumulation of lactic acid.

To know more on the difference between DOMS and an actual muscle injury, check here

Treatment Considerations and Guidelines for Muscle injuries

  • Acute Muscle Injuries:Within the first 24 to 48 hours, follow the RICE (rest, ice, compression, elevation) principle to minimize swelling and afford relief of pain. The main goal is to limit the extent and duration of inflammation so that further treatment can be started early in the rehabilitation phase, and early recovery is achieved. The RICE protocol is called for at this stage as its components are directed towards decreasing the internal bleeding.
  • Chronic Muscle Injuries:The treatment of overuse injuries is made complicated by the insidious and cumulative nature of the injury. When athletes seek treatment, the injury is often well established and more difficult to manage. Specific problems, such as limitation of motions and weakness, should be addressed appropriately with a specific rehabilitation protocol. A physiotherapist should properly identify and treat these problems to prevent aggravation and possibly reverse the detrimental effects.

Most muscle injuries respond well to conservative treatments, and treatment options are based primarily on whether the muscle injury is sustained abruptly or acquired over time. Appropriate and timely management can prevent aggravation of injury and the occurrence of complications in muscle lesions. Let’s take a look at some of the common procedures used in treating muscle injuries.

Immobilization and Mobilization

A brief period of immobilization is usually required for a few days after an acute injury to prevent scar tissue formation and prevents the re-rupture of the affected muscle. This allows the muscle to gain sufficient strength to bear contraction forces, which will be required on later rehab protocols. Immobilization restricts the motion of the injured area to allow the injured area to heal. It can help reduce pain and swelling, as well as muscle spasms. This also allows for protection and proper alignment early in the healing process. This, however, should not go beyond the acute phase to avoid the deleterious effects of muscle atrophy, further weakness, and excessive formation of connective tissue in the muscle.

Early mobilization can start a few days after the acute phase when complications are not seen and recovery seems to be progressing. Mobilization induces increased vascularization for muscle repair.


Stretching is needed by our muscles so that the ideal length is maintained for optimum performance. Precautions should be observed when stretching exercises are performed in acute cases of muscle strain, otherwise, the injury could be aggravated. Also, when dealing with muscle contusion, untimely initiation of stretching exercises can complicate the case, producing a condition known as myositis ossificans or the formation of bony substance on the muscle. Ask your physical therapist when to safely stretch your injured muscle to avoid these untoward consequences.

Heat and Cold

The use of cold and heat has been an issue for those who don’t understand the processes that involve in injury and the body's response to these therapies. During acute injuries, there is a presence of internal bleeding, which causes inflammation. Treatment methods ideal in this case should be those that encourage constriction of blood vessels so that blood flow to the area is limited. Ice or cryotherapy is applicable for this stage.

When inflammation has subsided, the injured area needs oxygen and nutrients for recovery, and such is provided by blood. Therefore, the appropriate treatment would be those that encourage blood flow, that is, heat. Warm therapies relax tensed muscles, making way for flexibility exercises and from there, other rehab procedures follow until the patient can safely return to sport.

Vibration Therapy

Percussive vibration therapy, like Recovapro Massage Guns, has been gaining popularity as a treatment method for muscle injuries. After the acute phase of muscle injury, Recovapro can be used to stimulate the healing process by improving blood circulation into the injured area. When soft tissue adhesions are already formed, such as those in chronic injuries, Recovapro can break up these scar tissues, making the muscle pliable and compliant with flexibility exercises. At every stage of the rehabilitation process of muscle injuries, Recovapro can provide the best vibration therapy effect, even during the training period itself, so that muscle injury is prevented. Use it before exercise to release muscle tension, improve flexibility, and enhance muscle performance during training.  After exercise, use it as a muscle recovery tool so that muscle repair happens faster after an exhausting workout, and thus prevent or minimize the occurrence of DOMS.

Clinical Bottom Line

The appropriate treatment will be based on the best judgment of the doctor, physical therapist, athletic trainer, and other health practitioners and should be considered in the best interest of the injured athlete.


Järvinen, T. A., Järvinen, T. L., Kääriäinen, M., Kalimo, H., &Järvinen, M. (2005). Muscle injuries: biology and treatment. The American journal of sports medicine, 33(5), 745–764. https://doi.org/10.1177/0363546505274714

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