“Strain” is the term given to a full or partial tear of the muscle fibres, muscle fascia (connective tissue) or muscle tendons – basically anything to do with the muscular structure.
This is different from a “sprain” which is a tear injury to the ligaments or joint capsules, which are different to the muscles.
- Tendons attach muscles to bones; a tear injury is called a strain.
- Ligaments attach bones to other bones; a tear injury is called a sprain.
Both ligaments and tendons are made up of pretty much the same stuff: a very firm collagen based cord-like structure. They change shape very little as you move, since they stabilise your joints and hold the bones in place. They do not contract.
Muscles on the other hand are incredibly pliable. They are meant to flex and move as you do, so they are a lot more floppy. The muscles, not the ligaments or tendons, are what contracts. Fascia (connective tissue) wraps around and holds the muscles in shape like a kind of skin.
So a strain injury involves tearing to the muscle and/or tendon mechanism.
The weakest part of the structure is the junction where muscle fibres attach to tendon fibres. This musculo-tendonous junction is the most common site of strain injuries.
You might have either a grade 1, grade 2 or grade 3 strain:
- Grade one tears are not very serious, and often just involve an over-stretching of the fibres. A bit like when you stretch a bed sheet and the fibres stretch but don’t break.
- A grade two tear is more serious. There are more fibres torn apart and there is often some deep bruising as blood vessels within the muscle also tear open.
- A grade three tear kind of sucks. A lot. The muscle and/or tendon is basically totally ruptured. If you are unlucky enough to have a grade three tear, you’ll probably be out of action for a while.
Tendinitis versus Tendinosis
The suffix ~itis means that the site of injury is inflamed. Signs of inflammation are redness, swelling, and heat in the local area around the injury. If these signs are not present, but there is still pain, it cannot be defined as tendinitis.
Instead it is defined as tendinosis, which is a degeneration, degradation or tear in the tendon without inflammation. This can often happen in a tear injury older than 6 weeks.
We need to take special care with an inflamed tendinitis injury, so as not to cause more damage, which would be painful and slow down the healing process.
With a tendinosis injury, on the other hand, we can go straight into full therapy.
Case study: Calf Muscle Strains
A common strain injury happens when you sprint off too quick from a standstill, and all your body weight goes suddenly through your gastrocnemius (calf, or gastroc) muscle as it contracts explosively. I’ve had clients tell me they did this by suddenly running for public transport.
In one of my cases recently the explosive movement through the muscle resulted in a grade one tear to the medial head of her gastroc. An ultrasound scan by a physiotherapist confirmed this.
Thankfully a muscle strain injury, especially a low-grade one, is one of the easiest injuries to resolve.
In treatment we apply myofascial release, compression broadening, and deep cross-fibre gliding strokes to release the belly of the muscle and unload any extra pull coming from a tight muscle.
We then test the muscle under a light load, just enough to allow a pinpoint location of the site of injury. Usually you can point to the site with one finger, as opposed to it being a wider area. This is especially true with older strains.
Having located the site of injury, I apply moderate depth frictioning with the pads, not the tips, of my fingers for up to 30 seconds. This may hurt just a little, but should not be ‘painful’, per sé.
I apply the frictioning in multiple directions, after the multiple directions that your body lays down scar tissue in a cross-thatched way (to stabilise the site of injury). This softens (but does not realign) the scar tissue matrix.
Once the collagen matrix has been softened, I help you through very lightly resisted muscle shortening and lengthening contractions. It is this movement that realign the disorganised scar tissue into correctly oriented, organised, functional tissue.
Then we re-test. If we can still find pain, we do another pass of frictioning and resisted contractions. Most often the pain will decrease significantly with each pass.
In many cases, especially older injuries, we can completely resolve the pain and any discomfort in movement simply goes away. Many of my clients have said that “its is like magic.”
I like to reassure them that it is just biology! Although, I will admit it certainly looks like magic sometimes…!