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.
Symptoms
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.
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.
Treatment
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.
Prognosis
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.