What is a muscle tear?
Muscle tears are when the fibers that constitute a muscle are torn due to over exertion or stretching them beyond their physical ability.
The probability of muscle tear injuries increases as one ages. This is because muscles lose flexibility and resiliency to some degree as we age.
Most muscle tears occur between ages 40 – 60. Muscle tears are also known as STRAINS. Not to be confused with SPRAINS which are tears in ligaments.
Muscle tears have 3 grades of severity: Grade 1, Grade 2, and Grade 3. The grading has to do with the percentage of muscle fibers torn, the healing process required, and the time to get back to normal function.
The muscle strain grading system corresponds to the following:
- Grade 1: Less than 15% of the muscle is torn. No surgery is required and recovery can be done at home. Usual recovery time is 2 weeks.
- Grade 2: 15% – 50% of the muscle is torn and the damage is more extensive. Surgery is not required and recovery can be done at home. Recovery time is 3 weeks to 3 months depending on the amount of tissue torn. There may be some deformity and/or loss of strength due to scar tissue. The extent depends on the amount of scar tissue formed.
- Grade 3: These are the most severe and involve near complete (75%+) or complete rupture of the muscle. Surgery is the only way to resolve the issue. Even after surgery, the muscle will never be the same and recoup 100% strength and flexibility. The muscle will also have some deformity. Recovery time is anywhere from 3 months to 1 year depending on the location and severity.
Now let’s discuss the biology of muscle strains:
Muscle tissue is contractile tissue – meaning it stretches and then returns to normal to create force. Muscles, however, do not heal like bone.
When a bone breaks, it is replaced with new bone that is stronger than the old. Muscles do not do this. When a muscle is torn, it eliminates the dead and torn muscle fibers.
Stem cells within the muscle are then stimulated to lay down a small layer of new muscle sarcomeres. The rest of the tear is filled in with scar tissue from fibroblasts.
When a muscle tears, a large hematoma forms (internal bleeding, clotting factors, fibroblasts) that begin the healing process.
The problem is that scar tissue is neither contractile and flexible nor as strong as muscle fibers.
The result is you can have a deformity in the muscle at the tear and may experience strength loss because the longer and more fibers a muscle has, the more force it can generate.
Scar tissue doesn’t do this, as it is not contractile tissue and thus can’t generate force.
You may experience deformity in the muscle at/near the tear. Most muscle tear deformities are permanent.
Surgery doesn’t work because stitching muscle tissue is like trying to sew hamburger meat together. Only when a muscle has completely torn in half is surgery required.
One has to be extremely careful not to re-tear it once they return to normal activities as scar tissue makes this a constant possibility.
The body has an amazing power to recover especially when given rest and proper nutrition. It even learns to compensate for damaged or weakened muscles by recruiting more fibers from surrounding muscles so as to maintain strength.
Proper training, rehabilitation, diet, and rest are critical. Also, the FIRST 72 HOURS are the most important to your recovery and long term prognosis.
What you do in this window will determine how well you heal and how much scar tissue you have. The more scar tissue, the more chance of re-injury.
The First 72 Hours:
Upon realizing you have torn a muscle, immediately stop whatever you are doing and get ice on the muscle. Alternate every 20 minutes.
20 minutes with ice followed by no ice for 20 minutes, then ice again for 20 minutes, etc. DO NOT touch, massage, or apply any heat to the torn area. Immobilize the muscle and use ace bandages to protect and compress the area.
You will have a lot of internal bleeding and swelling.
You may or may not see a lot of bruising depending on how many capillaries were damaged and how gravity directs the blood flow.
For me, my forearm was black and blue but my bicep was fine. Gravity forced all the internal bleeding down into my forearm.
While this bleeding and the eventual hematoma it forms are critical for healing, you need to minimize swelling so as to speed up healing. Ice is the only way to do this.
After 72 Hours:
The pain and/or swelling should be stabilized and not getting worse. If they are getting worse, get to a doctor/hospital ASAP.
By the 4th day you can now start cycling ice with heat. You also should try to gently massage the muscle if it does not hurt too much to do so.
By doing this you will accomplish two things: minimize the amount of scar tissue formed and help the scar tissue heal inline with your muscle fibers.
Scar tissue grows all over the place, not in any specific pattern. This is why people with this injury who don’t treat it properly always re-injure the area.
By the 7th day, try to do some VERY LIGHT exercises and/or lifting. This helps align the scar tissue and lengthen it.
As the injury gets better, stretching is critical to lengthen and straighten the scar tissue as much as possible. You need to start using and stretching the injured muscle as soon as you can within your pain limits.
If you don’t, the scar tissue will heal weak and contracted. The key is NEVER stretch or lift anything if it causes pain. You have to work gradually until the pain goes away.
Therefore using NSAIDs or pain relievers is not recommended during re-hab because pain is your healing and progress feedback.
With proper rest, diet, and re-hab, you can be back to 100% as quickly as 2 weeks (type 1 strain) to 3 months (type 2 strain).
Type 3 strains will take a more concerted effort and longer time but with the proper program and diet you can be back to close to 100% as possible.