Soft tissue therapy for muscle strains

A strained muscle not only causes pain but can also render an athlete incapable of performing their sport. An intelligently applied combination of soft tissue techniques can accelerate healing and relieve a lot of suffering.

In simple terms, a strain is a tearing or a pulling of a muscle and/or tendon. It is usually caused by a traumatic ripping of the muscle tissue close to the tendon, regardless of pre-disposing factors. Strains can occur either during an excessive stretch or under the force of a muscular contraction.
 
The seriousness of a strain is determined by the number of muscle fibres torn.

• In level 1a there is a 1-10% partial tear of fibres with little or no loss of function and the muscle can hold against resistance with pain.
• In level 1b the tearing is 10-50%, there is pain but holding against resistance is still possible. When it gets closer to 50% tearing, there is swelling and muscle guarding and holding against resistance becomes more difficult.
• In level 2 50-99% of the muscle fibres are torn. It is not possible to hold against resistance but holding against gravity may be possible. There is significant amount of pain, edema, muscle guarding and swelling.
• In level 3 strains the muscles is completely torn apart. In most cases there a snap can be heard when the injury occurred. Resistance is impossible and there may be pain in the area. This requires the immediate attention of a physician and there is usually compensational pain present as well.

 
Muscles that cross more than one joint (multi-articulate) are most susceptible to strains as they are more vulnerable. The muscle’s extensibility is limited, so it is not possible for all joints to achieve full range of motion at the same time. The excess tensile strength a muscle faces when stretched across multiple joints makes it more susceptible to strains and tears.
 
Causes
 
In general, strains can occur either gradually or as an acute traumatic event. Overtraining and any other form of overuse and failing to properly warm up regularly can lead to a gradual muscle strain. Poor form, stress beyond the muscle’s current capacity or overstretch can cause an instant traumatic strain. 
 
General treatment guidelines
 
The acute (protection) stage can last up to 72 hours and is usually accompanied by swelling. The RICE (rest, ice, compress, elevate) is recommended during this phase. Additionally, lymph drainage and ice massage may also be beneficial to by helping to reduce the swelling. Passively engaging the muscle through its range of motion is also recommended. This prevents immobilisation and the formation of dysfunctional scar tissue.
 
In the subacute (repair) stage, which starts around day 2-3 and can last up to 6 months, the body starts healing itself. Cross fibre frictions (CFF) and myofascial release (MFR) are beneficial at this stage for breaking down scar tissue and adhesions and restoring normal posture. Muscle energy techniques (METs) can be used to lengthen the muscle and neuromuscular techniques (NMTs) can be used to alleviate trigger points referring pain. As inflammation subsides and the muscle regains functional capacity some strengthening exercises can be introduced.  
 
During the chronic or maintenance stage, repair and remodeling of the tissue continues. At this phase, a variety of techniques may be appropriate depending on the case. In general, CFF for the joints and the muscles is beneficial and it can be combined with a more comprehensive approach to recovering the bulk and strength of the muscle.
 
Treating strained quad muscles
 
Depending on the severity of the strain and the body’s healing capacity, 2-3 days after the trauma some form of massage can be applied. Let’s illustrate what a soft tissue therapy session for strained quads may look like.
 
Initially, the area of the front of the legs will be warmed up with effleurage, light and gentle longitudinal strokes. These are applied upward along the leg towards the heart. Gradually, the pressure on the upward motion of the stroke can be increased.
 
After several minutes of effleurage, the therapist may proceed to petrissage. Kneading and wringing techniques can be applied to further manipulate and loosen the muscle fibres.
 
Next, some stripping can be performed by applying deep sustained pressure to the muscle. This allows the therapist to identify areas of scar tissue and tightness and also irons out lumps, bumps, and knots in the muscle. Usually, these are applied in a slow and deliberate manner with the thumb of one hand supported by the other. Cross fibre friction (CFF) can be applied to any knots, tightness or scarring that the therapist identifies in the muscle.
 
This can be followed by stripping of the iliotibial (IT) band. Usually, the heel of the hand is used to apply pressure along the side of the thigh. It is recommended to start gently and gradually increase the pressure depending on the client’s level of comfort.
 
Neuromuscular techniques (NMTs) can be used to alleviate painful trigger points. Using fingers or the thumb, the therapist would apply pressure on the painful spot until it reaches a level of 7 on a scale to 10. Then the client exhales and relaxes into the discomfort allowing the tension to be released. When the pain reaches level 4/10 the pressure is increased again until pain reaches level 7 again. This cycle can be repeated 2-3 times, which resets the nervous system and eases off the tension in the muscle. When applying this deep and sustained pressure, the therapist needs to be careful with their fingers and thumb. Ideally, they must be slightly flexed to avoid putting too much pressure on the joint.
 
Finally, the session can be concluded with some petrissage and then gentle effleurage.
 
Considerations
 
Any soft tissue technique applied too strongly can potentially aggravate the recovering muscle and delay healing. Therefore, caution is recommended and pressure must be applied within the client’s comfort level. The muscle must not be over-stretched as it may rapture again at the site of the initial trauma.

Soft tissue therapy can be a great aid in the recovery from muscle strains. Not only will it reduce suffering and the risk of re-injury but it will also speed up the healing process and allow the muscle to reach full functional capacity. 

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