Muscle tears: classification and treatment

Muscle tears come in all shapes and sizes! They can present like a minor nagging ache that just won’t go away or as a sharp shooting snap that occurs suddenly during interval training. Despite their frequency in sport, little information is available in the international literature about muscle injury definitions and classification systems. So how does one know if what they have is a “muscle strain”, a “pulled muscle” or a “muscle tear”? And why are these definitions important?

A recent article by Muller-Wolfhart 2012 have divided muscle injuries into 2 groups:

Group one: Functional muscle disorders (FMD)

Group two:  Structural muscle injuries (SMI)

FMD are less serious muscle injuries. They still result in pain and can cause an inability to participate in sport, however with these injuries there is no evidence of actual muscle fiber damage. If one would be lucky enough to get an MRI or ultrasound, these injuries would  present with no evidence of a tear on the scan. Some swelling or inflammation may be seen, but no structural change to the muscle has occurred.

SMI do present with changes on scans. Depending on the severity of the tear both muscle fibre disruption and haematoma can be seen. SMI have further been divided into minor, moderate and total tears. It is important to note that if not treated properly, functional muscle disorders can turn into a structural muscle injuries and it is therefore important that proper management is followed.

Considering most of us don’t have an MRI machine lying around in our back yard waiting to be used, its important to be able to classify tears via certain signs and symptoms.

FMD will often feel like a painful increase in the tone of the muscle or a general increase in muscle firmness or tightness. They may be described as more of an aching pain that increases with continued activity. Pain can be felt during or after activity. Stretching of the muscle often leads to relief. No sign of any bleeding or bruising is seen although some swelling may be present. These are injuries that runners often try to “run off” however may worsen with repeated use

SMI will present with more of a sudden sharp stabbing pain at the time of injury. Often a snapping sound may be heard. Pain can be more localised to a specific area. Often but not always bleeding is seen (present on moderate and total  tears but not on minor). Stretching this muscle will more likely aggravate the pain rather than sooth it.

The importance of defining a muscle injury can often help both with diagnosis and treatment. For example structural injuries take longer to recover than functional disorders and need a greater time off sport.  Treatment also differs for example: stretching may help a FMD but not a SMI

How will my muscle repair?

Healing of soft tissue takes place in 4 phases: bleeding, inflammation, proliferation and remodeling (See figure 1). The bleeding phase is usually short lived and not always relevant depending on the extent of the injury. Most of the bleeding phase will end within the first 4-6 hours. The inflammatory phase starts a few hours after injury and can continue for days. Inflammation is an essential part of the healing process and therefore stopping it (ie with Ant-inflammatories ) is not always a good idea. Scar tissue is then laid down in the proliferation stage. Cells called fibroblast are called to the area and lay down collagen. This initial collagen tends to be weak and is laid down in a haphazard manner with random orientation. During the remodeling phase stronger collagen replaces weaker.

Figure 1:

What can I do to help?

Our bodies have an amazing ability to heal themselves, however knowing how to manage an injury is essential (see more on acute injury management). Stress is important for tissue healing but too much stress can disrupt healing. For example, running on inflamed or weakened muscle tissue can disrupt the repair process and prolong it.

Physiotherapy can be an important part of the healing process. Physiotherapy tends to stimulate rather than change the natural events of healing, increasing the efficiency of the response, improving quality of the repair and decreasing healing time. Techniques such as soft tissue massage, taping, ultrasound therapy, stretching and strengthening exercises are some of the treatments used in the different phases of tissue healing.

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