Leg muscle injuries are far more common than we think. There are many muscles in our legs, some that help to give the joints support and some that help to hold us upright and allow us to move.
Muscle strains account for 30% of the injuries seen in a sports medicine practice.
What are muscle strains or tears?
When a muscle is injured it will be graded by the severity of the strain/tear.
- A Grade 1 strain involves a small number of the muscle fibres which have been stretched rather than torn. There is local pain, minimal bruising and no loss of strength.
- A Grade 2 tear involves a significant number of muscle fibres. There is pain, swelling and bruising at the site of the tear. The strength/power in the muscle is reduced and movement of the joint is limited.
- A Grade 3 tear is a complete tear of all the muscle fibres. This is usually extremely painful at the time of injury and then becomes pain-free quite quickly. However, there will be severe bruising and swelling and there is a complete loss of strength in that muscle.
Why do muscle strains/tears happen?
Leg muscle injuries are most likely to happen during sudden acceleration or deceleration activities and the large muscles that cross two joints are more susceptible to injury. The strain injury is not only as a result of the muscle contracting, but as a result of excessive stretching or being stretched while the muscle is being activated.
There are other factors that contribute to a muscle strain/tear and some of these might be imbalances between the strength of your leg muscles, poor biomechanics or due to overuse and muscle fatigue. Sometimes over-training or poor recovery techniques also contribute to muscle fatigue.
Which muscles are involved?
Anatomy of the calf muscles.
The common sites for muscle strains/tears in the leg are:
- the hamstring,
- quadriceps,
- adductor and
- calf muscles.
Stages of healing for leg muscle injuries.
Different tissues in our bodies heal at different rates, but below is the general time frame for muscles.
Stage 1 (Inflammatory phase) Lasts up to 7 days. There is a lot of bleeding and bruising around the damaged muscle fibres. This is an important stage, as the healing mediators needed for repair are brought to the area with the increased blood flow.
Stage 2 (Reparative phase) This is 1-3 weeks long. During this phase, there is regeneration of the muscle myofibres, as well as production of connective scar tissue.
Stage 3 (Remodelling phase) This phase lasts up to 12 weeks. During this time, the new muscle fibres mature and the scar tissue is reorganised to become strong.
There are very important roles that your physiotherapist will play in all three stages of the healing process to ensure that your muscle heals correctly and that you regain your full function.
Physiotherapy for leg muscle injuries
The treatment of leg muscle injuries depends on what grade and what stage of healing the muscle is in.
- Initially during the inflammatory phase treatment is focused on allowing the correct amount of inflammation to occur to allow the healing to start. During this phase you might be advised to use a brace or to have strapping to help prevent excess movement in the area.
- A recent review discussed the uncertainty of using NSAIDs (Non steroidal anti inflammatory drugs) in soft tissue injuries. The study shows that using NSAIDs too early (in the first 72 hours) will delay the healing response by blocking the body’s natural healing chemicals from getting to the injury site.
- During the reparative phase, it is very important to load the area correctly to encourage collagen formation, but at the same time not encouraging an over-production of scar tissue. There is a risk of re-injury while the scar is still weak.
- In the remodelling phase, the physiotherapist will focus is on giving the patient a specific loading programme for their injury and their biomechanical factors. The emphasis here is on getting the muscle to fire correctly. There are numerous studies which show that a previous muscle strain which was not rehabilitated/treated correctly is one of the contributing risk factors to a future tear.
- Be aware that there is no consensus as to when an athlete can safely return to sport after a leg muscle injury, as there is no single test or observation which is considered to be the ‘gold standard’. But a safe approach is that one can return to sport once full range of motion, strength and functional activities have been gained.
This article was updated by Shelagh Green, Associate Manager at the Woodmead Practice of Lamberti Physiotherapy. Contact her directly to discuss any concerns you may have, or else complete our appointment form.
References
- The management of muscle strain injuries: an early return vs the risk of recurrence. J Orchard, T Best. Clinical Journal of Sports Medicine: January Vol 12 Issue 1 p3-5.
- Brukner and Khan’s Clinical sports medicine book, 4th Edition.
- Muscle Strain Injuries. WE Garrett Jr. The American Journal of Sports Medicine 1996 Vol 24 No 6.