A muscle tear happens when a muscle is stretched beyond its limit and its fibres tear; a partial tear, in which some of the fibres are torn, is what people usually mean by a pulled muscle or a torn muscle fibre [2][4]. Treatment is mostly non-surgical: protection, cold, a bandage and elevation in the first days, followed by gradual movement and strengthening [1][2][3]. Return to sport can take 10 days to 3 weeks after a mild tear and up to 6 months after a severe one [2].
What is a muscle strain or a torn muscle fibre?
When a muscle is stretched beyond its limit, its fibres tear; this is called a muscle tear, a pulled muscle or a muscle strain (the medical term) [1][2]. The tear usually happens near the point where the muscle joins its tendon, the tissue that attaches it to bone [2][4].
What is commonly called a "torn muscle fibre" (in Turkish, lif kopması) is a partial tear, in which some of the fibres are torn; most muscle tears are of this kind, and a tear through the whole muscle is very rare [4]. In the most severe injuries the tendon tears completely away from the bone where it attaches (an avulsion) [3].
A sprain is a stretch or tear of the ligaments that hold a joint together [1]. In a muscle strain, what is damaged is the muscle itself or the place where the muscle joins its tendon [1][2].
What causes it, and which muscles are affected most often?
The injury usually happens when a muscle is suddenly and forcibly lengthened while it is contracting powerfully; sprinting is the typical example [3][4]. Exercising without warming up, tired muscles and playing sport are common causes [1]. Tight or weak muscles, an imbalance of strength between opposing muscles and fatigue increase the risk [2][3].
In football, 92% of muscle injuries affect four muscle groups of the leg: the muscles at the back of the thigh (hamstrings) 37%, the inner thigh muscles that run up to the groin (adductors) 23%, the muscle at the front of the thigh (quadriceps) 19% and the calf muscles 13% [4].
Symptoms: what do you feel at each grade?
At the moment of injury there is a sudden, sharp pain, sometimes with a snapping or popping sensation in the muscle [2][3][4]. Swelling can appear in the first hours and bruising over the first days; the bruising may spread towards the calf and ankle within a day or two [2][3]. Muscle spasm, weakness and difficulty using the injured part can also occur [1][3].
What you feel depends on the grade of the tear [2][3][4]:
- Grade 1 (mild): there is no appreciable tear and no loss of strength; it usually heals quickly [2][4]
- Grade 2 (partial tear, the "torn fibre"): a sharp, stabbing pain, often with a snap; the pain is at one well-defined spot and increases when the muscle is stretched, and the muscle is weaker [4]
- Grade 3 (complete or near-complete tear, or a tendon torn away from the bone): tearing is felt and the person often falls; there is a gap in the muscle that can be felt, extensive bruising and loss of function [3][4]
How is it diagnosed: when are ultrasound and MRI needed?
The diagnosis rests first on the history and the examination: the muscle is felt for tenderness, swelling and bruising; larger tears can be felt by hand [2][3][4]. Imaging complements the examination, and the diagnosis is not based on imaging alone [4].
An X-ray is taken if there may be a fracture or if the tendon may have torn away with a piece of bone [2][3]. Ultrasound performed between 2 and 48 hours after the injury shows disruption of the muscle structure and any collection of blood (haematoma) [4]. MRI may be requested when a structural tear is suspected; it reveals where the tear is, its approximate size and whether the tendon is involved [2][3][4].
Pain in the back of the thigh or in the calf can also come from nerve problems arising in the lower back; if this is suspected, the assessment is carried out by the relevant specialty [4].
What should be done in the first days, and what helps?
First aid has long been based on rest, ice, compression (a bandage) and elevation; the National Health Service in England (NHS) adds protection and advises these measures for the first two to three days [1][2][3].
An editorial published in the British Journal of Sports Medicine recommends protection for 1 to 3 days; it states that prolonged rest can weaken the tissue and that there is no high-quality evidence for the efficacy of ice [5]. The sources do not agree about ice; they do agree on a bandage, elevation and early movement that does not increase the pain [1][2][5].
The measures that can be applied at home are [1][2][3]:
- Stopping the activity that caused the injury and trying not to put weight on the injured part
- An ice pack wrapped in a towel for up to 20 minutes every 2 to 3 hours; ice should not be placed directly on the skin
- Wrapping the area lightly with an elastic bandage
- Keeping the injured part raised as much as possible
- Avoiding heat, alcohol and massage for the first couple of days
- Starting to move the area once pain no longer prevents it
Which cream helps, and should painkillers be used?
The NHS advises speaking to a pharmacist and, at first, trying a simple painkiller for pain and an anti-inflammatory gel or spray applied to the skin for swelling [1]. According to a Cochrane review, in acute injuries such as sprains and strains, gels, creams and sprays of this kind reduced pain by at least 50% in more people than a gel without the drug (placebo); skin reactions were generally mild and transient [6].
Anti-inflammatory painkillers taken by mouth may be recommended by a doctor [2]. On the other hand, it has been suggested that suppressing inflammation with medication, especially at higher doses, may adversely affect healing [5]. Ask your pharmacist or doctor which medicine or cream is suitable for you [1].
How does it heal, and how long does it take?
As pain and swelling settle, physiotherapy begins: gentle stretching comes first, and strengthening exercises are added gradually [2][3].
Most sprains and strains feel better after two weeks; it is advised to avoid strenuous exercise such as running for up to eight weeks [1]. For the thigh muscles, return to sport can take 10 days to 3 weeks after a mild tear and up to 6 months after a severe one [2].
Small partial tears usually heal completely, whereas larger ones can leave scar tissue in the muscle [4]. Most hamstring tears heal very well with simple, non-surgical treatment [3].
Before a return to sport the muscle should be at full strength and pain-free [2]. In professional football 16% of muscle injuries are re-injuries [4]; re-injury increases the risk of permanent damage [3].
When is surgery considered?
Surgery is not commonly performed for tears within the body of the muscle; it is most often performed for injuries in which the tendon has torn completely away from the bone where it attaches (avulsion) [3]. Such avulsions are seen most often at the upper ends of the front, back and inner thigh muscles [4].
In the operation the tendon is reattached to the bone; rehabilitation before a return to sport takes at least 6 months if the hamstring tendon was torn from the pelvis and about 3 months if it was torn at the knee end [3].
If, after a hamstring injury, the pain is close to the sitting bone, you need to be assessed for a tendon tear; such tears are time-sensitive and may benefit from surgery [2].
When not to wait
In the following situations seek care without waiting; there may be a severe tear, a torn tendon, a fracture or a circulation or nerve problem. In the first four, go to an emergency department [1]:
- You heard a crack at the moment of injury
- The injured part has changed shape
- There is numbness, tingling or pins and needles
- The skin has turned blue or grey, or is cold to touch
- You cannot put weight on the leg or cannot walk more than a few steps
- There is a large amount of swelling or bruising, or it is getting worse; the pain is very severe
- There is a gap in the muscle that you can feel, or you cannot use the muscle at all [4]
- Severe pain near the heel that began with a "pop", and you cannot rise onto your toes: this may be a ruptured Achilles tendon [7]
- There is no improvement despite care at home
Frequently asked questions
- How many days does a pulled muscle take to get better?
- After a mild injury, return to sport can take 10 days to 3 weeks; most strains feel better after two weeks [1][2]. After a severe tear, recovery can take up to 6 months [2].
- Does a torn muscle fibre heal on its own?
- Most of the time, yes: small partial tears usually heal completely, and most hamstring tears heal very well with non-surgical treatment [3][4]. Larger tears can leave scar tissue in the muscle, so sport should not be resumed before healing is complete [2][4].
- Which cream is good for a muscle tear?
- Anti-inflammatory gels, creams and sprays applied to the skin have been shown to reduce pain in sprains and strains; their side effects are generally limited to mild skin reactions [6]. Ask your pharmacist or doctor which one is suitable for you [1].
This article is a general summary; diagnosis and treatment decisions are made by the doctor who examines you.
Sources
- Sprains and strains. NHS (nhs.uk), 2024. nhs.uk
- Muscle Strains in the Thigh. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Hamstring Muscle Injuries. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Terminology and classification of muscle injuries in sport: the Munich consensus statement. British Journal of Sports Medicine (Mueller-Wohlfahrt HW, et al.), 2012. pubmed.ncbi.nlm.nih.gov
- Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine (Dubois B, Esculier JF), 2019. pubmed.ncbi.nlm.nih.gov
- Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database of Systematic Reviews (Derry S, et al.), 2015. pubmed.ncbi.nlm.nih.gov
- Achilles Tendon Rupture (Tear). American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
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