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What Are the Three Grades of Muscle Strain? Symptoms

Depending on the severity of damage, muscle strains are classified into three grades. Learn about symptoms, causes, and treatment

Muscle strain, also called a “pulled muscle,” occurs when muscle fibers are stretched or torn. It may include injury to the tendon, which is the fibrous structure that connects muscles to bones.

To plan treatment, doctors classify the severity of muscle strain into three grades:

  • Grade I strain. A few fibers are stretched or torn. However, there is no problem with the functioning of the muscle. Pain is present, though minimal.
  • Grade II strain. A greater number of fibers are injured. The pain is greater with mild swelling and a noticeable loss of strength.
  • Grade III strain. The muscles are torn all the way through and may be ripped into two separate pieces. These are serious injuries that result in complete loss of muscle function. You may feel considerable pain and swelling. The injured area is tender and discolored. You may notice a gap under the skin due to ripped pieces of muscle and be unable to move the affected body part.
  • How do you know if you have muscle strain?

    You may have a muscle strain if you have overstretched your muscle beyond its limits. 

    Muscle strains most commonly occur in the lower back and at the back of the thigh (hamstrings). They are often caused by poor posture while working or abnormal body posture when lifting or pushing heavy weights or bearing overhead loads.

    Signs and symptoms depend on the severity of the injury and may include:

    • Sudden pain (stabbing pain) that worsens when using the strained muscle
    • Swelling
    • Bruising
    • Decrease in or loss of muscle strength
    • Limited motion
    • Muscle spasms
    • Muscle weakness

    What causes muscle strain?

    Acute muscle strains result from poor body postures when lifting heavy objects. Chronic muscle strain results from repetitive use of the muscle.

    Playing sports such as soccer, football, hockey, or wrestling can increase the risk of developing muscle strain.

    How are muscle strains treated?

    A muscle strain may be treated in various ways depending on its grade. 

    Grade I strains may be treated with a combination of the following:

    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
      • Take anti-inflammatory medication, such as ibuprofen or naproxen, for 5-7 days.
      • Use an NSAID in the form of gel or patch applied to the skin.
    • Rest: Try to avoid using the strained muscles until symptoms improve. Getting rest is vital to the healing process. Rest the affected part for at least 48 hours after strain (even if the strain is minor). Here are some strategies that you can adopt:
      • Lift objects by keeping the arm close to the body.
      • Do not lift light weights that are above the shoulder; only lift the ones that are below the level of the shoulder
    • Ice application: Apply ice to the affected area for 15-20 minutes several times a day to alleviate pain and swelling.
    • Physical therapy: If there is no relief in pain with NSAIDs, rest, and ice application, a course of physical therapy may be recommended. This usually includes:
      • Stretching exercises
      • Strengthening exercises
      • Massage (avoid deep tissue massages)
      • Ultrasound treatments

    Grade II strains may require casts or bandages to keep the muscle in a neutral position and avoid repetitive strain to the affected part. Casts may be kept for as long as 3-4 weeks depending on the degree of stain. 

    Grade III strains may require surgical interventions.

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    Medically Reviewed on 10/4/2021

    References

    Harvard Health Publishing. Muscle Strain. https://www.health.harvard.edu/a_to_z/muscle-strain-a-to-z

    Mayo Clinic. Muscle Strains. https://www.mayoclinic.org/diseases-conditions/muscle-strains/symptoms-causes/syc-20450507

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