Hi! Good evening, everybody! So, tonight's session is about muscle strains. And I'm gonna give … try
and give you a recipe that you can use and apply to fix pretty much any muscle strain or help a
muscle strain recover. Let me talk you through what I'm gonna cover today. So, we're going to
look, first of all, at the grading system of muscle strains and why that's important. Then
I'll talk you through my recipe; basically, it has three steps to it. And then lastly, we're going to
talk about the rules of strength training after you've had an injury to a muscle. So, my name
is Maryke, for those of you who don't know me. I'm the physiotherapist from sports-injury-physio.com,
where you can get online physiotherapy assessment as well as treatment for injuries. If you want
to find out more about my website, check out the description of this video – I've popped a
link in there. Excellent! So, let's get started. Let me just get that slide up. So, first of all,
the grading system of muscle strains. Now, if you look at the research and the literature,
there are loads of different ways of grading muscle strains. They range from 0 to 5, depending
on what papers you read. And to be honest, it's not for you and me, who just want to try and
help ourselves. It's not that important that we home in on the zeros and the fours and fives,
because that's really only from … for academical importance, or if you're in a high-level sports
situation where you've got the luxury of scans and things where you can see exactly what parts of
muscles are injured. So, for this video, I'm going to talk about three grades of muscle strains,
where a Grade 1 is a very minor little muscle strain or tear, where you've only injured a
small part of the muscle or a small number of the muscle fibres. In the literature they talk about
less than – if you looked on a scan – less than 5 millimetres size. Usually, you can pretty much
walk and even jog sometimes without pain; it's usually only painful if you use the muscle and
contract it strongly; you very rarely have pain at rest if you've got a Grade 1 muscle tear. Then,
a Grade 2 means that you've torn a lot more of the muscle fibres, but you still have relatively okay
power in there; it can be painful when you’re just resting it, and you can have quite a bit
of swelling and bruising with it. Now, a Grade 3 muscle tear: you've torn at least 85% or more of
the muscle, so you've nearly torn it through or you have fully torn it through; in which case,
if it's fully torn through, you may not even have that much pain, because there's nothing
to be tugged, because it's totally severed. But you usually will have a lot of swelling,
there will be quite a bit of bruising, the muscle function will be severely limited. So,
for instance, if you’ve properly torn your calf muscle, you won't be able to raise up on your
heel if you're on just one leg, or if you’ve fully torn your quad muscle, you'll really struggle to
straighten out your leg. So, your muscle function will be severely limited. Now, if you suspect
that you've got a severe muscle strain, I would strongly suggest you go and seek medical advice,
so, a sports physiotherapist or a sports doc are good places to start because you will need
a bit more specialist advice and attention to make sure that you don't have long-term problems with
it. Okay, so that's the grading system. Now, if we move on to recipe for treating muscle strains. So,
we're talking about a Grade 1 or Grade 2 that's not that severe. On Day 1, you always apply the
RICE regime. Now, what's the RICE regime? By now, most people know. It stands for Rest, which means
that as soon as you injure yourself, stop whatever activity you're doing, and then during that day,
take it very easy. And the reason for this is, as soon as you get a muscle tear, you've injured some
of the muscle fibres, so now that muscle isn't as strong as it used to be. So, if you continue
to run or play on it, you can actually tear more muscle fibres more easily because the strength is
reduced. Also, you very often injure little blood vessels and things when you tear a muscle. So,
if you're going to continue training on it or you are on your feet all day after you've torn it,
you can increase the bleeding dramatically, which creates a secondary injury because of the pressure
it creates inside the muscle. If you get a lot of pressure inside the muscle, it will cut off
the blood supply to the muscle fibres around the injury, which weren't injured in the first place,
and that can actually then cause more damage. So, that's why rest is really important. Then we move
on to Ice, that's what the I stands for. And that is again to try and limit the internal bleeding
on that day of injury. So, as soon as you've come off the pitch or you've stopped running
and you can get to some ice or a packet of peas or whatever you have that’s cold, whack it on there,
because you want to stop that internal bleeding so you don't get a lot of pressure inside the muscle.
Word of caution: The reason it stops bleeding is because the body doesn't want to lose heat,
so it narrows the blood vessels to that area. If you leave the ice on for too long,
you will get a vasodilation, where the blood vessels open up again, and you can get more
bleeding. And the reason for this is, if you cool the skin so much that the brain realizes you're
going to cause damage or blisters to the skin, it tries to warm the area back up. So, don't just
put cold on there and leave it on there for hours on end, because it's not going to be productive.
You put ice on for 10 minutes, take it off for 10 minutes, and then you can reapply it for 10
minutes. That should be okay and prevent it from actually opening up and bleeding more. And you can
repeat that regime every two to three hours. But make sure you give it that little bit of a break.
And remember, you also need something between your skin and the ice pack or the cold you use so that
you don't get any blisters or damage to your skin. Another point: If you have any sensory deficits –
so, it means that you can't feel so well in that area – don't use ice, because … or check regularly
that you haven't created any blisters or anything, because your sensation won't tell you when
you're starting to … when the skin is starting to experience damage. Then, the C is for Compression.
And compression is again to do with limiting the amount of internal bleeding on that first day.
Now, when we talk about compression, it's not as hard as you can. If you're going to cut the blood
circulation off because you're compressing it too much, again you're gonna cause more tissue damage
to cells that's not actually injured in the first place. So, the level of compression you should
look for, it's just something like a firm hug. It should be firm but comfortable. If you feel really
uncomfortable after putting a compression bandage on or even just wearing your compression garments,
it means it's too tight, and you've got to take it off because it's not gonna be useful;
it can actually cause further injury. Also, if you toes turn blue or you get a tingling in your
extremities after you've applied the compression – likely a sign that it's too tight, cutting off
the blood circulation – definitely take it off immediately. So, it's not as strong as you can,
it's just like a firm hug that you want to combine with the ice and the rest you’re doing. And then
the E is for Elevation, because if you elevate the body part above the level of your heart, you make
it more difficult for the blood to run there. So, if you think for instance again of a calf strain
or something in the legs; if your legs are below your heart, the blood pools, so you can get more
bleeding, whereas if you can spend some time in your back with your leg up, you can actually limit
the amount of bleeding because it's a little bit harder for the blood to get there. And if
you combine it with the ice and compression, that will work even better. So, that is the first step
in the recipe; that's for the initial day – that first day of injury. I forgot to say, if you've
got any questions, make sure you ask them in the comments, and if you're watching this on replay,
feel free to ask them as you go … as they come up, and if you tag me, especially on Facebook,
I will get back to you and answer you as soon as I see them. But you're also welcome to just message
me if you want to. Then, Day 2 to 5, that's the next step in the regime of a muscle strain. At
this point, you continue with the RICE regime, but you add in gentle movement. And the reason
for that is that we now know through research that just immobilizing something really doesn't help
the healing process; it's much better to gently move it and help the blood circulation and things;
that helps it to heal early on. Now, I've written in red there ‘Do not stretch it.’ And the reason
for that is, when you've got a fresh muscle strain, it kind of … Think of it as forming
a bit of a scab inside; it's like a blood clot that forms in there, and it's quite fragile. So,
if you're going to go and stretch it quite hard, or just into pain, you can actually
disrupt that and you can cause more bleeding, and the damage can be larger than what it should be;
you can get more scar tissue in there. So, absolutely no stretching of anything of a
torn muscle within the first five days at least, okay? And if you've got a severe muscle strain,
you may want to leave stretches for way after two weeks. The movement you're looking for is
within the pain free range of movement. So, if I can show you on my arm, for instance. Let me just
see which arm will show best. Say, for instance, I've torn my bicep muscle. Now, it may be okay
to take it that straight, but not fully straight. So, pain starts there and pain starts there. So,
when you move it gently, you just move it to where the first discomfort starts. Now, what you'll find
often is that the more often you do little bits of that, the less uncomfortable it will become and
the larger your range of movement will become. So, if we think of calves, for instance, then
a very easy thing to do for that if you've torn your calf is just point and flex your toe. Now,
this is annoying because this thing is now in the way … Actually, move the camera … Okay, so,
point and flex the toe; that will gently move the calf muscle if you've strained it. But I'm
not pulling up as hard as I can until I feel pain or a stretch there, I'm just going to the first
resistance. Your aim is very gentle movement; that is the second thing that you add in after the RICE
regime, okay? So, then we move on to from Day 5 onwards … Now, if I can just get my head back
in the shot … That's better! Okay, so when you've injured a muscle, you now have to replace the old,
damaged cells. And you first absorb it through the inflammatory phase, which happens within the first
five days; that's why everything is quite a bit fragile. And then your body starts regenerating
itself and starts forming new cells. Now, these little new cells that form aren't strong yet;
they’re very basic cells. So, you need to slowly strengthen them up. When I say ... So, at this
point, you start strength training. But now you have got to forget about what you could do in the
past, because these new cells are not as strong as they used to be. So, you've got to start quite
further down, way back from what you could do. And actually, I may as well, while I talk about that,
bring on the strength training rules, because that is the final part of it. So, the first rule is,
Forget! Forget what you could do. If you were able to squat a hundred kilos and you've torn your calf
muscle ... you've torn your quadricep muscle in your thigh, you're gonna have to cut that back
all the way, and you may even have to start with just isometric holds of your quad muscle. I often
find the safest place after five days to start feeling it out and seeing what the muscle can
do is with isometric holds, and quite low load ones, to see what the response is. So, if we
think of a quad muscle tear: Yes, you could squat 100 kilos beforehand, but now it may be that you
start with something simple like, for instance, just holding it isometrically, and holding it like
that and counting for 20 to 30 seconds, depending on what it wants ... can do. You basically decide
what you can do according to how much discomfort you feel. And while there's certain injuries that
we don't mind if you feel a bit of discomfort and pain, when you've torn a muscle, during the
first initial stages you don't want to feel any pain there, because that may be an indication
that the exercise is too hard. Progression from just isometric quad exercises for a quad strain
would be, for instance, just bodyweight squats, until they’re comfortable, and then you start
to slowly load it. And by loading, I mean you add a bit of weight, but you don't jump to 50 kilos,
you try it out with 10 kilos, see how it is, and you slowly progress from there. Now, how slowly
you've got to progress will depend on how severe your injury was. So, sometimes people can start
back with about 80% of what they were able to do; other times they'll have to cut it right back. So
yes, the second rule of strength training after you've had a muscle strain is, you have to listen
to pain, especially in the first few weeks. You have to train in a pain free range and
with weights that don't cause an increase in pain during or after your session. And then the third
and probably the most important … or no, they're all three are very important, but a very important
one that people miss out is that you have to strengthen that muscle enough that you actually
strengthen it to the level that is needed for your sport. So, as an example, I often get people ask
me or mention on the Internet that they have torn a calf muscle and then they rested it, and they
were pain-free walking and with stairs and things, and then they went to play football again and then
they can't understand why, after 10 minutes, their calf muscle is sore, and they’ve re-torn
it. And the point is that there's a massive gap in how much strength you need for just walking
around and doing stairs, versus fast sprinting, change of direction, pushing off; that is quite a
high load. They reckon that … Some of the studies have shown that between something like four to six
times your body weight goes through your Achilles tendon and your calf muscles when you run. So,
you can see why you have to strengthen it to the right level before you can actually go into full
level sport. And it's not as difficult as you think it is. For instance, very simple regime for
calf strains would be that you start with double leg body weights. Can do that? Go on to single leg
heel raises. Can do that? Do it with extra weight in a backpack or in your hand. If you can do that,
start a run-walk program, because that starts to strengthen it for running, but the walk bit
gives it time to recover. And then once you can continuously jog, then you've got to add
in faster runs, so, for instance, little sprints in your normal jog. If you're playing football,
you've got to be able to sprint fast in directions as well as to the sides before you can go and do
a full match. So, make sure you take the time to strengthen it specifically for the sport you
want to be doing and the volume and level of sport you want to be doing, because it will differ from
a person who just wants to jog a 5K three times a week versus somebody who actually wants to do
endurance sport, or a sprinter, for instance. I've put there in green, you can see the rough recovery
times for muscle strains. Now, if it's a Grade 1 one muscle strain, so, you've pulled your muscle,
but you can walk pretty near normal, you can … you could just feel it a bit and it doesn't
really hurt when you're sitting down or resting, then those muscle strains often take about four
weeks to get to full strength. And that doesn't mean just resting it for four weeks, it means
going through your recovery phases and making sure that you strengthen it up properly. If it's a more
severe strain, so, we're looking at a Grade 2 strain, that can take anything between six to
twelve weeks, depending on how bad it is, again, and depending on what type of sport you want to do
and what activity you're taking it back to. So, make sure that you don't just rest your muscle
and think you can go back into full sport because it's not painful anymore. It doesn't matter how
long you rest it for, you have to strengthen it as well; it's not going to get strong through not
doing anything. A good example of that is, if you want a six-pack, you know you've got to do some
exercises to get the muscles stronger, that they look nice. And the same concept goes for this:
you can't get it stronger by just resting it. And then lastly, make sure that you actually
strengthen it to the level that you need to be using it at. Excellent! So, let me know if
you've got any questions. And if you need more help with an injury, you're always welcome to
consult me via video call online, and I can work out a bespoke program for you. The link to the
website is in the comments or in the description of this video. Have a good evening! Bye-bye!