Muscle "Pulls" - Why Rest Isn't Enough

“I think I pulled my muscle, now what?” The dreaded muscle “pull” is an injury that often leaves runners frustrated. Usually (or hopefully!) when a runner feels a pull, they stop running. Depending on how much pain they are in, they might rest for a few days or even a few weeks. What I often hear is that as soon as they start running again, the pain comes right back even though they rested. Why?

Muscle “pulls,” can occur from running on fatigued legs (i.e. not taking enough recovery time after a hard workout or race) or increasing the intensity of your run through either sprinting or running up hill.

To understand why rest isn’t always enough, we need to understand what is actually going on in the muscle when a “pull” occurs. A “pull,” technically referred to as a muscle strain, is an overstretching of either the muscle fibers or the tendon. There are different degrees of strains, ranging from minor with barely any swelling or loss of motion to severe which can include swelling, discoloration, and loss of motion.

An overstretching of the muscle involves small tears in the fibers. When a tear occurs, there is a degree of inflammation associated with it. A larger muscle tear or rupture will obviously have a larger degree of inflammation, but small strains also generate inflammation. Inflammation is the body’s response to injury and the way it repairs itself. Inflammation is a very involved process. The basic overview of what occurs following injury is tissue death followed by formation of a hematoma, or collection of blood. Hormones are then released that will consume the dead tissue. Muscle cells will then reproduce and fuse with injured cells. This fusion of tissue basically fills in the gap that was created in the muscle fiber by the strain. This tissue then turns into scar tissue which gives the muscle strength to withstand contractions.

It is this scar tissue that is so crucial to muscle repair that may also become a problem and limit full recovery of the functional capacity of the muscle. The scar is the weakest point of the muscle within the first two weeks after injury. With time, the scar becomes the strongest part and if there is going to be a re-injury, it will often occur in the muscle tissues next to the scar.

Early Motion = Quicker Recovery

There are a few things that you can do to help your body heal from a muscle strain. The first is early mobilization. While rest is good initially as early stages of inflammation occur, too much rest might actually be counterproductive. Movement of the injured muscle can help with vascularization, or blood flow, through the damaged tissue. I don’t mean go run, but gentle muscle motion such as walking, easy biking, swimming, or gently stretching can be beneficial to the recovery process. The goal during this time period is to maintain the available range of motion that you have. You might be limited a little due to your injury, but you don’t want to become more limited because of stiffness.

Strengthen to Realign Muscle Fibers

 The second important piece of healing is realigning the contractile (muscle / tendon) tissue. When the scar tissue is laid down, it is in haphazard formation. Initially, this is a good thing as it fills in the injured area and creates strength within the tissue. If this tissue is not realigned along the angle of pull of the muscle, it will not function well and can come back to haunt you in the form of chronic overuse injuries and pain. In order to realign the tissue along the angle of pull, the muscle must contract.

Depending on the severity of your injury, you might have to start with isometric contractions (contractions where there is no change in length of your muscle). For example, when your leg is out straight in front of your and you squeeze your quad muscle. Your knee doesn’t straighten anymore because your leg is already straight, but the muscle generates force. Once this becomes pain free and easy, start with isotonic exercise, meaning the muscle will shorten and lengthen throughout the motion of the joint. For example, sitting on a chair with your knee bent, actively straighten your knee, and then slowly allow it to bend again. This is an isotonic contraction of your quad muscle. Once you can perform isotonic exercises without pain, you can start to introduce some easy running back into your routine.

Scar Massage

Gentle massage of the injured area and around it can also be beneficial. Massage can help improve the blood flow through the involved tissues, allowing them to become more pliable and receptive to stretching and strengthening. It also helps to break up adhesions that were formed when the scar tissue was laid down along healthy tissue as the body went through the inflammation process to repair the initial muscle strain.

As you can see, a lot goes on within the muscle after a strain occurs, even a seemingly minor one. Simply not doing anything for a few days / weeks usually is not enough to get a runner running again. Sure, you might feel better after a few days of doing nothing. Remember, that muscle will not function normally unless you retrain it to. Gentle mobilization, gently stretching and massaging, and controlled muscle contractions can help get you back to running hopefully without any nagging setbacks!