You may have been here: you’re lifting a weight you’ve lifted a hundred times before and you feel a tweak. A wave of anxiety rushes over you and you think, “Oh no. I can’t be injured. I am going to lose everything I’ve worked so hard for.”
You move your freshly injured body part around and pray that the twinge goes away. You do another set, but it feels no better.
You may even try to push through the workout, possibly with lighter weights. You change around your exercises. You pray some more. You run through every devastating scenario you can think of in your head as you leave the gym, scared you won’t be able to shake off the injury in the morning.
The good news is, yes, you will be able to lift again. The human body is remarkably resilient, and with proper diagnosis and appropriate treatment, you can minimize your recovery time and get back to making progress sooner.
Soft tissue injuries (injuries to muscles, ligaments and tendons) are the most common type of injury amongst regular exercisers. They can be acute, i.e. occurring at an identifiable point in time, or chronic. Chronic injuries often are the result of overuse and repetitive stress (think shoulder pain in a tennis player). Soft tissue injuries result in pain, swelling, and loss of function. Acute injuries that are not identified and treated properly can easily turn into a chronic injury, which can be very frustrating and mentally challenging.
A pulled muscle is a colloquial term for a muscle strain, which is an injury to a muscle caused by overstretching of the muscle fibers.1 Strains can occur acutely or develop over time from repetitive use. It is important to distinguish strains from the microscopic tears to muscle, which occur as a result of proper weight training. Muscle adaptation to progressive resistance training depends on, to a significant degree, this type of “injury,” which is desired. A strain, on the other hand, is not normal and is most definitely not a desired outcome of exercise.
Muscle tears are usually painful and result in swelling and bruising (as blood leaks from torn vessels in the injured area). Depending on the degree of the tear (i.e. partial/minor versus full), there will be varying levels of difficulty in moving the muscle. For example, in a full rotator cuff tear, it is often impossible to raise the arm over the head. If you are in the gym and feel a tweak or a sharp pain followed by swelling and bruising, a muscle tear2 is likely.
Muscle tears are divided into grades based on the degree of injury.3 Grade 1 tears are limited to a few muscle fibers. The sheath that encases the muscle, known as the fascia, remains intact. In Grade 2 tears, more fibers are injured but the fascia remains intact. Grade 3 tears involve still more fibers damaged and the fascia is partially torn. And finally, a Grade 4 tear is defined as a complete tearing of the muscle and fascia.4
Proper precautions can minimize your chances of injuring a muscle:
If you believe you have torn a muscle, use the PRICE formula.9
P: Protect the area from further injury. In other words, if you just hurt yourself bench pressing, do not do another set.
R: Rest the affected area. Avoid any pain inducing movements. Rest is important for recovery, but resting too long can result in deconditioning and delayed recovery. For this reason, I think it is a good idea to see a sports medicine physician for any pain lasting more than a day or two.
I: Applying ice to the area immediately will help reduce pain and swelling. 20 minutes of ice every hour while awake for the first day is a common recommendation, though you should never apply ice to bare skin.
C: Compression (using an elastic wrap) can provide supports and decrease swelling. Do not wrap too tightly and do not use for prolonged periods, as this can hasten deconditioning.
E: Elevating the affected area, when possible, may also accelerate healing.
Anti-inflammatory medications (like Motrin or Aleve) can help with pain and swelling, though certain experts believe it is counterproductive to inhibit the body’s own response to injury. Tylenol does not have significant anti-inflammatory effects but may provide pain relief.
I recommend seeing a specialist for all but the most minor injuries. A doctor can help determine the extent of the damage and how to best treat it. A lack of severe pain does not necessarily mean the injury isn’t severe. Additionally, a minor injury can quickly become a major one if not handled properly.
To keep in shape, make sure your muscles are in shape, so treat them well.