New ideas for muscle injury management 

With sporting season in full swing, muscle strains or tears are a common injury that presents particularly at this time of year.

Muscle strains are injuries that occur to muscle groups that result in muscle fibres being damaged or torn. This is usually due to the muscle being placed under an extremely high load (eg. sprinting or change of direction) or asked to contract in a particularly lengthened position (eg. kicking or reaching out for a ball).

There is some exciting new ideas and evidence about ways to manage muscle injuries of the hamstring, quadriceps and calf.

A New Type of Muscle Injury

Epimyseal tears are a new concept in the understanding of muscle injuries. The epimysium is the layer of covering between two muscle groups. Tears can develop within this covering with no actual muscle fibres being disrupted. The way in which these present and test upon assessment are different from other types of muscle strains and can be easily differentiated by your physiotherapist. If requiring an image a MRI would be the preference as the level of penetration gathered from ultrasound technology is usually not sufficient to penetrate deeper muscle groups.

A key component of rehab from these types of injuries is load management and modifying related risk factors. These type of injuries are often acceptable to play with but addressing the reasons as to why they developed is key in their recover and preventing recurrence.

New Management Concepts

Previously running has been an activity that when diagnosed with a muscle strain has been avoided until 7-10 days after injury has occurred. It is now understood that an early return to running (within 2-3 days for some injuries) can prove to be beneficial. An early return to running aims to minimise muscle atrophy (wasting), reduce tightness in muscles and increase tissue length. These are all factors that will optimise the outcomes from rehabilitation. The timeframes associated with returning to running will be dictated by the type of injury, the site of injury (eg affected muscle) and guided by pain levels. These should be guided by your physiotherapist.

What hasn’t Changed

Management of muscle injuries still require:

  • RICE  – Rest, ice, compression, elevation – within the first 72 hours, and especially for compression for longer periods (eg compression wear)
  • Strengthening – for return to activity and to reduce the risk of recurrence, addressing strength deficits is still key, and not just for the affected muscle. Often the reason a muscle group is overloaded (eg quadriceps) is because another muscle group (eg gluteals or adductors) are not doing their job when required or when the body is fatiguing
  • Functional activities – retraining proprioception (awareness and balance) around the affected muscle group is also highly important to avoid recurrence, and this is best done with exercises that mimic the activity you want to return to.
  • Cross-train in the interim before returning to full activity – maintain your cardiovascular fitness and optimise strength and function of the rest of your body while your injury heals. Think less weightbearing activity like bike, pool or elliptical trainer or Pilates & yoga


  • Pollock N, Patel A, Chakraverty J, et al Time to return to full training is delayed and recurrence rate is higher in intratendinous (‘c’) acute hamstring injury in elite track and field athletes: clinical application of the British Athletics Muscle Injury Classification 
  • Prakash A, Entwisle T, Schneider M, et al Connective tissue injury in calf muscle tears and return to play: MRI correlation 
  • van den Tillaar R, Solheim JAB, Bencke J. Comparison of hamstring muscle activation during high-speed running and various hamstring strengthening exercises. Int J Sports Phys Ther. 2017;12(5):718–727.