The successful treatment of muscle injuries depends on understanding what phase of healing is taking place. In the early days (first week) after an injury, the body mounts an inflammatory response. This is sometimes referred to as the destructive phase.
It is during this period of time that the macrophages are released. Macrophages are from the immune system and are designed to destroy damaged, bleeding, or injured cells. Application of the R.I.C.E. approach (Rest, Ice, Compression, Elevation) is the most often recommended treatment during this early acute phase of muscle injury.
But there is really no convincing evidence that this treatment is an effective way to treat soft tissue injuries. In fact, in animal studies, scientists have shown that applying ice too long can actually reduce blood flow to the area impairing recovery. And other studies using compression bandages right away after injury (within the first five minutes) does not decrease the amount of swelling or speed up healing.
Whether or not to immobilize the muscle (in a splint or cast) remains a point of debate and controversy. On the one hand, keeping the muscle from moving during the early healing (destructive) phase can minimize the gap that develops when the ruptured muscle stumps pull apart. As the body sets up a collagen scaffold that will be filled in with repair cells, a smaller gap between the injured tissue means a smaller scar.
On the other hand, immobilizing the damaged soft tissue too long can cause excessive scarring. Since scar tissue is less flexible, the muscle is at risk of reinjury under lower loads or force compared with normal, healthy muscles. And there is clear evidence that early movement aids the regenerating muscle fibers to heal in an organized fashion. With early mobilization and better tissue alignment, fewer adhesions can form.
Treatment also depends on the severity of muscle injuries (mild, moderate, or severe). Accompanying swelling, loss of motion, tearing of muscle fibers, and loss of function help determine how the muscle injury is classified. Mild injuries usually have only minor swelling and pain with no loss of motion or function. Complete rupture of a muscle will be obvious when the patient cannot contract or use that muscle to move the body part (e.g., arm, leg).
Whereas nonsteroidal antiinflammatory drugs (NSAIDs) were once routinely prescribed after muscle injury, more recent (animal) testing has brought about a change in thinking here as well. For example, there is evidence that these drugs can delay the destruction of damaged cells thus slowing repair and regeneration of the muscle tissue. Likewise, the use of steroids has been shown (again in animals only so far) to permanently impair healing.
Conservative care (applying the RICE principle) for the first two or three days may be all that’s needed. With time (typically four to six weeks, sometimes longer depending on your age, health, and severity of injury), the soft tissue will regenerate and remodel. The result will be a return to activity as before the injury.
If you think there is something more serious going on that might require surgery (or the conservative approach doesn’t work), don’t hesitate to seek medical evaluation and treatment. Your primary care physician, a sports medicine physician, or an orthopedic surgeon will be able to assess your condition and make the most appropriate recommendations.