A blog by runners. For runners.

Don't Ignore the Pain of Muscle Strains

This article was written by our guest blogger, Dr. James Nace, MD. He writes articles on common running injuries, and also tackles questions of your own once per month.


Muscle strains are another very common injury for runners and many of the questions I get from the readers here at WalkJogRun and from patients in my clinic. Anyone can experience muscle strains, but they might be more prevalent among active people, especially runners, athletes, etc.

Muscle strains are defined broadly because there are varying degrees of strains spanning from what are commonly known as muscle pulls all the way to micro-tearing or partial tearing. A strain is a situation in which the muscle fibres overstretch and sometimes tear slightly. Occasionally muscle strains are a symptom of overuse that can develop gradually over time. Muscles that are overstretched can turn into micro-tears and they can become more symptomatic over longer periods, but anytime undue pressure is placed on muscles there is an increased risk – even when doing housework, so take it easy with that feather duster!

While sprain and strain are occasionally used interchangeably, strain is defined as an injury to muscle or tendon, as opposed to sprain being an injury or stretch to a ligament, ie ankle sprain.

Once you experience a full muscle or tendon tear, however, it is termed a rupture and doesn't fall under the definition of a muscle strain. An acute partial tearing of the muscle can cause damage to the blood vessels around the area and this can result in some bruising or discoloration.

Symptoms of Muscle Strains

The most common symptoms for muscle strains are swelling, tightening, bruising and pain specifically related to whenever that particular muscle is stretched. If it is an acute injury, there could be some redness mixed in with the bruising.

Where I See it Most Commonly

The most common muscle strains I see are from runners who dramatically increase their distances too rapidly. These runners make significant additions to the amount of time they run or the miles they are logging and their muscles become overstretched and overtime, they develop micro-tears.

I also see it in the acute sense in runners who already logged a lot of miles. Their muscles become fatigued and the protective mechanisms that usually compensate for the weaker muscle groups are not as effective. It does not take much to put already fatigued muscles over the edge.

Treatment Options

  • Activity modification and modalities
  • RICE Protocol  Rest, Ice, Compression, Elevation

  • Using a bag of frozen peas works best for me and I recommend using a protocol of 20 minutes on, then 20 minutes off and repeat as much as necessary.

  • Ice VS Heat aahh, a heated debate!

  • Ice is best for immediate relief so I would use that for the first 24  48 hours; after that it becomes dealer's choice. If ice makes you feel better, then go with it. Moist heat, heating pads and hot showers are some modalities that alleviate pain/ache for individuals that prefer heat. I prefer ice for the first 24 hours and then I stretch under some moist heat in the shower.

  • Stretching and developing a good muscle tension relationship. Long, slow stretching is important and DO NOT BOUNCE when stretching because it could further damage or cause micro-tears in muscles. I would rather see patients stretch for 60 seconds 10 times a day than for 10 seconds 60 times a day.
  • OTC pain medication if you are medically able to tolerate it

  • There is no silver bullet pain medication so I would go with whatever has worked for you in the past. I prefer Naproxyn or Aleve because you only have to take it twice a day in comparison to others that call for 3  4 doses each day.


    When taking anti-inflammatory medicines, make sure to get ahead of the pain and try to knock it out in the beginning. I recommend patients take it for 3  5 days like it says on the package instead of just taking it whenever something flares up.

Know When to Seek Treatment

If you have a little tightness and discomfort for around a week or two then the treatments mentioned above should do the trick. If you have pain that persists for longer than two weeks and the bruising or redness is not subsiding, it is time to visit your physician. Another sign that it is time to visit your physician is if you are unable to move a particular joint because of pain as this might be a complete rupture of the muscle or tendon.

Running Injuries

Dr. James Nace, MD

James Nace, MD is an orthopedic surgeon-joint replacement and doctor of general orthopedics specializing in hip, knee and shoulder joint preservation and reconstruction. He practices out of the Rubin Institute for Advanced Orthopedics at Sinai Hospital of Baltimore, Maryland. Throughout his career as a physical therapist and orthopedic surgeon, Nace has gained the most satisfaction from treating runners and all types of athletes for their injuries and helping get them back to training and competing.

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