The term 'pulled muscle' comes from the description of how the injury takes place. Usually the muscle is forcibly stretched beyond its limits and the muscle tissue becomes torn. A tear in a muscle is referred to as a strain and depending on its severity it is classified as a first, second or third degree strain.

With a grade one strain there is a sensation of cramp or tightness, and a slight feeling of pain when the muscles are stretched or contracted. A grade two strain produces more immediate and severe pain; the hamstring is sore to touch and there will be bruising below the injury site after a few days. With a grade three strain the athlete is unable to move without pain, and there may be a bulge of soft tissue through the muscle layer.

The immediate treatment of any muscle injury consists of the RICE protocol - rest, ice and compression and elevation (never apply ice directly to the skin). Depending upon the severity of the injury, the leg must be rested from sporting activity for between 3 weeks and 3 months.

Rest - No weight should be put through the injured ankle and crutches should be used. Pain relieving medication prescribed by a doctor may be necessary.

Ice - Ice packs are applied for periods of twenty minutes every couple of hours (never apply ice directly to the skin). The ice packs relieve pain and are thought to reduce bleeding in the damaged tissue.

Compression - A compression bandage is applied to the injured ankle to prevent excessive swelling.

Elevation - To relieve pain and prevent excessive swelling, the ankle is elevated above waist height.

Muscle injuries can be classified according to their severity. There are three main categories:

First degree strain

There is damage to individual muscle fibres (less than 5% of fibres). This is a mild strain which requires 2 to 3 weeks rest.

Second degree strain

There is more extensive damage, with more muscle fibres involved, but the muscle is not completely ruptured. The rest period required is usually between 3 and 6 weeks.

Third degree strain

This is a complete rupture of a muscle. In a sports person this will usually require surgery to repair the muscle. The rehabilitation time is around 3 months.

In the example given below, the injury referred to is the hamstring muscle, but the same principles apply to all muscle strains.

Treatment for a first degree muscle strain - example Hamstring strain

• Days 1 to 5 - RICE protocol - rest, ice, compression and elevation (never apply ice directly to the skin, use ice in a plastic bag wrapped inside a towel). This treatment is aimed at reducing the bleeding and damage within the muscle tissue. Try and apply ice at least times per day.
• Days 6 to 10 - The player can begin gentle stretching- Click here to see examples of good muscle stretches. The patient should stop when the tension of a stretch in the muscle begins to be felt - the stretch position should then be held for thirty seconds.
• This stretch should be pain-free. Repeat each stretch for a maximum of 3 stretches
• Days 11 to 14 - Free exercises to strengthen the muscles can begin.
• For example with a hamstring strain, The player starts by sitting on the floor and sliding the heel up to the bottom. Repetitions x 20, 3 times each day. If this can be done without pain, progress to the next position can be made:
• The player lies on their front and brings the heel up to the bottom. Repetitions x 20, 3 times each day. If this can be done without pain, progress to the next position can be made:
• Standing, the player brings the heel up to the bottom. Repetitions x 20, 3 times each day.
• Hamstring stretches are also continued. Click here for example of muscle stretches
• Days 15 to 17
• Intermittent jogging and walking can begin.
• 5 minutes at first, then build up in 5 minute increments. Once the patient can do 15 minutes they should build up to to half pace running.
• Squats can begin - repetitions x 20, 3 times daily.
• Hamstring curls using a resistance weight machine can also begin.
• All exercises should be pain-free.
• Day 18+
• Backward running can begin.
• If pain-free, the player progresses to full pace forward running.
• The player continues stretching and strengthening exercises.
• The player begins football specific activities and training
• Each day the player should be able to stretch a little further. Stretching helps to align the scar tissue which is forming to heal the muscle tear. This ultimately produces a stronger scar. After stretching exercises, the RICE protocol can be applied.

Treatment for a second degree muscle strain - example Hamstring strain

• Days 1 to 5
• RICE protocol - rest, ice, compression and elevation (never apply ice directly to the skin). This is aimed at reducing the bleeding and damage within the muscle tissue.
• Days 6 to 11
• The player can begin gentle hamstring stretching, sitting on the floor and slowly bending forward, sliding the hands down the thighs. The patient should stop when the tension of a stretch in the hamstring begins to be felt - the position should then be held for thirty seconds. Repetitions x 3.
• This should be pain-free.
• Each day the player should be able to stretch a little further. Stretching helps to align the scar tissue which is forming to heal the muscle tear. This ultimately produces a stronger scar.
• Days 12 to 19
• Free exercises to strengthen the hamstring muscles can begin.
• The player starts by sitting on the floor and sliding the heel up to the bottom. Repetitions x 20, 3 times each day. If this can be done without pain, progress to the next position can be made:
• The player lies on their front and brings the heel up to the bottom. Repetitions x 20, 3 times each day. If this can be done without pain, progress to the next position can be made:
• Standing, the player brings the heel up to the bottom. Repetitions x 20, 3 times each day.
• Hamstring stretches are also continued.
• Days 20 to 26
• Intermittent jogging and walking can begin.
• 5 minutes at first, then build up in 5 minute increments. Once the player can do 15 minutes they should build up to to half pace running.
• Squats can begin - repetitions x 20, 3 times daily.
• Hamstring curls using a resistance weight machine can also begin.
• Everything should be pain-free.
• Day 27+
• Backward running can begin.
• If pain-free, the player progresses to full pace forward running.
• The player continues stretching and strengthening exercises.
• The player begins football specific activities and training
• Each day the player should be able to stretch a little further. Stretching helps to align the scar tissue which is forming to heal the muscle tear. This ultimately produces a stronger scar. After stretching exercises, the RICE protocol can be applied.

Third degree muscle strain - example Hamstring strain (Complete Rupture)

• Follow the advice of an orthopaedic consultant.