Strains - Treatment and Condition

Question 1

Where strains occur most often?

Answer 1

The weakest area in the musculotendinous unit at the time of injury.

Question 2

What is the definition of a Strain?

Answer 2

An overstretch injury to a musculotendinous unit.

Question 3

What is a Musculotendinous Unit?

Answer 3

This includes Tendons, their osseous attachments and the musculotendinous junctions.

Question 4

What are the causes of Strains?

Answer 4

A sudden overstretching of the muscle,

An extreme contraction.

Question 5

What are contributing factors to getting a strain?

Answer 5

This can include:
inadequate warm up before activity, 
Limited flexibility, 
Fatigue, 
Repudiative overuse / Over-stressing, 
Strength imbalance, 
A history of previous strains in the area.

Question 6

How many Grades of Strain is there?

Answer 6

1 - 3

Question 7

What does Grade 1 Strain consist of?

Answer 7

This is a Minor Stretch / Tear to the Musculotendinous unit.
There is minimal loss of strength.
The person can continue activity with mild discomfort.

Question 8

What does Grade 2 Strain consist of?

Answer 8

Tearing of the Musculotendinous fibers,
The degree of tearing is variable, from several fibers - to the majority of fibers.

There may be a snapping sound at the time of injury.
A palpable gap may be present.
There is difficulty continuing activity due to pain or weakness.

Question 9

What does Grade 3 Strain consist of?

Answer 9

This is a complete rupture of the Musculotendinous unit or an avulsion fracture.
There is a snapping sound / Sensation at the time of injury.
A palpable / Visible gap can be seen / felt at the site of injury.
The client cannot continue with activity due to Significant pain and weakness.

Question 10

What is the symptom picture for a Client in the Acute stage of Grade 1 Strain?

Answer 10

Local Edema, heat and bruising are minimal or not present,
Tender to touch at the lesion site,
Little or no loss of strength / ROM,
Client can continue activity.

Question 11

What is the symptom picture for a Client in the Acute stage of Grade 2 Strain?

Answer 11

There is a snapping noise or sensation at time of injury,
Moderate local Edema, heat and hematoma and bruising.

A gap may be palpable in the tissue,
Moderate tenderness at the lesion site,
Moderate pain with activities,
Moderate loss of strength and ROM.

Question 12

What is the symptom picture for a Client in the Acute stage of Grade 3 Strain?

Answer 12

There is a snapping noise or sensation at time of injury.
Marked local Edema, heat, hematoma and bruising present.

A gap may be palpated at the injury site,
Severe pain at lesion site,
Immediate loss of strength and ROM,
Client cannot continue activity.

Question 13

What occurs in both Grade 2-3 strains in the Acute stage?

Answer 13

Bruising is red, black and blue.
A hematoma is present at the lesion site.

Decreased ROM, of the joint that the affected mm crosses, as protective mm spasm.
Depending on severity, there may be loss of function of the affected limb.

Question 14

What occurs in the early subacute stage of a Grade 1 strain?

Answer 14

Strain has little or no pain and reduced Strength.

The pain, edema and inflammation are still present but reduced from the acute stage.
Adhesions are developing around the injury site.
Protective mm spasms reduce.

Question 15

What occurs in the Early subacute stage of a Grade 2 Strain?

Answer 15

Strain has pain and moderately reduced strength.
Bruising is black, blue and red / Hematoma is present.

There is an alteration in the contour of the mm.

Question 16

What occurs in the Early Subacute Stage of a Grade 3 Strain?

Answer 16

Strain has pain and markedly reduced strength with AR ROM and strength testing.
The bruising is red, black and blue.

There is a gap in the tissue and the mm may bunch up, unless it was repaired.

Question 17

What does a Grade 2-3 strain consist of in the Late subacute?

Answer 17

Bruising is yellow, green and brown, the hematoma diminishes and a Gap is still palpable.

Mm guarding may be present.

Question 18

What does a Grade 2-3 Strain consist of in the chronic stage?

Answer 18

The bruising is gone,
HT and TP’s are found and adhesions have matured.
Tissue may be cool due to ischemia.

The full rom of the joint crossed by the affected mm may be reduced.

Question 19

What does AF ROM of a Strain in the Acute stage?

Answer 19

The ROM is more affected the higher the grade.

Grade 1 there is mild local pain when mm is used,
Grade 2 there is moderate pain only and only mid ranges of movement are possible.
Grade 3 the pain is severe and there is loss of function.

Question 20

What is CI’d with testing in a strain?

Answer 20

Any other testing is CI’d in the Acute stage of healing of a strain if it is Grade 2-3.

Question 21

How would you know if a client has a Grade 2-3 Strain?

Answer 21

If the client hears or feels a snapping sensation at the time of injury.
The client is having trouble continuing activity or being unable to continue the activity.
The presence of a palpable gap in the tissue.

Question 22

When testing a clients ROM in PR ROM what would be tested last?

Answer 22

When testing the PR Rom you would test the Painful range last.
A painful mm spasm end feel would be present before reaching the full length.
Pain may also be encountered with tissue approximation.

Question 23

What does AR ROM testing of a grade 1 strain reveal?

Answer 23

Testing of the affected mm would show minor to insignificant loss of strength and some discomfort.

Question 24

What are all the CI’s for treating a client with a Strain?

Answer 24

In the Acute stage, testing of grade 2-3 strain other than pain free active free range is Ci’d to prevent tissue damage.
Avoid removing protective mm spasm.
Distal Circulation techniques in the acute and early-subacute to avoid increasing congestion through the injury site.
Frictions are Ci’d if the client is taking blood thinners or Anti-inflamitories.

Question 25

What are the treatment goals for treating a client with a Acute Stage Strain?

Answer 25

The mm is treated with RICE, Rest, ice, compression, elevation.
Reduce inflammation.
Hydrotherapy in Acute is cold such an Ice pack or gel pack to the injured area.