July 1, 2009 -- Question: How long does it take for a strain to heal, and when can I return to sports after such an injury?
Answer: Well, let's start with the definition of a strain. People often times confuse the terms "strain" and "sprain." A strain is an injury, a stretching, or even a tearing of what we call the muscular tenuous unit. The tendon and the muscle that attaches to it, when those are injured or torn, we call that a "strain": s-t-r-a-i-n. When it's a ligament, which attaches one bone to another crossing a joint, we call that a "sprain" with a "p."
When we're talking about strains, we grade them: one, two and three. So a grade-one strain is actually if you look at the structure, there's no macroscopic or visible damage to the structure. All the damage is microscopic. It's what we call a mild or minor type of strain, or pull of a muscle.
A grade-two injury is the type of injury or level of injury that most people will seek medical attention for. And that's where there's actually some macroscopic tearing of the fibers. In other words, if you did surgery on that muscle or that tendon, you would actually see tearing and some bleeding of that structure. And what you would notice as the patient, you would notice some swelling in the area and you might even notice what we term "ecchymosis," or bruising, such as the discoloration you might get with a black eye. That signifies that there has been some tearing of the fibers and there's some bleeding. And we call that a "grade-two" or partial tear of that strain. Those can take anywhere from three to six weeks to heal and to recover from and most often require that the athlete stop the sport that they are participating in, whether it's running or basketball or working out.
Finally, we have a grade-three injury, and that's the most severe and luckily the least common type of injury. That's a complete tearing of that muscle or tendon, oftentimes occurring where the muscle attaches to the tendon just above or below the joint. Those are severe and are accompanied by weakness. You no longer can use that muscle. If you examine that muscle or that injury, you'll actually feel a gap where the muscle has torn away from the tendon initially, above or below the joint. Soon, thereafter, it will fill with blood. There will be a lot of swelling, a lot of ecchymosis or discoloration, and those certainly need to be seen by a health care professional because those –- as opposed to grade-one or grade-two --- the grade three [injuries] are complete tears and often require cast immobilization and sometimes surgery. Those can take anywhere from three to six months and longer to recover from because of the severity of the injury.