Muscle strains or injured tendons (tendinopathies) are common injuries that can affect anyone – from athletes to office workers. Muscle strains are when the pain or irritated tissue is located in the muscle belly verses, a tendinopathy in when that irritation is coming from the tendon which connects our muscles to our bones, but sometimes they can be hard to differentiate.
Signs and Symptoms
Both can cause pain, limit movement and affect overall function. Typically, ultrasound or MRI is the gold standard of formal imaging and grading of tendinopathies and muscle strains and tears, but physiotherapist can gauge the severity and type of injuries from a physical assessment.
Generally, tendinopathies are related to gradual overuse injuries and occur in the tendon (at either end of the muscle). The pain is often described as a dull ache which is worse with activity or stretching of the affected tendon. Tendinopathies are typically formally diagnosed under ultrasound, however there is a symptom grade also:
- Grade 1: Pain during stretching, pressure or activity
- Grade 2: Pain at the beginning of movement, reducing post warm up, and reappearing post fatigue onset
- Grade 3: Paid during & after activity, being unable to complete the exercise, program or sport
- Grade 4: Lack of ability to contract, complete rupture
Muscle strains can be acute onset, and come on after an incident or particular movement, typically high impact or high intensity, causing pain in the middle portion of the muscle. They be often associated with swelling and bruising depending on the severity. Muscle strains are graded into grade 1, grade 2 and grade 3 in increasing severity of micro tears (<5%), partial tears (~50%) and complete ruptures (100%) respectively.
So, when should you seek help from a physiotherapist?
Challoumas et al (2019) completed a systematic review study which found that physiotherapy intervention was as effective as surgery for low grade (grade 1&2) tendinopathies in both long term and short-term pain, function and range. (Barh et al, 2006 & Brox et al, 1993) This research shows that for low grade tendinopathies, patients should engage in 12- weeks of physiotherapy prior to surgery, depending on their medical history, pain, severity and activity levels.
If you’re experiencing persistent pain in a tendon or muscle that’s not improving with rest, or if the area feels weak, stiff, niggly or painful during everyday activities or your exercise regime, it’s time to see a physio. Early treatment can significantly speed up your recovery and reduce the risk of long-term damage.
If you feel you have irritated or even a little tear in your muscles or tendons, it is best to reduce your activity level on the affected area. If there is heat and/or swelling, you can apply ice to the area and in some cases, gentle compression is appropriate.
Here are the top reasons to see a physiotherapist for tendinopathies or muscle strains:
- Diagnosis – We identify the root cause of your pain, contributing factors and assess the severity of your injury.
- Personalised Treatment – No two bodies or injuries are the same; we tailor a plan to your needs, including hands-on therapy and targeted exercises.
- Faster Recovery – We help you return to work, sport, or daily activities more quickly and safely.
- Injury Prevention – We address movement patterns and strength imbalances to reduce your risk of re-injury.
- Referral for Scans or Specialists if required
Don’t let pain linger – early physiotherapy intervention can make all the difference. Book an assessment today and start moving better, sooner.
– Katherine Plume, Doctor of Physiotherapy, Bachelor of Exercise and Nutrition Science
Tendinopathy & Muscle Strain References:
Bahr R, Fossan B, Løken S, et al. Surgical treatment compared with eccentric training for patellar tendinopathy (jumper’s knee). A randomized, controlled trial. J Bone Joint Surg Am 2006; 88:1689–98.
Brox JI, Staff PH, Ljunggren AE, et al. Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome). BMJ 1993; 307:899–903.
Dimitrios Challoumas, Christopher Clifford, Paul Kirwan, Neal L Millar – How does surgery compare to sham surgery or physiotherapy as a treatment for tendinopathy? A systematic review of randomised trials: BMJ Open Sport & Exercise Medicine 2019;5:e000528
