A strain is when a muscle becomes overstretched and tears. This painful injury, also called a "pulled muscle," can be caused by an accident, improper use of a muscle, or overuse of a muscle.

• Excessive physical activity or effort
• Improperly warming up before a physical activity
• Poor flexibility

• Pain and difficulty moving the injured muscle
• Discolored and bruised skin
• Swelling

• Apply ice immediately to reduce swelling. Wrap the ice in cloth -- avoid using ice directly on the skin. Apply ice for 10 to 15 minutes every 1 hour for the first day. Then, every 3 to 4 hours.
• Use ice for the first 3 days. After that, either heat or ice may be helpful.
• Rest the pulled muscle for at least a day. If possible, keep the pulled muscle elevated above the level of the heart.
• Avoid using a strained muscle while it is still painful. When the pain subsides, start activity slowly and in moderation.

• You are unable to move the muscle.
• The injury is bleeding.

Call your doctor if the pain does not go away after several weeks.

• Warm-up properly before exercise and sports.
• Keep your muscles strong and flexible.

Mercier LR. Sports medicine. In: Mercier LR, ed. Practical Orthopedics. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 15.

Cohen I, Jouve C. Trapezius strain. In: Frontera, WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 8.

Geiderman JM. General principles of orthopedic injuries. In: Marx J, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St Philadelphia, Pa: Mosby Elsevier; 2006:chap 46.