Pains, Strains and Muscle Complaints: Its Complicated!


If you are physically active in sports or exercise, or if you work at a physically demanding job, you are no stranger to muscle pain. More often than not, you rest it, ice it, pop some NSAIDs and ignore it, and it eventually goes away. Sometimes, however, a muscle strain can put you on the sidelines with pain, stiffness and moderate disability in the injured area. Prevention and treatment of muscle pain depends on a number of factors.

A muscle strain, sometimes called a pulled muscle, occurs when muscle tissue is overstretched and torn. Some primary causes are fatigue, repetitive overuse, or inefficient movement mechanics. Muscle strains can happen during any type of physical activity, but their underlying cause may be due to structural limitations that appear at first glance to be independent of the area of injury.

It’s All Connected

Muscles do not function independently of one another, nor independently of other structures like tendons, ligaments, bones and nerves. Unbalanced muscle tone and poor flexibility in one area of your body can affect muscles in another part of your body, especially during physical activity when your muscles work overtime to stabilize and control movement.

Stable ligaments, flexible joints, uninhibited neural bodies and strong muscles all work together in coordinated ways to produce efficient movement. When elements of gravity and momentum are thrown into the mix, especially as the body moves at accelerated velocities, deficiencies in any of those areas can lead to muscle strain and injury.

The most common site of muscle strain is at the muscle-tendon junction. Tendons are thick fibrous structures that are continuous with muscle, meaning the cells blend smoothly from soft muscle tissue to tough tendon fibers. Tendons cross over joints to anchor your muscles to bones, and they have a tensile strength greater than a steel cable.

When the musculotendinous structure is subjected to high force loads, the tendon holds steady, while the soft tissue of the muscle contracts to protect itself. When the muscle’s capacity to resist force loads is exceeded, muscle tissue begins to stretch and tear, causing muscle strain.

Deficiencies that Lead to Muscle Strains

Your body’s structures work together to produce movement in much the same way as an engine works to propel your car forward. As long as all the moving parts are optimally aligned and in good working order, you have a smooth and quiet ride. But when things get out of alignment or parts become worn, the engine becomes clunky and inefficient, giving you a bumpy and noisy ride that can eventually lead to major repairs.

Some things that can undermine the efficiency of human movement and lead to muscle strains include:

  • Poor postural habits
  • Inefficient walking or running gait
  • Poor flexibility
  • Tight or weak muscles
  • Poor coordination and timing of movement
  • Weak and imbalanced pelvic and core muscles
  • Neuromuscular deficiencies

A well designed program of stretching, strengthening and correction of movement deficiencies can help resolve motor issues that lead to injury.

Reducing the Risk of Muscle Strains in NYC

Whether you are an athlete or exercise enthusiast prone to injuries, or you work at a physically demanding job, the sports medicine professionals at NYDNRehab are experts at identifying deficient links in your body’s structures and correcting them. We use the latest technologies to analyze your posture, gait and movement patterns and retrain them for greater mechanical efficiency. Improved performance with decreased risk of injury are desirable outcomes that can be yours with a customized training program from the team at NYDNRehab.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

Buy now 3D Gait
Payment Success
Request TelehealthRequest Telehealth Request in office visit Book now