Muscle Strains & Bruises: who to see and what helps

Muscle Strains & Bruises · Kitchener, Waterloo & Cambridge

A muscle strain, or pulled muscle, is a muscle that has been overstretched or torn; a muscle bruise comes from a direct blow. Most strains feel better within about two weeks, with a few days of protection and then a gradual return to movement and exercise. At CARESPACE the first visit is with a physiotherapist or a chiropractor, who assesses the injury and starts treatment that day.

What a muscle strain is

A strain is an injury to a muscle; a sprain, which it is often confused with, is a torn or twisted ligament. Strains happen when a muscle is stretched beyond its limit and its fibres tear, frequently near the point where the muscle joins its tendon. They are most common in the feet, legs and back. A grade 1 strain is mild and usually heals fairly quickly; a grade 3 strain is a severe tear that may take months.

A muscle bruise, or contusion, comes from a direct blow, a fall, or jamming part of the body against a hard surface. Torn blood vessels may leave a bluish mark, and blood can collect into a lump in the muscle (a haematoma).

Symptoms

• Pain, tenderness or weakness in the muscle
• Swelling or bruising
• Muscle spasms or cramping, where the muscle painfully tightens on its own
• Trouble putting weight on the injured part or using it normally (if you cannot put any weight on it, see the urgent signs below)
• In the thigh, a popping or snapping feeling as the muscle tears
• After a blow: a stiff, weak muscle and less movement in the nearest joint

The common strains, and how they differ

The muscles at the back and front of the thigh are at particular risk because they cross both the hip and the knee. Each common leg strain has its own page.

• Hamstring Strain. Sudden sharp pain in the back of the thigh, classically while sprinting. It has the most research, including its own clinical practice guideline.
• Quad Strain. The front of the thigh. That page also covers a deep thigh bruise.
• Calf Strain. A pull or sharp pain in the back of the lower leg, often on pushing off.
• Groin Strain. The inner thigh, in the muscles that pull the legs together.
• Hip Flexor Strain. The front of the hip, including longer-standing hip flexor tendinopathy.

What causes strains and bruises

A strain can happen when you exercise, lift something or fall: a sprint in a rec-league game, a heavy lift on a warehouse or plant floor, a slip on an icy driveway. Not warming up and tired muscles are common causes, and for thigh strains the list of risks adds tight muscles, an imbalance between opposing muscle groups and poor conditioning. An earlier strain of the same muscle is among the best-documented risks for hamstrings and calves.

How it is diagnosed

From how it happened and an examination: where the muscle is tender, and whether stretching or tightening it brings on the pain. The examination has limits: when Danish sports physiotherapists graded the research, most clinical tests for acute muscle injuries showed very low to low diagnostic effectiveness. An X-ray may be needed if a broken bone is possible, and an MRI can show a suspected severe tear.

When a muscle injury needs urgent care

Call 911 or go to an emergency department, and do not drive yourself, if you heard a crack when the injury happened; the injured part has changed shape or points at an odd angle; it is numb, tingling or has pins and needles; or the skin around it has turned blue or grey or feels cold to the touch. Do the same for sudden, severe muscle pain after an injury or a hard blow, or under a bandage that is too tight, which may be worse when the muscle is stretched, with swelling, tightness, numbness, weakness or pins and needles. That can be acute compartment syndrome, a medical emergency that may need urgent surgery.

Hip or groin pain follows a stricter rule. If the pain is in the hip or groin, call 911 or go to an emergency department when it is severe after a fall or injury, or when you cannot walk or put weight on the leg. Hip Pain has the full list.

Get medical care the same day, from a physician, a nurse practitioner, an urgent care clinic or an emergency department, if the injury is very painful or the pain is getting worse; there is a large amount of swelling or bruising, or either is getting worse; you cannot put any weight on it or walk more than a few steps, where the injury is in the thigh, lower leg or foot (with hip or groin pain, that is the emergency sign above); it feels very stiff, or is difficult or impossible to move; or you have a very high temperature or feel hot, cold or shivery, which could be an infection. See a physician or nurse practitioner if the injury is not feeling any better after you have treated it yourself. These lists follow NHS advice on sprains and strains, with Ontario’s routes to care.

Calf pain is a special case. A blood clot in a leg vein and a torn Achilles tendon can each pass for a pulled calf, and each needs medical care the same day, from a physician, a nurse practitioner, an urgent care clinic or an emergency department. Call 911 if a painful or swollen leg comes with shortness of breath or chest pain. That is only part of the picture: Calf Strain lists every sign of both.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

What the evidence says about treating a muscle strain

• Where this comes from. The Danish statement, which graded 44 studies of leg muscle injuries in sport and rated most outcomes very low to moderate quality; a clinical practice guideline for hamstring strains; NHS and Alberta health advice; and a 2020 editorial in a sports medicine journal by two Canadian authors.
• First two or three days: protect it. Stop the activity, try not to put weight on the injury, ice it, wrap it and keep it raised. Avoid heat, alcohol and massage for the first couple of days, to help prevent swelling, and do not massage a bruised muscle.
• Then move it. Once pain allows, keep the muscle moving so it does not stiffen. Rest should be short, because prolonged rest can weaken the tissue, and there is a case for adding load early and resuming normal activities as soon as symptoms allow.
• Exercise has the trial evidence, mostly in hamstrings. There, clinicians should use eccentric training, which strengthens the muscle as it lengthens, within a programme of stretching, strengthening and progressive running. For calf and quadriceps strains there are only very low quality treatment studies.
• Three habits the editorial challenges. Ice: the NHS, Alberta and orthopaedic surgeons all advise it, but the authors find no high-quality evidence for it in soft-tissue injuries. Anti-inflammatory medicine: they say standard care should not include it. Passive treatments such as electrotherapy, manual therapy or acupuncture early after an injury: little effect on pain and function compared with an active approach, and possibly counterproductive in the long term. This is two authors’ reading of the research, not a guideline, so ask a pharmacist, physician or nurse practitioner about medicine.
• Prevention works for some muscles. In studies of athletes, specific exercise programmes reduced hamstring and groin injuries by 40% to 65%.

What a doctor may offer

CARESPACE does not provide these, but it helps to know where they fit: an X-ray or MRI; advice on pain medicine; draining a large haematoma that persists for several days after a blow; and surgery in a few situations, compartment syndrome among them.

How each CARESPACE service treats a muscle strain

Physiotherapy

A physiotherapist can work out which muscle is injured and how badly, from the story and from tenderness, stretch and resistance testing, and say what to protect for the first days. After that the plan can be graded: movement as pain allows, then strengthening, then the running, lifting or sport the muscle has to cope with.

See our physiotherapy team →

Chiropractic

The back is one of the commonest places to strain a muscle, and a chiropractor can assess a strained back or leg muscle: where it is tender, and what stretching or tightening the muscle brings on. None of the sources here recommends joint manipulation for a muscle strain, so the plan can follow the evidence above.

See our chiropractic team →

Kinesiology

A return to sport waits until the muscle is at full strength and pain-free. A kinesiologist can run that last stage: progressive strengthening, then running, agility work or lifting built up toward what your sport or job asks of the muscle.

See our kinesiology team →

Other services people ask about

Massage therapy. Beyond the advice to avoid massage for the first couple of days, none of the sources here tested it: the hamstring guideline lists soft tissue work only as an area for future research. Acupuncture. No source here supports it for a muscle strain, and it is one of the passive treatments questioned above.

Where most people start

Start with a physiotherapist or a chiropractor. Both assess and treat at the first visit. If any of the urgent signs above fit, get medical care first.

How your team works together

A strain can be looked after by one practitioner, the physiotherapist or chiropractor you start with. A kinesiologist can take on the build-up to sport or heavy work after a larger strain.

Browse by service: physiotherapists, chiropractors and kinesiologists.

What to expect at your first visit

1. How it happened. The movement or the blow, what you felt, and when any bruising or swelling appeared.
2. The examination. Where the muscle is tender, what stretching and tightening it does, and how you walk or use the limb.
3. How severe it looks, and whether a physician should see it.
4. Treatment that day and a plan to leave with: what to protect and for how long, what to keep doing, and the first exercises.

What you can do at home

• Hold an ice pack wrapped in a towel on the injury for up to 20 minutes every two to three hours.
• Wrap it with a bandage for support during the day, and keep it raised on a pillow as much as you can.
• Skip hot baths and heat packs for the first couple of days. After two or three days you can try heat.
• Rest a bruised muscle in a gently stretched position: for the thigh, with the knee bent.
• When you start moving again, do nothing that makes the pain worse, and return to exercise gradually.
• Ask a pharmacist about pain relief.

How long it takes, and whether it comes back

After two weeks most strains feel better, though strenuous exercise still carries a risk of further damage for some weeks after that. Severe strains can take months. After a deep bruise, a return to contact sport may take several weeks or longer. If pain and swelling in a bruised muscle persist, see a physician or nurse practitioner: bone can form in the injured muscle (myositis ossificans), which vigorous stretching may make worse. Strains do come back: in pooled studies of athletes, a previous hamstring strain carried about 2.7 times the risk of another.

Muscle strain treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractic in Kitchener and Kinesiology in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractic in Waterloo and Kinesiology in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is it a strain or a sprain?

A strain is an overstretched or torn muscle; a sprain is a torn or twisted ligament, most often at the wrist, ankle, thumb or knee. The first days of care are the same; Ankle Sprains has its own page.

Should I use ice or heat on a pulled muscle?

Ice at first; heat only after the first two or three days.

When can I run or play again?

When the muscle is at full strength and pain-free. Strenuous exercise such as running is best avoided for up to eight weeks.

Is a deep muscle bruise treated differently from a strain?

Early care is similar, with two differences: the muscle is rested in a gently stretched position, and it should not be massaged.

Where can I get a pulled muscle looked at in Cambridge?

At our Hespeler Road location, starting with Physiotherapy in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Ishøi L, Krommes K, Husted RS, Juhl CB, Thorborg K. Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport: grading the evidence. A statement paper commissioned by the Danish Society of Sports Physical Therapy. British Journal of Sports Medicine, 2020.
• Martin RL, Cibulka MT, Bolgla LA, et al. Hamstring Strain Injury in Athletes: Clinical Practice Guidelines. Journal of Orthopaedic & Sports Physical Therapy, 2022.
• Dubois B, Esculier J-F. Soft-tissue injuries simply need PEACE and LOVE. Editorial, British Journal of Sports Medicine, 2020.
• NHS. Sprains and strains. Reviewed April 2024.
• NHS. Compartment syndrome. Reviewed September 2026.
• NHS. DVT (deep vein thrombosis). Reviewed April 2026.
• HealthLink BC. Achilles Tendon Tear. Current as of November 2022.
• NHS. Hip pain in adults. Reviewed November 2025.
• HealthLink BC. Deep Vein Thrombosis. Current as of December 2022.
• MyHealth Alberta. Muscle Strain: Care Instructions. Current as of July 2024.
• Green B, Pizzari T. Calf muscle strain injuries in sport: a systematic review of risk factors for injury. British Journal of Sports Medicine, 2017 (abstract).
• American Academy of Orthopaedic Surgeons. Muscle Strains in the Thigh. OrthoInfo.
• American Academy of Orthopaedic Surgeons. Muscle Contusion (Bruise). OrthoInfo.

Related conditions

Sports Injuries & Return to Sport
Muscle Soreness (DOMS)
Tendonitis & Tendinopathy

Ready to book?

Book online with a physiotherapist or chiropractor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

Online booking