How to Rehab Muscle Strains and Tears

Muscle tears and strains are a common injury, but they can be easily treated with proper rehabilitation. Here’s what you should know about the process, including when to see a doctor!

Muscle strains and tears are common injuries that can happen to anyone. They often cause pain and swelling, but they don’t always require medical attention. Here are some tips on how to rehab muscle strains and tears.

Note from the editor: Matt Reynolds, proprietor of Barbell Logic Online Coaching, is a powerlifter, strongman, and Starting Strength coach. And, as Matt will point out later in the essay, this way of rehabbing has not been subjected to any medical tests or scientific study. It’s based on years of expertise from strength and conditioning instructors who have helped hundreds of athletes heal from muscle rips on the ground. You’ve reached adulthood. You must decide for yourself whether or not you want to give it a go. Be astute.

Attempting a 450-pound bench press at the Starting Strength Coaches Conference surrounded by some of the top strength coaches in the world about two weeks ago, I tore my left pectoralis major (“pectoralis major” to be specific, or “chesticle” for you dudes)

My warm-up for the bench press was going swimmingly. The gym was buzzing, and I was especially delighted since my wife had just benched 215 pounds (a personal best) a few minutes before. Now I wanted to work my way up to a new maximum. I got to 315 pounds and had a three-rep break. After that, do 365 reps for a single rep. Then there’s 415. All of this happened in a flash, and it was all quite simple.

We placed 450 pounds onto the bar, and I focused my mind to bench press the weight. I acquired a solid stance on the bench, inhaled deeply, and a coach gave me a fantastic lift-off. I lowered the bar to my chest slowly. Because it seemed so effortless going down, I knew I’d be able to bench press this weight today. I stopped for a full second when the barbell hit my chest, then burst the weight up to lockout, every muscle in my body contracting and contributing to the lift. Everything was wonderful. Until…

In my left pec, I had a little muscular spasm. I thought to myself, “No problem,” and pushed through the spasm. The spasm suddenly became more intense, and it seemed as though the centre of my pec “unzipped.” As the bar sank a few inches on the left side, I could feel the individual muscle fibers ripping beneath the strain, rendering my now-tearing pec unable to contract at full effort and lift the load. The spotters quickly grabbed the bar and rescued me.

I reached for my pec right away. I knew I’d ripped it and that it was a nasty tear.

Dammit.

I’d ripped my pec muscle right down the center of the “muscle belly” (basically, the meat of the muscle, between the tendons).

I started icing the pec right away, frustrated. With all the ripped muscle fibers and the related blood flow to those muscle fibers, I knew I was bleeding under the skin. It’s time to get back into shape.

The Starr Rehab Protocol is a program designed to help people get back on their feet

Fortunately, our Starting Strength trainers are familiar with an exceptional strategy for rehabilitating damaged muscle bellies in a short period of time. We call it the “Starr Rehab Protocol,” after the late Bill Starr, the best strength coach who ever lived.

This rehab approach was taught to me by Mark Rippetoe, who learned it straight from Starr. In preparation for this piece, I phoned Rip to inquire about the method’s background. He informed me that Bill Starr discussed it with him in the early 1980s, but that he believes Starr invented the rehab program while he was stationed at Sheppard Air Force Base in Wichita Falls, Texas, in the late 1950s or early 1960s.

Bill had been suffering from agonizing pain in his lower back, which was probably definitely due to a herniated disc giving him sciatic nerve agony. He was enraged since he had been suffering from this agony for months and had been unable to workout. He opted to train on it nevertheless one day, despite the fact that he was completely fed up with the back discomfort. So he put the bar up to 135 pounds and deadlifted it for 15 repetitions with flawless technique. He instantly realized that towards the conclusion of the set, his back felt better than it had before he began. He paused for a few moments before doing another set of 15 or 20 repetitions, and he felt even better. He then repeated the process for the third set, and by the time he was done, his back felt better than it had in months.

Bill resumed deadlift training, gradually increasing the weight each day, deadlifting four or five times a week, and keeping the reps high until the weight became heavy. Within a few weeks, his back was completely cured, and he was pain-free.

It was then that the Starr Rehab Protocol was developed.

This recovery approach was probably employed by Starr for decades, first with the lifters at York Barbell in the 1960s and subsequently with his players on the numerous teams where he served as head Strength and Conditioning Coach. We have no information or record of Starr writing about the approach, despite the fact that he was a prolific author. As previously stated, Starr passed the material on to a young Mark Rippetoe in the early 1980s, and Rip employed it (and still does) in his Wichita Falls Athletic Club.

Rip blogged about the strategy on his StartingStrength.com forum in September 2007, and it was the first time I heard of it. I’m republishing it in its full here (with his permission):

“Here’s the tried-and-true muscle-belly injury rehab approach we received from Starr, which has worked for years better than any other method I’ve ever tried.” It also works well on orthopedic injuries in general, and it should be attempted before moving on to anything more complicated. Wait 3-4 days for the pain to “blur,” indicating that the body’s natural healing mechanism has stopped the bleeding and begun to rebuild the tissue. Then, like in this instance, choose an activity that directly works the injury, i.e., one that makes it pain. Use the empty bar to do three sets of 25 reps with flawless technique, with no favoring of the affected side. The pain will tell you whether it’s ready to rehab: if it gets worse throughout the set, it’s not ready; if it remains the same or gets a bit better near the conclusion of the set, it’s ready.

THE NEXT DAY, repeat with a modest increase in weight, such as 45 x 25 x 2, 55 x 25 x 1 [weight x repetitions x sets]. 45 x 25, 55 x 25, 65 × 25, each for a set of 1 the next day Continue to increase weight to your workouts every day, accumulating as much as you can manage. It will hurt, and it should, but you should be able to distinguish between rehab pain and re-injury pain. If you can’t, don’t worry; you’ll find it out eventually. This approach works by driving the tissue to rearrange in its usual pattern of contractile architecture while flushing blood through the lesion.

After 10 days of 25s [repetitions], increase the weight and decrease the reps to 15s, 10s, and eventually 5s. DO NOT DO ANY OTHER HEAVY WORK DURING THIS TIME TO ALLOW YOUR RESOURCES TO FOCUS ON THE INJURY. In approximately two weeks, you should be back to normal, squatting more than you damaged yourself with.

Because the muscle is pushed to mend in the context of work and regular contraction, utilizing the movement pattern it typically utilizes, this approach has the benefit of avoiding scar development in the muscular belly. The crucial factors are: 1) precise form with light weights that can be handled for high repetitions, 2) every day for two weeks, and 3) no additional hard labor that will interfere with the tear’s system-wide healing processes.

Ice should be utilized throughout the whole process of healing the injury, both during the first phase following the injury and after exercises. Use it for 20 minutes on, 20 minutes off, numerous times a day at first, then reduce to morning, after the exercise, and before bed. In a muscular belly injury, ice is your greatest friend, reducing inflammation and fluid buildup (“swelling”) while promoting helpful blood flow through the injury. ICE SHOULD NOT BE USED FOR MORE THAN 20 MINUTES AT A TIME. More than that might result in more harm than good.

… If you follow this strategy to the letter, you can save yourself a lot of time in the gym and long-term muscle-belly scarring. Try it out and see what happens.”

The Starr Rehab Protocol: Why and How It Works

The fibers of the muscle tissue are physically split in two and frayed when a muscle belly is torn (the phrase “muscle strain” is really a tiny muscle tear). The body quickly launches an inflammatory reaction and delivers blood to the affected region to start the healing process. We need to freeze the damage for the first 36-48 hours to halt the internal bleeding caused by the torn tissue and to prevent a hideous bruise.

We begin the process of working the muscle through its complete range of motion after the bleeding has stopped and the pain is less intense and more of a “blur,” as Rip describes it. For fear of re-tearing the torn muscle belly, the great majority of physical therapists, sports trainers, and physicians would never advise you to be forceful with the tear and would nearly always recommend many weeks of ice and rest.

The difficulty with resting the muscle is that the body will still try to mend the tissue by forming scar tissue at the damage site. When small filaments glide across one other and make the muscle “shorter,” the muscle contracts. (Exercise at home: When your elbow is straight and your arm is down at your side, measure the length of your bicep. Bring your hand up to your shoulder while bending your elbow. What happened to the biceps’ length? The filaments of actin and myosin slid over each other, causing the muscle to contract and “become shorter.”

Scar tissue, however, does not slide. It is not capable of contracting. So, if we do nothing, our damage will heal, but it will do so by laying down a huge quantity of non-sliding scar tissue in the center of a muscle belly, where the rest of the fibers will readily move across each other to contract. So now, months or even years later, when you begin to strengthen the muscle again, there is a large scar running across the muscular belly, substantially increasing your risk of re-tearing the muscle at the place where the healthy muscle meets the scar tissue, which cannot contract and relax.

If, on the other hand, we begin working the muscle through its entire range of motion within a few days after injury, we will encourage muscle fiber regeneration without the formation of scar tissue. New muscle fibers will be laid down across the damage by the body, with the capacity to contract and relax by sliding across each other.

Furthermore, we have discovered that when we employ complex multi-joint exercises to target the damaged region, the body has an amazing capacity to enable the supporting muscles to possibly take on more load than usual, while only giving the injured muscle as much work as it can manage. If I have a strained hamstring, instead of performing an isolation exercise like lying leg curls, where the hamstring is isolated and pushed to do the work on its own, risking additional damage, I should squat and allow the glutes, quadriceps, and calves to assist with knee and hip extension and flexion. (The hamstrings and glutes are both important for hip extension (straightening). Knee flexion (bending) is likewise controlled by the hamstrings, although the calves are also involved.)

Because each element was created to operate as PART of something bigger than itself, we think the body must be trained as a system. Muscles do not operate in isolation in any typical human activity, therefore we don’t train them that way. They collaborate with both agonists and antagonists for the benefit of the whole body. As a result, we exercise and rehab the body as a whole, rather than in pieces.

Important Points to Remember About the Starr Rehab Protocol

So, which injuries does the Starr Rehab Protocol work best for? Simply said, we’ve found that it’s most effective for muscle belly injuries, such as strains and torn muscle bellies. It also seems to work effectively with back ailments caused by disc problems, in our experience (herniation, facet joint issues, sciatica, etc.).

Connective tissue injuries are the only ones for which it does not function. This is not the technique to heal torn ligaments and tendons. Tendonitis/tendonosis cannot be trained in this manner, since overuse injuries (such as tendonitis) do not react well to increased barbell usage. Plantar fasciitis is not helped by this method. It is not effective for Achilles injuries, however it is effective for calf injuries. In the end, the location and type of the damage are critical.

The Starr Rehab Protocol will clearly not function if the “muscle tear” is an avulsion, in which the muscular tendon totally breaks and no longer acts (as in the instance of a pec tendon tear, or more often a bicep tendon rupture), and the muscle rolls up and moves away from the tendon’s insertion. (Did I really need to tell you that?)

The Starr Rehab Protocol, on the other hand, works remarkably effectively and quickly for common muscle injuries like strained hamstrings or calves from running, strained/torn pecs, biceps, lats, adductor/groin (quite common), and so on.

Why isn’t this procedure utilized more extensively, and why isn’t it embraced by the medical establishment, if it works so effectively and quickly? To begin with, no research has ever been done on this strategy, and it is unlikely to be done in the future. Can you image going to the IRB and requesting that a study be conducted in which we aggressively repair muscular belly tears? There is zero likelihood that such a research would be allowed. So let me state unequivocally that I have no scientific evidence that this works. It’s only a hypothesis for now, and it’ll probably stay that way. However, we’ve seen this strategy work well in practice hundreds of times.

The Method of Charlie Francis

One more point: when researching the Starr Rehab Protocol some years ago, I came upon an incredibly comparable strategy recommended by the late Charlie Francis, possibly the greatest sprint coach of all time. Sprinters’ hamstrings are constantly strained. What do you think they’ll do if they tear their hamstring 10 days before a major international race? Do you want to shut it down and miss the international competition, or do you want to find out how to fix it and participate 10 days later?

Coach Francis’ technique was adapted from Gerard Mach’s book Sprints and Hurdles, which was published in 1980 but is no longer available. “Charlie showed his customers that with careful and thorough therapy, even the most serious tears may be healed in as little as ten days.” Charlie also emphasized the need of correctly managing scar tissue to avoid associated injuries from pushing away from the initial scar tissue.” (CharlieFrancis.com)

Coach Francis recommends icing the injury for 24-48 hours to halt internal bleeding. Charlie would then have his sprinters do some low-intensity and medium-volume exercises like marching, skipping, brief 10-20 meter tempo runs (60-70 percent effort), and squats on day 4 after the injury (and specifically no jumping or high impact work).

Coach Francis gradually increased the lengths of the tempo sprints and the intensity with which his sprinters raced as the day continued. They’d keep squatting the whole time. They’d be sprinting 100-300 meters by day seven. On day 9, they would begin from the beginning. Coach Francis learned the same thing we did from his experience: muscle belly tears must be trained and pushed through complete range of motion in order to recover swiftly, correctly, and scar tissue-free.

My Personal Experience

The Starr Protocol has helped me recover a seriously damaged right pec (3 years ago), a torn lat, a torn bicep muscle belly, a torn adductor (left groin), and my current left pec rehab.

Bruise caused by a torn lat muscle.

I’d want to concentrate on two of those situations that I meticulously recorded. I tore my left lat ten days before my last powerlifting event while deadlifting with a mixed grip. My left hand was supinated (underhanded), and the tension on my lat was too much halfway through the lift, and it tore right in the midst of the muscle belly.

I spent the following ten days deliberately and aggressively rebuilding my lats, starting with inverted rows and supinated lat-pulldowns, then progressing to chin-ups with bands (to effectively lower my bodyweight) and deadlifting, but not heavily.

I deadlifted 701 pounds in the match ten days later with ease and had no concerns with my lats. I actually missed a 725-pound deadlift, barely above my knees, after straining and battling with the weight for almost 5 seconds before giving up. The lat held up well. The Starr Protocol was a huge success.

48 hours after the rip, a bruise from a damaged pec muscle.

I tore my left pec 11 days ago, which is my present predicament. Since the rip, I’ve bench pressed practically every day with high repetitions and little weight. I benched the empty barbell (45 pounds) for three sets of 25 reps 48 hours following the rip.

The next day:

I benched 65 pounds three times, for a total of three sets of 25 pounds.
3 x 25 x 75 x 3 x 75 x 75 x 75 x 75
4th day: 85 3 x 25
5th day: 95 3 x 20
115 3 x 20 on day 6
7th day: 135 3 x 15
155 3 x 15 155 3 x 15 155 3 x 15 155 3 x 15
9th day: 175 3 x 12
185 3 x 10 x 10 x 10 x 10 x 10 x 10 x 10

The SlingShot is being used in the rehabilitation process.

On Day 7, I began adding SlingShot training to the bench press, and by Day 5, I was benching roughly 50 pounds heavier with the SlingShot than I was benching without it. I’ll be benching 225 for sets of 10 at the end of two weeks, which is really astounding when you think about it — not because I’m fantastic, but because the system is.

In 4-6 weeks after the injury, I’ll be 90% recovered. With such a significant injury, the final 10% will definitely take a bit longer, but I’ll most likely be pressing 405 within 4 or 5 weeks after a bad pec tear. That’s how effective this strategy is. (This post was originally written by Matt about a month ago.) He’s back to benching 315 pounds for 10 reps currently.)

Muscle sprains and rips are common. If you’re a hard-working man who works out, plays hard, and trains hard, you’re certain to strain or tear a muscle or have low back discomfort at some time in your life. Regardless of what traditional medical thinking suggests, an injury like this doesn’t have to keep you off the field.

Be astute. Work the region through its whole range of motion while maintaining proper form. Use high repetitions (20-25), start with modest weights, then gradually increase the weight. You’ll mend the muscle quicker than you ever imagined, lay down new muscle fiber with the capacity to glide and contract, significantly minimize scar tissue development, and return to your pre-injury strength far faster than you ever imagined.

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Matt Reynolds is a strongman and powerlifter who competes in competitions. He’s also a Starting Strength instructor. Matt’s website, ReynoldsStrong.com, provides online coaching. (Note: Brett is presently a client of Matt’s, and with his coaching and programming, he is seeing some excellent improvements in his lifts!)

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Torn muscles are one of the most common injuries that people experience. They can be caused by a variety of things, including muscle strains and tears. That’s why it’s important to know how to properly rehabilitate torn muscles. Reference: torn muscle symptoms.