• Progressive exercise is highly recommended for all cases of muscle strains. Progressive exercise is the most effective approach to reduce the risk of recurrence.

• Most exercise programs should be maintained for at least three months before expecting less dosage to be adequate to maintain injury protection risk. We probably would have expected you to be close to unrestricted activity or sport by then in most small to moderate muscle strains.

• Exercise will generally improve your tolerance to previously painful activities and improve your performance at these activities.

• It's common for people with previous muscle strains to become less active long-term, which is not good for long-term health. Our Physio options will help you stay active.

• A certain amount of “tolerable” muscle pain is safe during exercise. If pain increases excessively during exercise and the next day after, the dosage might be too much, or there is no need to progress. “Tolerable” pain is individual and decided during your physiotherapy consultation. Returning to the injury-inciting activity involves monitoring and progressing exercise dosage based on a shared decision between you and your Physio.

• We will guide you with the most appropriate amount of muscle pain or discomfort during and 24 hours post-exercise for you.

• Remember, your response to exercise depends not just on exercise type or dosage. Lifestyle factors can affect your response to exercise, so optimising recovery strategies while improving recovery from exercise and mental stress is very important.

• Exercise should be continued after muscle strain resolution as a preventative strategy to minimise recurrence and severity of a recurrence.

• Sometimes, it can be hard to commit to exercise. Perceived barriers to exercise are normal for all people, and we will help you find time and access to consistent exercise. If you are concerned about time, you don’t have to do as much exercise as you might expect. If you are concerned about access or cost to a gym or exercise equipment, most of the time, a good exercise program can be completed at home, but if your sport or hobbies demand large muscle activity, consider a gym membership a time and cost investment to help you tolerate life-long exercise tolerance.

Instructions for specific exercise modalities are provided below:

Resistance/Strength Training-

• Early strength training can start as soon as possible.

• We will find the intensity, volume, range of motion, and speed of painful or pain-free exercise to get you started. All these parameters should be progressed over time.

• Muscle contraction types include isometric (joint and muscle are still), concentric (joint and muscle are shortening), or eccentric contractions (joint and muscle are lengthening). Picking strength exercises, where the eccentric portion is emphasised with slow and high speed, should be a staple of a muscle strain exercise program. This is because, compared to other contraction modes, eccentrics at any speed promote more significant morphological and neuromuscular adaptations than other contraction modes. However, start and progress with what you can tolerate. Sometimes that is a prolonged isometric contraction, but don’t assume isometrics will always be more tolerable than an eccentric exercise.

• Different exercises targeting the same muscle can be tolerated differently.

• Early strength loss is not only because of muscle damage. Most perceived muscle weakness is due to pain inhibition of strength, which is the nervous system's messy response to perceived danger. We are not concerned that you might increase muscle damage during painful exercise (might increase sensitivity although equal to non-painful movements) but rather when returning to new activities without pain.

• Selecting strength exercises to directly load the muscle is important, as well as targeting other muscles around the injured site. Make sure you keep strengthening other muscles, especially the other limb, if a single limb is injured.

Aerobic training-

• We will help you return to your valued aerobic activity at a controlled dosage.

• There are always aerobic options to try for your upper or lower body. Single-arm or single-leg aerobic exercise is also possible to complete.

• Strength training is sometimes important to assist the muscle function to tolerate more aerobic activity.

Returning to sport or full unrestricted activity

• Just like with strength and aerobic training, sports training should be dosed progressively over time. This phase of rehab tends to be the hardest part.

• We encourage you not to leave participation in sports at all levels. Participating in coaching or supporting the involved staff and teammates where you can is a good way of keeping yourself distracted from the frustration of being unable to play.

• We will develop a plan for return to sport and also give you a plan for how to balance training with your other sporting commitments.

• The most significant risk of muscle strain recurrence in sports is within four weeks of return, so a gradual return to sports exposure is optimal for preparing your muscles for the demands of sport or your previous vigorous hobbies.