The first 48 hours after a muscle strain: what to do and what to avoid
Step-by-step care for a pulled hamstring, calf or groin in the first two days: protection, gentle loading, what to skip, and when to get it assessed.
You felt the hamstring grab at the end of a sprint, or the calf “kick” halfway through a run. What you do in the next two days shapes how quickly you get back. The old advice was rest, ice, compression and elevation; the modern version keeps the protection but adds early movement and leaves out the things that slow healing.
The first 48 hours
Protect. Stop the activity. For the first one to three days, avoid the movements that reproduce the sharp pain, but do not go to bed. Walking with a normal pattern, as far as pain allows, is part of treatment.
Elevate the leg when you are sitting, above the level of your heart if you can, to limit swelling.
Compress. A firm bandage or compression garment over the area reduces swelling and feels supportive. Loosen it if the limb tingles or changes colour.
Move gently. Pain-free range of movement from day one, for example slowly bending and straightening the knee for a hamstring strain, or ankle pumps for a calf strain. Little and often.
Ice for comfort, 10 to 15 minutes at a time with a cloth between the ice and your skin, if it helps the pain. It is a comfort measure rather than a cure.
What to avoid
- Stretching the injured muscle. It pulls on the fibres that are trying to knit.
- Deep massage directly on the tear in the first days. Hands-on treatment helps a great deal later, and gentle work around the area can begin early, but pressing hard on a fresh tear can increase bleeding.
- Heat on the injured spot for the first two days.
- Alcohol, which increases swelling and slows healing.
- Testing it. Resist the urge to sprint on it “just to see”. Re-injury in the first week is the most common way a two-week strain becomes a two-month one.
Days three onward
Once the sharp pain settles, treatment starts in earnest: remedial massage around the injury to settle protective spasm, red light therapy for recovery between sessions, then a progressive strength program. For hamstrings that usually means isometric holds first, then eccentric work such as Nordic curls; for calves, heel raises and drops. A graded return to running follows once strength tests match the other side.
When to get it looked at straight away
See a doctor or go to an emergency department if you cannot put weight on the leg, there is an obvious gap or lump in the muscle, you heard a loud pop with rapid swelling, or the calf becomes hot and swollen without a clear injury. Otherwise, book an assessment in the first few days: knowing the grade of the strain lets us give you a realistic timeline and a plan rather than guesswork. Our sports injuries page covers the common strains in more detail.
Ben Duong, founder and Master Practitioner at Active Performance Clinic. Diploma of Remedial Massage, Certificate IV in Personal Training, Advanced Myofascial Dry Needling. About Ben.
Related questions
Should I stretch a pulled muscle?
Not in the first few days. Stretching a freshly torn muscle pulls on the healing fibres. Gentle, pain-free movement is fine; leave stretching until the sharp pain has gone and your practitioner has checked it.
Should I take anti-inflammatories?
Talk to your pharmacist or doctor. Current guidance suggests avoiding anti-inflammatory medication in the first days of a muscle strain if you can manage the pain otherwise, because some inflammation is part of healing.
When can I run again?
When you can walk briskly, hop and perform a strength test on the injured side without pain, which is usually one to three weeks for a minor strain and longer for bigger tears. A graded return protects you from re-injury, which is the most common complication.
Sources and further reading
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