# Strains, Tears & Tendon Injuries

Part of the First Aid Merit Badge Digital Resource Guide: [Introduction & Overview](https://merit-badge.university/merit-badges/first-aid/guide/index.md)

*8. Muscle & Bone Injuries*

> **8b.** Describe the symptoms and signs of and first aid for a muscle strain, a muscle tear, and a tendon rupture.

In Req 8a, you learned the difference between a strain, a muscle tear, and a tendon rupture. Now you'll focus on the specific symptoms and first aid for each. Note that the management of soft tissue injuries follows a consistent framework — the differences are mainly in severity and what to do about returning to activity.

## First Aid Framework: RICE

For strains and mild muscle tears, the foundational first aid is **RICE:**

- **R**est — stop the activity causing pain; protect from further injury
- **I**ce — apply ice or cold pack (wrapped in cloth) 20 minutes on, 20 minutes off, for the first 24–48 hours
- **C**ompress — a light elastic bandage reduces swelling
- **E**levate — raise the injured area above heart level when possible

Some guidelines now use **POLICE** (Protection, Optimal Loading, Ice, Compression, Elevation) to emphasize that some gentle movement during recovery promotes healing — but rest is still appropriate in the acute phase (first 24–48 hours).

![Correct versus incorrect ankle injury setup showing above-heart elevation, cloth-wrapped ice, and light compression compared with a poor setup](https://ik.imagekit.io/doulacoop/tr:w-800/mbu-assets/merit-badges/first-aid/guide/rice-elevation-and-compression?v=74d7dc81)

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## Muscle Strain

**Symptoms and signs:**
- Muscle pain that intensifies with use or stretching
- Mild to moderate swelling
- Stiffness — the muscle feels tight or knotted
- Possible bruising appearing 24–48 hours after injury
- Weakness of the involved muscle group
- Movement is painful but the muscle still functions

**Grades:**
- **Grade I:** Mild — minor fiber tearing, minimal strength loss
- **Grade II:** Moderate — partial tearing, noticeable strength loss
- **Grade III:** Severe — nearly complete rupture (transitioning into "muscle tear")

**First aid:**
- Apply RICE (see above).
- For Grade I–II strains: the Scout may be able to continue a hike with modified pace; monitor for worsening.
- For Grade III: treat as a muscle tear (see below).
- Over-the-counter pain relievers (ibuprofen/naproxen) help with both pain and inflammation.
- Return to activity only when pain-free — premature return worsens the injury.

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## Muscle Tear (Complete Rupture)

**Symptoms and signs:**
- A sudden, intense pain during activity — often described as being "hit" or "shot" in the muscle
- A pop or snap may be felt or heard
- Rapid onset of swelling and bruising (blood pooling from the tear)
- A visible or palpable "dent" or "gap" where the torn muscle has retracted
- Significant loss of strength — the affected muscle group may be nearly nonfunctional

**First aid:**
- Immobilize and support the injured extremity.
- Apply ice to limit swelling.
- Do NOT massage or try to "stretch out" the injury.
- Evacuate if in the wilderness — complete muscle tears typically require orthopedic evaluation and potentially surgery.
- Keep the person from using the affected limb.

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## Tendon Rupture

**Symptoms and signs:**
- A sudden, severe pain at the tendon location (Achilles tendon: back of the heel; patellar tendon: front of the knee; biceps tendon: front of the shoulder/elbow)
- A "pop" or "snap" at the moment of injury
- Rapid swelling
- A palpable gap in the tendon
- Inability to perform the function of the muscle attached to that tendon: can't push off the foot (Achilles), can't fully straighten the knee (patellar/quad), can't flex the elbow against resistance (biceps)

**First aid:**
- Immobilize the joint in a neutral position; do not allow weight-bearing on an Achilles or knee tendon rupture.
- Apply ice to limit swelling and pain.
- Transport/evacuate for medical care — complete tendon ruptures almost always require surgical repair for full functional recovery.

> **Be Prepared! Suspected Achilles Tendon Rupture at a Campout**
>
> If a Scout injures the back of their ankle and can't push off their foot:
>
> - **Stop all activity immediately.** Do not allow them to try walking normally.
> - **Improvise support:** Use a sleeping pad or foam rolled into a splint; wrap with a bandage to maintain a neutral ankle position.
> - **Evacuate:** This injury will require surgery — don't wait until you return from a week-long trip.
> - **Use a human crutch** (described in Req 10) to transport them from the backcountry to a trailhead.

Video: [Muscle Strains and Tears](https://www.youtube.com/watch?v=IM7BIO_kdk8)

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Now you know the soft tissue injuries. Next, you'll learn about joint injuries (sprains and dislocations) and bone fractures.

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- Previous: [Understanding Injuries](https://merit-badge.university/merit-badges/first-aid/guide/req8a/index.md)
- Next: [Sprains, Fractures & Dislocations](https://merit-badge.university/merit-badges/first-aid/guide/req8c/index.md)