A sprain is an injury to a ligament. A ligament is a thick, strong, fibrous tissue that connects bones together. The most commonly injured ligaments are those of the ankle, knee and wrist. Ligaments can be injured by being overstretched from their normal position. The purpose of ligaments is to keep the skeleton in normal alignment - ligaments prevent abnormal movement. However, when too much force is applied to a ligament, such as during a fall, the ligaments can be stretched or torn; this injury is called a sprain1.
Sprains are injuries that affect the ligaments, thick bands of cartilage that connect bones to each other. They occur in response to a stretch or tear of a ligament. Sprains are an acute type of injury that results from trauma such as a fall or an external force that moves the surrounding joint from its normal alignment. Sprains can range from a mild ligament stretch to a complete tear. Bruising, swelling, instability and painful movement are common symptoms after a sprain.
A sprain is an injury to a muscle or tendon. Muscles move your skeleton in a variety of ways. When a muscle contracts, it pulls on a tendon, which in turn is connected to your bone. Muscles are meant to stretch, but if they are over-stretched or stretched while contracting, the result can be an injury called a sprain. A sprain can be a stretch or a tear in the muscle or tendon.1
Strains are injuries that affect the muscles or tendons, the thick bands that attach muscles to bones. They occur in response to a tear, twist or rapid pull of the muscle. Strains are an acute type of injury that result from overstretching or overcontracting. Pain, weakness and muscle spasms are common symptoms after a sprain.
A sprain is caused by an overstretched ligament. Ligaments are very strong and can allow a joint to move, but they do not have much elasticity. This means that when the ligament is overstretched, tears can occur. A ligament tear can be partial or complete. In general, doctors indicate the severity of the injury by grading ligament injuries. Grade 1 and 2 injuries are usually partial ligament injuries, while a grade 3 injury is often a complete tear1.
Strains are injuries to the muscles or tendons that connect the muscles to the bones. Pulling a muscle too hard, or pulling in one direction while the muscle contracts (called an "eccentric contraction") in the other direction, can cause injuries in the muscle or tendon. Sprains can also be caused by chronic activities that overstretch muscle fibers.
Many sports put participants at risk for sprains and strains, including soccer, basketball, gymnastics, volleyball and many others. These injuries also often occur during normal daily activities, such as slipping on ice, falling on the wrist or catching a finger. Repetitive activities can also cause a sprain or strain.
Muscle strains are caused by high-velocity forces acting on a muscle. A sudden movement can cause the muscle to overstretch and then contract forcefully, resulting in a mild or severe tear in the muscle tissue. Sometimes, but not always, a bruise may be present in a muscle strain.
How do you know if you've strained a muscle? Usually, the muscle you pulled hurts when you try to contract it. For example, if you have strained your hamstring, you will probably feel pain when you try to use that muscle to bend your knee.
Overstretching a muscle that has suffered an acute strain can also cause pain. Stretching your hamstrings in the days following a hamstring strain will likely be painful, indicating that your muscle is tight.
Ligament sprains are caused by a violent movement of your body that puts pressure on a ligament. If you twist your ankle, for example, the ligaments in the outer part of your ankle joint may be too tight. They may even tear. This overstretching or tearing is a ligament sprain.
Assessment
The most common symptoms of a sprain or strain are:
- Pain at the site of the injury
- Swelling and bruising of the injured area
- Difficulty bending an injured joint
- Spasm of an injured muscle
Symptoms vary depending on the intensity of the injury. If you are unsure about the injury or the severity of the condition, you should seek help from an athletic trainer, physical therapist or health care professional1.
When to ask for help
It is important to know when to seek help. Many sprains and strains can be treated with simple measures, but you need to make sure your pain isn't caused by something more serious. Here are some signs that you may need help:
- You feel intense pain and cannot put weight on the injured extremity.
- The injured area seems distorted from the opposite side.
- You cannot move the injured area
- You cannot walk because of the pain
- Your limb buckles or gives way when you try to move it
- You have injured this area before
- You have severe swelling or swelling that does not improve with rest and elevation.
There are different grades of muscle strains, ranging from Grade I to Grade III.
- Grade I muscle strains indicate that the muscle tissue is simply overstretched.
- Grade II strains occur when the muscle tissue is partially torn.
- Grade III strains are complete tears of muscle tissue. They are generally considered severe and are accompanied by significant pain, swelling, bruising and loss of functional mobility.
If your doctor or physical therapist determines that you have a muscle sprain, he or she may consider obtaining diagnostic images such as an MRI to determine the full nature of the injury.
The grading of ligament sprains is similar to that of muscle strains.
- Grade I: the ligament is simply overstretched.
- Grade II: the ligament is partially torn
- Grade III: the ligament is completely torn
Ligament sprains are usually accompanied by excessive movement around the joint supported by the ligament. Significant swelling and bruising may also be present.
Treatment
Treatment for sprains and strains is often done using the "RICE" method. If you are unsure of the severity of your sprain or strain, talk to your doctor before starting any treatment or rehabilitation. Here is an explanation of the RICE method of treating sprains and strains:
Rest:
- The first 24-48 hours after the injury is considered a critical treatment period and activities should be reduced. Gradually use the injured limb as much as you can, trying to avoid any activity that causes pain. It is often necessary to use a splint, sling or crutches to properly rest the injured body part.
Ice:
- For the first 48 hours after the injury, apply ice to the sprain or strain for 20 minutes at a time, every 3 to 4 hours. The ice pack can be a bag of frozen food, which allows you to reuse it. Another popular treatment method is to fill paper cups with water, then freeze them. Use the frozen cube like an ice cream cone, removing the paper as the ice melts. Do NOT put ice on a sprain or strain for more than 20 minutes at a time! You will not help the injury heal faster and you may cause damage to the body.
Compression:
- Use compression when elevating a sprain or strain as part of early treatment. Using an Ace bandage, wrap the area by overlapping the elastic bandage by half the width of the band. The bandage should be tight, but should not cut off circulation in the extremity. So if your fingers or toes get cold, blue or tingly, re-bandage!
Elevate:
- Keep your sprain or strain as high as possible - try to place it higher than your heart if possible. Elevate it at night by placing pillows under your arm or leg.
Immobilization reduces pain and facilitates healing by preventing re-injury.
First-degree sprains are immobilized briefly, if at all. Early mobilization is preferred. Mild second degree sprains are often immobilized with a sling or splint for a few days. Severe second-degree and some third-degree sprains and tendon tears are immobilized for days or weeks, sometimes with a cast. Many third-degree sprains require surgery; immobilization is usually only an adjunct to treatment.
Patients with casts should receive written instructions, including the following:
- Keep the plaster dry.
- Never put anything inside the cast.
- Inspect the edges of the cast and the skin around the cast daily, and report any red or sore areas.
- Pad rough edges with soft tape, cloth or other soft material to prevent the edges of the cast from hurting the skin.
- When resting, position the cast carefully, perhaps with a small pillow or cushion, to prevent the edges from pinching or digging into the skin.
- Elevate the cast whenever possible to control swelling.
- Seek immediate medical attention if pain persists or if the cast tightens excessively.
- Seek immediate medical attention if an odor emanates from inside the cast or if a fever, which may indicate an infection, develops.
- Seek immediate medical attention if there is a gradual worsening of pain or any new numbness or weakness.
- Good hygiene is important.
Splinting can be used to immobilize certain stable injuries, including some suspected but unproven fractures, fast-healing fractures, sprains and other injuries that require immobilization for several days or less. A splint is non-circumferential, so it allows patients to apply ice and move more than a cast. It also allows some swelling and therefore does not contribute to compartment syndrome. Some injuries that ultimately require a cast are first immobilized with a splint until most of the swelling subsides.
Sources
- Danielle Campagne , MD: March 2021 "Overview of Sprains and Other Soft-Tissue Injuries" https://www.merckmanuals.com/en-ca/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/overview-of-sprains-and-other-soft-tissue-injuries?query=sprain [Last accessed January 20, 2023]
- Jonathan Cluett, MD: July 25, 2022 "Sprain and Strain Treatments" https://www.verywellhealth.com/top-sprain-strain-treatments-2549862 [Last accessed January 20, 2023]
- Laura Inverarity, DO: October 8, 2021 "The Difference Between a Sprain and a Strain" https://www.verywellhealth.com/strain-vs-sprain-2696546 [Last accessed January 20, 2023]