What Is the
Difference Between a Sprain and a Strain?
A sprain is an injury to a ligament--a
stretching or a tearing. One or more ligaments can be injured during a
sprain. The severity of the injury will depend on the extent of injury
to a single ligament (whether the tear is partial or complete) and the
number of ligaments involved.
A strain is an injury to either a muscle or a
tendon. Depending on the severity of the injury, a strain may be a
simple overstretch of the muscle or tendon, or it can result in a
partial or complete tear.
What Causes a Sprain?
A sprain can result from a fall, a sudden twist, or a blow
to the body that forces a joint out of its normal position. This results
in an overstretch or tear of the ligament supporting that joint.
Typically, sprains occur when people fall and land on an outstretched
arm, slide into base, land on the side of their foot, or twist a knee
with the foot planted firmly on the ground.
Where Do Sprains Usually Occur?
Although sprains can occur in both the upper and lower
parts of the body, the most common site is the ankle. Ankle sprains are
the most common injury in the United States and often occur during
sports or recreational activities. Approximately 1 million ankle
injuries occur each year, and 85 percent of them are sprains.
The talus bone and the ends of two of the lower leg bones
(tibia and fibula) form the ankle joint (see
fig. 1). This joint is supported by several lateral (outside)
ligaments and medial (inside) ligaments. Most ankle sprains happen when
the foot turns inward as a person runs, turns, falls, or lands on the
ankle after a jump. This type of sprain is called an inversion injury.
One or more of the lateral ligaments are injured, usually the anterior
talofibular ligament. The calcaneofibular ligament is the second most
frequently torn ligament.
The knee is another common site for a sprain. A blow to
the knee or a fall is often the cause; sudden twisting can also result
in a sprain (see
fig. 2).
Sprains frequently occur at the wrist, typically when
people fall and land on an outstretched hand.
What Are the Signs and Symptoms
of a Sprain?
The usual signs and symptoms include pain, swelling,
bruising, and loss of the ability to move and use the joint (called
functional ability). However, these signs and symptoms can vary in
intensity, depending on the severity of the sprain. Sometimes people
feel a pop or tear when the injury happens.
Doctors use many criteria to diagnose the severity of a
sprain. In general, a grade I or mild sprain causes overstretching or
slight tearing of the ligaments with no joint instability. A person with
a mild sprain usually experiences minimal pain, swelling, and little or
no loss of functional ability. Bruising is absent or slight, and the
person is usually able to put weight on the affected joint. People with
mild sprains usually do not need an x ray, but one is sometimes
performed if the diagnosis is unclear.
When To See a Doctor for a Sprain
-
You have severe pain and cannot put any weight on
the injured joint.
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The area over the injured joint or next to it is
very tender when you touch it.
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The injured area looks crooked or has lumps and
bumps (other than swelling) that you do not see on the uninjured
joint.
-
You cannot move the injured joint.
-
You cannot walk more than four steps without
significant pain.
-
Your limb buckles or gives way when you try to use
the joint.
-
You have numbness in any part of the injured area.
-
You see redness or red streaks spreading out from
the injury.
-
You injure an area that has been injured several
times before.
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You have pain, swelling, or redness over a bony
part of your foot.
-
You are in doubt about the seriousness of the
injury or how to care for it. |
A grade II or moderate sprain causes partial tearing of
the ligament and is characterized by bruising, moderate pain, and
swelling. A person with a moderate sprain usually has some difficulty
putting weight on the affected joint and experiences some loss of
function. An x ray may be needed to help the doctor determine if a
fracture is causing the pain and swelling. Magnetic resonance imaging is
occasionally used to help differentiate between a significant partial
injury and a complete tear in a ligament.
People who sustain a grade III or severe sprain completely
tear or rupture a ligament. Pain, swelling, and bruising are usually
severe, and the patient is unable to put weight on the joint. An x ray
is usually taken to rule out a broken bone.
When diagnosing any sprain, the doctor will ask the
patient to explain how the injury happened. The doctor will examine the
affected joint and check its stability and its ability to move and bear
weight.
What Causes a Strain?
A strain is caused by twisting or pulling a muscle or
tendon. Strains can be acute or chronic. An acute strain is caused by
trauma or an injury such as a blow to the body; it can also be caused by
improperly lifting heavy objects or overstressing the muscles. Chronic
strains are usually the result of overuse--prolonged, repetitive
movement of the muscles and tendons.
Where Do Strains Usually
Occur?
Two common sites for a strain are the back and the
hamstring muscle (located in the back of the thigh). Contact sports such
as soccer, football, hockey, boxing, and wrestling put people at risk
for strains. Gymnastics, tennis, rowing, golf, and other sports that
require extensive gripping can increase the risk of hand and forearm
strains. Elbow strains sometimes occur in people who participate in
racquet sports, throwing, and contact sports.
What Are the Signs and Symptoms
of a Strain?
Typically, people with a strain experience pain, muscle
spasm, and muscle weakness. They can also have localized swelling,
cramping, or inflammation and, with a minor or moderate strain, usually
some loss of muscle function. Patients typically have pain in the
injured area and general weakness of the muscle when they attempt to
move it. Severe strains that partially or completely tear the muscle or
tendon are often very painful and disabling.
How Are Sprains and Strains
Treated?
Reduce Swelling and Pain
Treatment for sprains and strains is similar and can be
thought of as having two stages. The goal during the first stage is to
reduce swelling and pain. At this stage, doctors usually advise patients
to follow a formula of rest, ice, compression, and elevation (RICE) for
the first 24 to 48 hours after the injury (see the box below).
The doctor may also recommend an over-the-counter or prescription
nonsteroidal anti-inflammatory drug, such as aspirin or ibuprofen, to
help decrease pain and inflammation.
For people with a moderate or severe sprain, particularly
of the ankle, a hard cast may be applied. Severe sprains and strains may
require surgery to repair the torn ligaments, muscle, or tendons.
Surgery is usually performed by an orthopaedic surgeon.
It is important that moderate and severe sprains and
strains be evaluated by a doctor to allow prompt, appropriate treatment
to begin. The box above
lists some signs that should alert people to consult
their doctor. However, a person who has any concerns about the
seriousness of a sprain or strain should always contact a doctor for
advice.
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RICE Therapy
Rest
Reduce regular exercise or activities
of daily living as needed. Your doctor may advise you to put no
weight on an injured area for 48 hours. If you cannot put weight
on an ankle or knee, crutches may help. If you use a cane or one
crutch for an ankle injury, use it on the uninjured side to help
you lean away and relieve weight on the injured ankle.
Ice
Apply an ice pack to the injured area
for 20 minutes at a time, 4 to 8 times a day. A cold pack, ice
bag, or plastic bag filled with crushed ice and wrapped in a towel
can be used. To avoid cold injury and frostbite, do not apply the
ice for more than 20 minutes.
Compression
Compression of an injured
ankle, knee, or wrist may help reduce swelling. Examples of
compression bandages are elastic wraps, special boots, air casts,
and splints. Ask your doctor for advice on which one to use.
Elevation
If possible, keep the injured
ankle, knee, elbow, or wrist elevated on a pillow, above the level
of the heart, to help decrease swelling.
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Begin Rehabilitation
The second stage of treating a sprain or strain is
rehabilitation, whose overall goal is to improve the condition of the
injured part and restore its function. The health care provider will
prescribe an exercise program designed to prevent stiffness, improve
range of motion, and restore the joint's normal flexibility and
strength. Some patients may need physical therapy during this stage.
When the acute pain and swelling have diminished, the
health care provider or physical therapist will instruct the patient to
do a series of exercises several times a day. These are very important
because they help reduce swelling, prevent stiffness, and restore
normal, pain-free range of motion. The health care provider can
recommend many different types of exercises, depending on the injury.
For example, people with an ankle sprain may be told to rest their heel
on the floor and write the alphabet in the air with their big toe. A
patient with an injured knee or foot will work on weight-bearing and
balancing exercises. The duration of the program depends on the extent
of the injury, but the regimen commonly lasts for several weeks.
Another goal of rehabilitation is to increase strength and
regain flexibility. Depending on the patient's rate of recovery, this
process begins about the second week after the injury. The health care
provider or physical therapist will instruct the patient to do a series
of exercises designed to meet these goals. During this phase of
rehabilitation, patients progress to more demanding exercises as pain
decreases and function improves.
The final goal is the return to full daily activities,
including sports when appropriate. Patients must work closely with their
health care provider or physical therapist to determine their readiness
to return to full activity. Sometimes people are tempted to resume full
activity or play sports despite pain or muscle soreness. Returning to
full activity before regaining normal range of motion, flexibility, and
strength increases the chance of reinjury and may lead to a chronic
problem.
The amount of rehabilitation and the time needed for full
recovery after a sprain or strain depend on the severity of the injury
and individual rates of healing. For example, a moderate ankle sprain
may require 3 to 6 weeks of rehabilitation before a person can return to
full activity. With a severe sprain, it can take 8 to 12 months before
the ligament is fully healed. Extra care should be taken to avoid
reinjury.
Can Sprains and Strains Be
Prevented?
There are many things people can do to help lower their
risk of sprains and strains:
- Maintain a healthy, well-balanced diet to keep muscles strong.
- Maintain a healthy weight.
- Practice safety measures to help prevent falls (for example, keep
stairways, walkways, yards, and driveways free of clutter, and salt or
sand icy patches in the winter).
- Wear shoes that fit properly.
- Replace athletic shoes as soon as the tread wears out or the heel
wears down on one side.
- Do stretching exercises daily.
- Be in proper physical condition to play a sport.
- Warm up and stretch before participating in any sports or
exercise.
- Wear protective equipment when playing.
- Avoid exercising or playing sports when tired or in pain.
- Run on even surfaces.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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