Sprains and Strains Definition
Sprains and strains are common injuries that share similar signs and symptoms, but involve different parts of your body.
A sprain is a stretching or tearing of ligaments the tough bands of fibrous tissue that connect two bones together in your joints. The most common location for a sprain is in your ankle.
A strain is a stretching or tearing of muscle or tendon. A tendon is a fibrous cord of tissue that connects muscles to bones. Strains often occur in the lower back and in the hamstring muscle in the back of your thigh.
Initial treatment for both sprains and strains includes rest, ice, compression and elevation. Mild sprains and strains can be successfully treated at home. Severe sprains and strains sometimes require surgery to repair torn ligaments, muscles or tendons.
Causes of Sprains and Strains
Soft tissue is made from bundles of fibres. Muscle and tendons contain specialised cells that monitor the degree of contraction and stretch. With general use, muscles and tendons use soft contractions to resist overstretching. However, sudden twists or jolts can apply greater force than the tissue can tolerate. The fibres overstretch beyond their capacity and tear. Bleeding from broken blood vessels causes the swelling.
Injuries to soft tissues such as ligaments and tendons can come on suddenly or may get worse gradually. A sudden injury is related to a specific incident and is often called an acute soft tissue injury. This means it has occurred within the previous 24 to 72 hours. An injury that gets worse over time (for example, over three months) is often referred to as a chronic soft tissue injury. These are commonly caused by overuse or changes in normal tissue stress.
Joints are held together and supported by tough bands of connective tissue called ligaments. The entire joint is enclosed inside a membrane filled with lubricating synovial fluid, which helps to nourish the joint and provide extra cushioning against impact. A sprain is a joint injury that typically involves small tears (micro-trauma) of the ligaments and joint capsule. Common sites for sprains include the thumb, ankle and wrist.
Muscles are anchored to joints with connective tissue called tendons. Injury to these tendons or the muscles themselves is called a strain. Common sites for strains include the calf, groin and hamstring.
Sprains and Strains Symptoms
The first symptom of a sprain or strain injury is usually pain, though there may be a delay in onset of the symptom until there is some onset of spasm. The person who is injured may not recall the specific event that caused the injury. For example, a person who paints a room may develop shoulder pain the day after the repetitive effort of brushing overhead. This is because inflammation, swelling, and spasm can take time (from minutes to hours) to develop.
Pain is always a symptom that indicates that there is something wrong with the body. It is the message to the brain that warns that a muscle or joint should be protected from further harm. In work, exercise, or sport, the pain may develop after a specific incident, or it may gradually progress after many repetitions of a motion.
Swelling almost always occurs with injury, but it may take from minutes to hours to be noticed. Anytime fibers of a ligament, muscle, or tendon are damaged, some inflammation and bleeding occurs. The bleeding (such as bruising on the surface of the skin) may take time to be noticed.
Sprains and Strains Treatment
Most soft tissue injuries take a few weeks to heal, depending on the severity of the sprain or strain, and the general health of the person. It is important to get the correct treatment as soon after the injury as possible to help rapid recovery. See your doctor if you don’t have full function of the area, or if the pain and swelling don’t subside after a couple of days.
Treatment may include:
- exercises, under the guidance of your doctor or other health professional, to promote healing, strength and flexibility
- manual techniques, such as mobilisation and massage
- pain-relieving medication (talk to your doctor or pharmacist before taking any medications, as they can sometimes disrupt the healing of soft tissue injuries)
- gradually introducing activities to back-to-normal levels.
A short period of immobilisation may help with the healing process for grade II type injuries.
Severe injuries, where the tissue has completely ruptured, may need surgery to put the torn pieces back together. Surgically repaired grade III injuries will require significant treatment to regain strength and function. Whether you have surgery, or immobilisation and physical therapy, as the treatment for a grade III injury, medium to long-term success is similar for either treatment.
Your treating therapist, together with a sports physician, may seek the opinion of an orthopaedic surgeon if you have a significant soft tissue injury (grade III). In some cases, it may be more suitable to immobilise rather than have surgery. This decision should be made by you and your treating team.
First Aid for Sprains and Strains
Your ligaments are tough, elastic-like bands that connect bone to bone and hold your joints in place. A sprain is an injury to a ligament caused by tearing of the fibers of the ligament. The ligament can have a partial tear, or it can be completely torn apart.
Of all sprains, ankle and knee sprains occur most often. Sprained ligaments often swell rapidly and are painful. Generally, the greater the pain and swelling, the more severe the injury is. For most minor sprains, you probably can start initial injury treatment yourself.
Follow the instructions for R.I.C.E.
- Rest the injured limb. Your doctor may recommend not putting any weight on the injured area for 48 hours, so you may need to use crutches. A splint or brace may also be helpful initially. But don’t avoid all activity. Even with an ankle sprain, you can usually still exercise other muscles to minimize deconditioning. For example, you can use an exercise bicycle with arm exercise handles, working both your arms and the uninjured leg while resting the injured ankle on another part of the bike. That way you still get three-limb exercise to keep up your cardiovascular conditioning.
- Ice the area. Use a cold pack, a slush bath or a compression sleeve filled with cold water to help limit swelling after an injury. Try to ice the area as soon as possible after the injury and continue to ice it for 15 to 20 minutes, four to eight times a day, for the first 48 hours or until swelling improves. If you use ice, be careful not to use it too long, as this could cause tissue damage.
- Compress the area with an elastic wrap or bandage. Compressive wraps or sleeves made from elastic or neoprene are best.
- Elevate the injured limb above your heart whenever possible to help prevent or limit swelling.