Sprains and strains

 

When you overdo it physically, you may experience sudden pain and swelling around a joint or a muscle. This may occur when you stretch too far, change direction or slow down abruptly, land awkwardly, or collide with another player during a sporting event. The injury you have may be a sprain or a strain. Here's the distinction:

bulletSprain. A sprain is a stretching or tearing of ligaments. Ligaments are tough bands of fibrous tissue that connect one bone to another. They help to stabilize joints, preventing excessive movement. Sprains are frequently caused by rapid changes in direction or by a collision. Common locations for sprains are your ankles, wrists and knees.
bulletStrain. A strain is a stretching or tearing of muscle. This type of injury often occurs when muscles suddenly and powerfully contract — or when a muscle stretches unusually far. This is called an acute strain. But overuse of certain muscles over time can lead to a chronic strain. People commonly call muscle strains "pulled" muscles. Hamstring and back injuries are among the most common strains.

Treatment depends on the severity of the injury. Many times, self-care measures and over-the-counter pain medications are all that you'll need.

Signs and symptoms

Illustration showing ankle sprainSprains

Sprains and strains vary in severity. Signs and symptoms depend on the severity of the injury.

Sprains
Sprains can cause rapid swelling. Generally, the greater the pain and swelling, the more severe the injury.

bulletMild. Your ligament stretches excessively or tears slightly. The area is somewhat painful, especially with movement. It's tender. There's not a lot of swelling. You can put weight on the joint.
bulletModerate. The fibers in your ligament tear, but they don't rupture completely. The joint is tender, painful and difficult to move. The area is swollen and may be discolored from bleeding in the area. You may feel unsteady when you try to bear weight on your leg.
bulletSevere. One or more ligaments tear completely. The area is painful. You can't move your joint normally or put weight on it. If you try to walk, your leg feels as if it will give way. The joint becomes very swollen and also can be discolored. The injury may be difficult to distinguish from a fracture or dislocation, which requires medical care. You may need a brace to stabilize the joint or surgical repair in certain ligament injuries.

Strains
Depending on the severity of the strain, signs and symptoms may include:

bulletMild. Pain and stiffness that occur with movement and may last a few days.
bulletModerate. Partial muscle tears result in more extensive pain, swelling and bruising. The pain may last one to three weeks.
bulletSevere. The muscle is torn apart or ruptured. You may have significant bleeding, swelling and bruising around the muscle. Your muscle may not function at all, and you may need surgical repair if the muscle has torn away completely from the bone.

Causes

Sprains and strains occur commonly, and most result in minor injuries.

A muscle becomes strained or pulled — or may even tear — when it stretches unusually far or abruptly. This type of injury — an acute strain — often occurs when muscles suddenly and powerfully contract. A muscle strain may occur when you slip on ice, run, jump, throw, lift a heavy object or lift in an awkward position. A chronic strain results from prolonged, repetitive movement of a muscle.

A sprain occurs when you overextend or tear a ligament while severely stressing a joint. You may sprain your knee or ankle when walking or exercising on an uneven surface. A sprain also may occur when you land awkwardly, either at the end of a jump or while pivoting during an athletic activity.

Risk factors

Factors contributing to sprains and strains include:

bulletPoor conditioning. Lack of conditioning can leave your muscles weak and more likely to sustain injury.
bulletPoor technique. The way you land from a jump — for example, when skiing or practicing martial arts — may affect your risk of injury to a ligament in your knee called the anterior cruciate ligament (ACL). Landing with an inward rotation at the knee ("knock-kneed" position) can predispose you to an ACL sprain.
bulletFatigue. Tired muscles are less likely to provide good support for your joints. When you're tired, you're also more likely to succumb to forces that could stress a joint or overextend a muscle.
bulletImproper stretching and warm-up. Properly warming up and stretching before vigorous physical activity loosens your muscles and increases joint range of motion, making the muscles less tight and less prone to trauma and tears.

When to seek medical advice

For a sprain, seek emergency medical care in the following situations:

bulletPopping sound. You may hear a popping sound when your joint is injured; you may have considerable swelling about the joint and be unable to use it. On the way to the doctor, apply an ice pack.
bulletInability to bear weight. You're unable to bear weight on an injured joint because of a feeling of instability or pain.
bulletSevere sprain. Inadequate or delayed treatment may cause long-term joint damage or chronic pain.

For a strain, seek medical help immediately if the area quickly becomes swollen and is intensely painful or if you suspect a ruptured muscle or broken bone. Also call your doctor if the pain, swelling and stiffness of less-severe strains don't improve in two to three days.

Screening and diagnosis

With both sprains and strains, the discomfort in the area is the key to diagnosis. Examination may reveal swelling, bleeding in the joint or muscle, and tenderness. Your doctor may order an X-ray to rule out a fracture or other bone injury as the source of the problem.

Treatment

Treating a sprain or strain depends on the joint involved and the severity of the injury. For mild sprains and strains, your doctor likely will recommend basic self-care measures and an over-the-counter pain reliever such as ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others).

In cases of a mild or moderate sprain or strain, apply ice to the area as soon as possible to minimize swelling. In cases of severe sprain or strain, your doctor may immobilize the area with a brace or splint. In some cases, such as in the case of a torn ligament or ruptured muscle, surgery may be considered.

Prevention

Regular stretching and strengthening exercises for your sport, fitness or work activity, as part of an overall physical conditioning program, can help to minimize your risk of sprains and strains. Try to be in shape to play your sport; don't play your sport to get in shape. If you have a physically demanding occupation, regular conditioning can help prevent injuries.

If you're prone to sprains, taping, bracing or wrapping knees, ankles, wrists or elbows can help while you're recovering from injury and when you're first getting back into your regular activities. It's best for many people to regard taping, bracing and wrapping as short-term protective measures. You can protect your joints in the long term by working to strengthen and condition the muscles around the joint that has been injured. The best brace you can give yourself is your own "muscle brace." Ask your doctor about appropriate conditioning and stability exercises. Also, use footwear that offers support and protection.

Self-care

For immediate self-care of a sprain or strain, try the P.R.I.C.E. approach — protection, rest, ice, compression, elevation. In most cases beyond a minor strain or sprain, you'll want your doctor and physical therapist to help you with this process:

bulletProtection. Immobilize the area to protect it from further injury. Use an elastic wrap, splint or sling to immobilize the area. If your injury is severe, your doctor or therapist may place a cast or brace around the affected area to protect it and instruct you on how to use a cane or crutches to help you get around, if necessary.
bulletRest. Avoid activities that cause pain, swelling or discomfort. But don't avoid all physical activity. Instead, give yourself relative rest. For example, with an ankle sprain you can usually still exercise other muscles to prevent deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on a footrest peg. That way you still exercise three limbs and keep up your cardiovascular conditioning.
bulletIce. Even if you're seeking medical help, ice the area immediately. Use an ice pack or slush bath for 15 to 20 minutes each time and repeat every two to three hours while you're awake for the first 48 to 72 hours. Cold reduces pain, swelling and inflammation in injured muscles, joints and connective tissues. It also may slow bleeding if a tear has occurred. If the area turns white, stop treatment immediately. This could indicate frostbite. If you have vascular disease, diabetes or decreased sensation, talk with your doctor before applying ice.
bulletCompression. To help stop swelling, compress the area with an elastic bandage until the swelling stops. Don't wrap it too tightly or you may hinder circulation. Begin wrapping at the end farthest from your heart. Loosen the wrap if the pain increases, the area becomes numb or swelling is occurring below the wrapped area.
bulletElevation. To reduce swelling, elevate the injured area above the level of your heart, especially at night. Gravity helps reduce swelling by draining excess fluid.

Continue with P.R.I.C.E. treatment for as long as it helps you recover. Over-the-counter pain medications such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others) also can be helpful. If you want to apply heat to the injured area, wait until most of the swelling has subsided.

After the first two days, gently begin to use the injured area. You should see a gradual, progressive improvement in the joint's ability to support your weight or your ability to move without pain.

Mild and moderate sprains usually heal in two to four weeks. If pain, swelling or instability persists, see your doctor. A physical therapist can help you to maximize stability and strength of the injured joint or limb.