Sprains and strains are extremely common injuries which affect the muscles and ligaments of the body. Often used as interchangeable terms, they can be distinguished as follows:
Strain: An injury to muscle tissue.
Sprain: An injury to ligaments, the fibrous tissue which connects bones together.
What is a sprain?
A sprain occurs when movement of the joint causes the ligaments to twist, stretch or tear. Commonly affected joints include the ankle, knee, wrist and thumb. Physical activities such as running on uneven surfaces or sudden twisting movements can cause a sprained ankle or knee, whilst playing racquet sports or falling can easily cause a sprained wrist or thumb.
It is common for swelling to occur shortly after a sprained ankle or other sprain injury. Bruising may take a bit longer to appear, not be present at all or could develop some way from the affected joint. Other symptoms of a sprain are inflammation, pain, tenderness and the inability to use the joint, or in the case of a sprained ankle, to weight bear on it.
What is a strain?
A strain is caused by a movement which forces a muscle to stretch or contract too far or too quickly. Most commonly occurring in the legs and lower back, strains are often the result of sporting activities and accidents.
Straining a muscle may cause a variety of symptoms, depending on severity, including:
- Muscle spasms
- Haematoma (a collection of blood under the skin)
- Loss of function
Grading of an injury
The severity of a sprain or strain is assessed using two different grading systems. Sprains are graded using a three point system:
Grade 1: Ligaments have been stretched mildly
Grade 2: Ligaments have been moderately stretched and partially ruptured or split. However the associated joint remains stable.
Grade 3: Ligaments are badly stretched and fully ruptured. The associated joint is not stable.
Strains are graded using a system of degrees. In a first degree strain, muscle fibres are mildly strained. Some strands have been torn or stretched, but not many. Although the muscle will tend to be quite painful and uncomfortable when in use, function is not usually affected.
In a second degree strain, muscles have been moderately strained. A more significant amount of fibres are ripped and stretched. Pain experienced is likely to be more severe. Bruising and mild swelling is also common with a second degree strain.
The most severe third degree strain is when the muscle splits completely in half or has become detached from the tendon (tissue connecting the bone to the muscle). All function of the affected muscle will be lost.
When should medical help be sought for a sprain or a strain?
It is not always necessary to see a doctor if you have suffered a strain or sprain. The NHS reports that over 1.5 million sprained ankles are diagnosed in A&E every year, a large proportion of these could be considered self-limiting (they will get better on their own) and therefore did not require a trip to the hospital.
There are however instances where a trip to your GP or other healthcare professional are advisable, such as:
- The pain is very severe and it is impossible to weight bear on the affected muscle or joint
- After several days of self-care, there is no improvement in the level of pain experienced
- The injury is preventing movement in the affected joint
- When attempting to use the joint, the limb is unstable and gives way
- Numbness is experienced in and around the affected joint and muscle
- Any unusual lumps, bumps or crooked areas around a sprained ankle, sprained wrist or other injury should be investigated. Some swelling is normal and is to be expected.
The importance of a diagnosis
A sprained wrist or sprained ankle are very common injuries, but can be extremely painful. Your doctor will examine the tender area. Depending upon the severity of your injury you may require an x-ray to confirm diagnosis and to check for breaks or stress fractures. Tell your doctor how the injury occurred, how long ago it happened and treatment already administered. It is important to inform the doctor about any medication you are taking, especially if they could potentially have an impact upon the injury. For example, anticoagulants can prevent blood clotting. The doctor will ask a number of questions and check for tenderness, discomfort, inflammation, swelling, lumps and bruising.
A severe sprain may cause the ligaments to loosen and the joints to become unstable as a result. The doctor will carry out an assessment to determine what range of movement you have in the joint and whether or not you are able to weight bear if the injury is in the foot, ankle or leg.
Although strain and sprains do not usually require an x-ray, there are occasions when one may be recommended. These include: if you are over 55, if you are finding it difficult to move the affected limb, if there are specific areas of tenderness or if weight bearing is difficult.
There is no doubt that sprains and strains can be painful, but they are rarely serious. The good news is that in most cases you can treat the injury yourself at home, and they can often be alleviated by painkillers.
The meaning of RICE
Treatment for a sprained ankle, sprained wrist or other type of strain includes using what is known as the RICE therapy. This is a helpful way of remembering what you need to do.
R is for rest. Don’t try to do any activity for a few days after you have injured yourself – it may be a good idea to speak to your GP for advice.
I is for ice. This can really help to reduce pain and swelling, so wrap some ice in a damp tea towel and apply to your sprained ankle or other injured area several times a day.
C is for compression. This is often applied using a relevant brace or support and typically used when active to help manage inflammation on the move.
E is for elevation. Raise your injured area above the level of the heart and keep it supported on a pillow.
If you have sustained a sprain or a strain then there are certain things you need to avoid. This is known as HARM.
H is for heat. Don’t take a hot bath, visit a sauna or use a heat pack.
A is for alcohol. This will lengthen the healing process and increase bleeding and swelling.
R is for running. Avoid this and any other type of exercise that could exacerbate your injury.
M is for massage. Tempting as it is, avoid massaging the injured area as this can increase swelling and bleeding.
To understand more about the differences and when to use what refer to our Ice versus Heat blog post.
Post injury treatment options
There are a number of treatment options available to you depending on your needs and the extent of the damage caused by the initial injury. Your doctor or physiotherapist will be able to offer advice on the best options available but typically a combination is offered to help effectively manage the injury.
You can take regular paracetamol, or ask your doctor for codeine or a non-steroidal anti-inflammatory drug, which could be in cream or gel form and is applied directly to the injured area.
A sprained ankle or sprained wrist is usually back to normal in about three months at the most, while a muscle strain can take anywhere from two weeks to six months to recover.
Strains and sprains can happen quite easily. However, you can reduce the risk of suffering an injury in several ways.
Undertaking a regular programme of strengthening and stretching exercises is one important way to prevent a sprained ankle or a sprained wrist. Conditioning the muscles will help the joints to remain as flexible and strong as possible. Keeping the muscles strong around the joints must be seen as a long-term objective, and therefore exercise of this nature should be ongoing.
For something specific check out the rehab videos from Sports Injury Clinic.
Taping or bracing
For those who are particularly at risk of sustaining a sprain or strain injury, strapping or taping the joint can be helpful in the short term. Wrapping the joint to protect it when recovering from an injury is sometimes recommended. However, it is essential that this is seen as a short-term measure, as overprotecting the joint in this way can eventually weaken it, increasing the chances of sustaining a serious injury in the future. The focus should always be on strengthening.
Your physiotherapist will be able to recommend a relevant brace but always ensure it is designed to manage your specific condition as a quick search online will show you that there are loads of different ankle supports, so selecting the right one can be challenging. If you are unsure at the point of purchase then ask someone from the company or contact the manufacturer as the wrong type of brace may not offer any benefit and in certain cases may even hinder your recovery.
Choosing the right footwear is incredibly important for those looking to avoid a sprained ankle, whether at home, on the sports field or at work. Footwear will naturally vary depending upon the type of activity but should always offer good support and protection for the foot and ankle. Keep an eye on the condition of the shoe, as the risk of injury may increase as they become more worn. If the heel wears down on one side, replace the shoe as soon as possible. Shoes that wear down unevenly can be a sign of flat feet or ‘over pronation’. It is therefore a good idea to purchase some insoles to ensure the foot is in the correct position inside the shoe.
Those who wear high heels are at a much increased risk of suffering a sprained ankle compared to those who wear flat shoes.
Strains and sprains can be prevented in a number of ways.
Exercise regularly. Before exercising, always warm up carefully. This prepares the joints and muscles for activity. Similarly, take the time to cool down again afterwards. Wear appropriate protective equipment were necessary.
Exhaustion can significantly increase the chances of suffering an injury. If possible, do not participate in an activity, especially sport or exercise, when in pain or tired.
To prevent slips, trips and falls, take care to keep walkways, driveways and gardens clear of debris. Put down salt or sand during the winter months, especially in those areas prone to becoming icy. In the home keep stairs and landings clutter-free.
Eating a healthy and balanced diet is another important way to keep muscles and joints strong and prevent a sprained ankle or sprained wrist. Maintaining a healthy weight is essential. Being underweight can weaken the bones, joints and muscles, while being overweight puts increased pressure on the joints.