Sprains and Strains

RICE (rest, ice, compression, and elevation) is the first line of treatment for most sprains and strains. For the first day or two after an injury, wrap a sprain or strain in compression bandages.

• Sprains and strains are common orthopedic injuries.
• A sprain is an injury to a ligament, and a strain is an injury to a muscle or tendon.
• A sprain is usually caused by trauma to a joint. A strain is usually the result of overstretching or overuse of muscles and tendons.
• People at higher risk for sprains and strains include athletes, people who have had sprains and strains before, and those who are overweight.
• Signs and symptoms of sprains and strains include pain, swelling, bruising, and decreased range of motion.
• The main treatment (first aid) for all sprains and strains is RICE: rest, ice, compression, and elevation.
• Home remedies may include over-the-counter pain relievers. Physical therapy or massage may also be prescribed.
• Most sprains and strains heal completely with adequate treatment, though you will be at higher risk of re-injuring the same area again.
• Prevent sprains and strains by stretching and conditioning, wearing the proper shoes for sports, and maintaining a healthy weight.

Sprains and strains are common orthopedic injuries.

• A sprain is an injury to a ligament, which is a band of tissue that connects one bone to another.
• A strain is an injury to a muscle or tendon, which is a band of tissue that connects muscle to bone.
• A strain is also sometimes referred to as a "torn muscle" or "muscle pull."

These injuries can occur in any body part but are most often found in the lower and upper extremities, such as the ankle, knee, elbow, or wrist. The most common sprain site is the ankle joint. More than 23,000 ankle sprains are estimated to occur daily in the United States. Ankle sprains can occur where the footfalls inward (inversion) or when the foot twists out (eversion).

The most common muscle strain sites are the lumbar spine (lower back) and the hamstring muscle in the back of the thigh. Some sprains and strains may occur together during the same injury process.

Sprains tend to have symptoms more localized to the injured joint. When the joint is injured, it's possible to feel a tear or pop in the joint. Pain is usually immediate, and depending on the severity of the injury, it may not be possible to use the joint. Signs and symptoms of sprains include

• pain,
• swelling,
• bruising,
• instability of the joint, and
• decreased range of motion.

Strains, whether acute or chronic, have symptoms localized to the muscle groups or tendons that are injured. Pain can be over a small area, or a larger area, such as a group of muscles. Pain can be immediate in an acute strain, or it may be delayed in the case of an overuse injury. Signs and symptoms of strains include

• pain,
• inflammation,
• muscle spasm,
• muscle cramping,
• muscle weakness, and
• bruising may occur but may be delayed for several days.

A sprain is usually caused by trauma to a joint (the space between bones).

• Twisting or forces overstretch the ligaments (such as hyperextension or hyperflexion) and can cause tears in the ligament tissue, which can be graded from mild to severe depending on the amount of damage.
• Sprains can happen when people twist an ankle or knee or fall on an elbow or shoulder.

A strain is usually the result of overstretching or overuse of muscles and tendons.

• An acute strain can be the result of sudden twisting or trauma to the muscles or tendons.
• Chronic strains are the consequence of overuse of muscles and tendons, such as with athletes who train constantly and do not rest adequately.

Anyone can get a sprain or strain, however, some people may be at higher risk, including the following people:

• Athletes
  • Jumping sports (for example, basketball, volleyball) carry a higher risk of foot, knee, and ankle strains and sprains.
  • Gymnastics, tennis, and golf carry a higher risk of hand, wrist, elbow, rotator cuff, and arm strains and sprains.
  • Contact sports (for example, hockey and football) carry a higher risk of sprains and strains of any type, including but not limited to the fingers, thumbs, toes, and neck.
  • Endurance sports (for example, running and triathlon) carry a higher risk of strains from overuse. Common areas for sprains and strains in endurance athletes include hips, calves, hamstrings, quads, and other parts of the legs.
• Those with a history of prior sprains or strains
• People who are overweight
• People who are starting physical activity or exercise programs for the first time
• People with neurologic problems or balance disorders may be at higher risk for strain and sprain injuries from falling.

There are many treatment options for your sprains and strains, depending on the severity of your injury. Usually, you can treat mild sprains and strains on your own with a combination of home remedies and over-the-counter medications. More serious injuries may require physical therapy or surgery, based on your doctor's recommendations.

RICE Treatment

The main treatment (first aid) for all sprains and strains is RICE (rest, ice, compression, and elevation). 

• Rest — give your injured limb a break,
• Ice —  to dull the pain,
• Compression — to reduce swelling, and
• Elevation — elevate the injury to reduce swelling and pain.

Pain Relief

To manage the pain, over-the-counter pain relievers may be helpful. These may include

• Nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce pain, inflammation, and swelling (use in children varies; discuss with a pediatrician)
  • Aspirin (caution; do not use in children)
  • Naproxen (Aleve)
  • Ibuprofen (Advil, Motrin)
• Acetaminophen (Tylenol)
• Pain-relief creams such as Aspercreme and Biofreeze

Physical Therapy

Some sprain and strain injuries may require physical therapy rehabilitation to help the tissue heal and to retain and strengthen the muscles and tendons.

Casting, Splinting, & Surgery

A more severe sprain or strain may require evaluation by a doctor if your symptoms or pain don't improve while treating the injury at home. Joint or extremity splinting or immobilization (putting the limb in a cast) may be needed to allow the injury to heal. Some severe sprains and strains may require surgery.

Other Therapies

Complementary therapies and homeopathic remedies may help reduce inflammation and ease the pain. Consult a doctor before using any of these supplements and homeopathic remedies, as many have not been scientifically tested or proven effective.

These treatment modalities, supplements, and homeopathic remedies may help someone recover from a sprain or strain injury. You should always consult a doctor first to see if these adjunctive therapies are advised.

• A primary care provider, such as a family practitioner, an internist, or a child's pediatrician, may diagnose a sprain or strain.
• You may also see an emergency-medicine specialist in a hospital's emergency department.
• If your strain or sprain is due to an athletic injury, you may see a sports-medicine specialist.
• If the sprain or strain is severe, you may be referred to an orthopedist, a specialist in injuries and disorders of the musculoskeletal system.
• Physical therapists may also be involved in rehabilitation.

Most sprains and strains are diagnosed by a history and physical exam. A doctor will examine the joint or muscle group and move them through their normal range of motion, looking for pain, tenderness, weakness, or instability.

If there is a possibility of a bone injury or fracture, an X-ray may be ordered. Magnetic resonance imaging (MRI) is sometimes necessary to determine the exact extent of the injury because strains and sprains occur in soft tissue and do not show up on routine X-rays.

A doctor will determine the severity of a sprain or strain injury by degree or grade.

Degrees/grades of sprains, from mild to severe

• First degree (grade 1, mild): limited pain or swelling to the joint, no instability
• Second degree (grade 2, moderate): moderate pain, swelling, and bruising, and some instability during the range of motion
• Third-degree (grade 3, severe): severe pain, swelling, and bruising; joint is unstable; ligament is ruptured or torn completely

Degrees/grades of strains, from mild to severe

• First degree (grade 1, low): limited pain, mild tenderness
• Second degree (grade 2, moderate): moderate pain; limited range of motion; swelling and bruising possible
• Third-degree (grade 3, high): severe pain, limited or no movement, muscle tissue severely damaged and torn

• Mild sprains or strains may take two to six weeks for recovery, while severe sprains or strains may take six months to a year to fully heal.
• A grade 1 strain, which is mild, requires two to three weeks of rest for recovery.
• Grade 2 strains are more extensive and usually three to six weeks of recovery time is needed.
• A grade 3 strain is a complete rupture of a muscle and may require surgery to repair, with at least three months of rehabilitation.
• If there are other associated injuries to the bones or surgery is required, healing time and complications will increase.
• Complications of sprains and strains include joint dislocation, pain and recurring swelling, ruptured muscle, or cartilage injuries.

It is possible to prevent many sprains and strains from occurring. The American Academy of Orthopaedic Surgeons suggests the following to help reduce one's injury risk:

• Participate in a conditioning program to build muscle strength.
• Do stretching exercises daily.
• Always wear properly fitting shoes.
• Nourish the muscles by eating a well-balanced diet.
• Warm up before any sports activity, including practice.
• Use or wear protective equipment appropriate for that sport.

In addition to the above suggestions, prevent future sprains and strains by

• maintaining a healthy weight;
• wearing proper-fitting shoes, designed for the specific activity;
• keeping household areas safe to prevent falls; and
• not participating in sports or exercise if overly tired or in pain.

The prognosis of a sprain or strain injury depends on the severity and the site of the injury. Most sprains and strains heal completely with adequate treatment, though there will be a higher risk of reinjuring the same area again.