Sprains and strains are some of the most common types of injuries in any sport. They involve the stretching or tearing of tissue. Sprains occur to ligaments (which connect bone to bone), while strains involve muscles or tendons (which connect muscle to bone).
How Are Sprains and Strains Classified?
Sprains and strains are placed into three categories according to severity. They are classified as follows:
Grade I (Mild): Tissue is stretched.
- Slight swelling (hardly noticeable)
- Mild loss of range of motion (ability to move in various directions) and strength (0 – 25%)
- No decrease in stability
Grade II (Moderate): Involves stretching and some tearing of tissue.
- Moderate swelling (may look “baseball” size)
- Usually includes some bruising
- Moderate loss of range of motion and strength (25 – 75%)
- Some decrease in stability
Grade III (Severe): Complete tearing of tissue.
- Significant swelling and bruising
- Near complete loss of range of motion and strength (75 – 100%)
- Marked decrease in stability
Range of motion and strength percentages are determined by comparing the injured body part to the uninjured side. Severity of injury is best determined by a physician or athletic trainer. Immediate first aid for all sprains and strains is Rest, Ice, Compression, and Elevation or R.I.C.E. After initial first aid is administered, prompt referral to an appropriate medical professional should be sought to ensure proper injury treatment.
“It’s Just a Sprain…What’s The Big Deal?”
Sprains and strains can be a big deal and lead to prolonged time away from sport, especially if not treated appropriately. Additionally, sprains and strains can mimic other more serious injuries. For example, young athletes are prone to growth plate injuries called Salter-Harris fractures.
“Growth plates are located near the ends of long, growing bones in children and gradually close as a child reaches skeletal maturity,” explains John Kean, M.D., Orthopedic Surgeon at Nationwide Children’s Hospital. “The growth plate in growing children is weaker than the nearby ligaments and tendons. Therefore, the growth plate will become injured under lower forces than those that would injure a tendon or ligament.”
Young athletes with Salter-Harris fractures will be very tender over the growth plate. They may have bruising and are often reluctant to bear weight. A careful physical exam is the best way to confirm this diagnosis although x-rays are often helpful as well. Even if the initial x-rays are negative, repeat studies can sometimes reveal subtle fractures. There are complications of growth plate injuries that are undiagnosed, untreated, or treated incorrectly. This confirms the importance of seeking the advice of a qualified medical professional with experience in dealing with these injuries even when it looks like it is “just a sprain.”
Initially, the inability to bear weight (about 4 steps) after the injury or tenderness over any bone should prompt an evaluation that includes x-rays.
“Within a few days, any continued significant pain, continued reluctance to bear weight, or significant swelling and/or bruising may warrant re-evaluation and possibly an x-ray. Any other unusual symptoms such as numbness, loss of pulses near the injured area, discoloration, out of proportion pain, or rashes would indicate the need for further evaluation,” states Dr. Kean.
If your child is unfortunate enough to sustain an injury, remember that quick and proper treatment is the key to limiting time on the sideline.
Nationwide Children’s Hospital Sports Medicine specializes in diagnosing and treating sports-related injuries in youth, adolescent, and collegiate athletes. Services are available in multiple locations throughout central Ohio. To make an appointment, call 614-355-6000 or request an appointment online.
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A strain is when a muscle or tendon (tissue that attaches muscle to bone) is stretched too far. A strain is sometimes called a "pulled muscle." Depending on the level of muscle strain, it may heal within a few weeks, but reinjury can happen.
A sprain is when ligaments (bands of tissue that hold bone to bone at the joints) stretch too far or tear. A sprain may can take 4–6 weeks to heal or sometimes longer.
What Are the Signs & Symptoms of Strains and Sprains?
Strains and sprains can cause:
- pain, either at the time of injury or later
- tenderness in the soft tissue, usually close to the bone
- swelling
- bruising
- muscle spasms
- weakness or pain when using or moving the injured area
What Causes Strains and Sprains?
Strains can happen when you put a lot of pressure on a muscle or push it too far, such as when lifting a heavy object. They usually happen when someone is active, contracting, stretching, or working body part. They're more likely when a person hasn't warmed up first to get blood circulating to the muscles. Strains are common when athletes return to a sport after the off-season. They often affect the muscles in their backs, necks, or legs.
Sprains are caused by injuries, such as twisting an ankle or knee, or from contact with another player. They're common in sports, but can happen any time.
How Are Strains and Strains Diagnosed?
To diagnose strains and sprains, doctors:
- ask questions about the injured body part
- do an exam, observing range of motion and doing strength tests
Depending on the injury, the doctor may order an X-ray or other imaging study to see if there are other injuries, such as a broken bone. Ultrasounds can sometimes diagnose a minor tear.
How Are Strains and Sprains Treated?
Treatment for strains and sprains usually includes:
- rest, which is the key to recovery and preventing reinjury
- immediate treatments to help with swelling, such as:
- ice wrapped in a towel placed on the area for about 20 minutes every 1–2 hours
- an elastic bandage wrapped around the area for compression or a compression sleeve
- raising the injured area
- immobilizing the affected area right away and keeping it still for a few days
- warm compresses or a heating pad (after the swelling goes down)
- strengthening exercises, especially eccentric strengthening exercises (movements that lengthen muscles)
- pain medicine for no more than 1 week
Doctors may treat some strains and sprains and strains with a splint or temporary cast.
Can Someone With a Sprain or Strain Play Sports?
If you have a sprain or strain, you'll probably need to take some time off from sports. You can go back when:
- the swelling goes down
- the sport does not cause pain
- the doctor says it's OK
- you can participate without a limp
- you have your full range of motion
- you're back to full strength
What Else Should I Know?
Strains and sprains usually heal without any lasting problems. Be sure to follow the doctor's instructions so the injury heals as quickly as possible.
To avoid strains and sprains, do a good dynamic warm-up before activity. You can try jogging, high knees, butt kicks, and active stretching. After activity, do some static stretching (holding each stretch for 30 seconds or longer).
A coach, personal trainer, doctor, or physical therapist can show you how to do eccentric strengthening exercises to help with recovery and lower the risk of reinjury.
- Strains and sprains both refer to soft tissue damage - in the case of sprains and strains this is damage to the muscles, tendons or ligaments
- Strains refer to damage to muscles and tendons
- Sprains refer to damage to the ligaments
- Strains may either be acute (sudden) or chronic (developing over time)
- Sprains are acute injuries, in almost all cases
- Light to moderate sprains and strains may be treated at home, but severe soft tissue injuries require medical attention
While many people may use the two terms interchangeably and share many of the same symptoms and both refer to damage done to soft tissue, sprains and strains are different and as a result require different treatment and rehabilitation.
- Strain - a strain refers to stretched, twisted or torn muscle fibres or tendon. Strains may be acute (sudden) or chronic (develop over time) due to repetitive movement, overexertion (such as experienced when lifting heavy objects) or being in an awkward physical position for long periods of time.
Strains most often occur in weight bearing or highly flexed muscles, such as the lower back, neck, calves, shoulders or hamstrings.
- Sprain - a sprain refers to a stretched, twisted or torn ligament. Unlike strains which can be acute or chronic, sprains are always acute, as they are typically caused by a joint being stressed by a fall, impact or rotation and the ligament being stretched or torn as a result.
Sprains can occur in any joint, but are most typically seen in the ankles, wrists, knees and digits.
Both ligaments and tendons are made up of tough, flexible, fibrous tissue, however, the similarities essentially end there. Ligaments have a dense, criss-cross structure and serve to connect bones to other bones, lending stability and structure to joints. Tendons are flexible collagen bands that connect muscles to bones, allowing muscles to transmit energy to the bones to facilitate motion.
The size of tendons is directly related to their purpose, with load bearing tendons or those connected to large, powerful muscles typically being short and wide, and those intended for fine control, such as the tendons in the fingers being long and thin.
Soft tissue injuries such as strains and sprains are graded on a three point scale in regards to their severity:
- Grade 1 - only a small percentage of fibres in the affected tissue are disrupted. This may result in pain and inflammation but the strength and function of the muscle or joint remains largely unchanged.
- Grade II - a moderate amount of tearing in the affected soft tissue, leading to pain and inflammation as well as some degree of reduction in function and strength in the affected area. This grade of injury is commonly the most painful.
- Grade III - significant rupturing to the affected soft tissue (either a partial or complete tear) leading to significant pain, inflammation and reduction in strength and function of the affected area. Shortly after a Grade III injury, the pain may actually resolve. This is because the nerve endings are also damaged in the complete rupture, and there is nothing left to feel the pain with. This is especially common in the well known Anterior Cruciate Ligament (ACL) Rupture. Immediate medical attention is recommended for grade III soft tissue injuries.
Symptoms of a Strain
Depending on the severity of the muscle or tendon strain, the symptoms may vary but typically include:
- Pain at the site of the injury - the area around the strained muscle or tendon will typically be the epicentre of the pain. With a minor strain this may simply be a tenderness or twinge. With severe strains in which the muscle or tendon is torn, the pain may be excruciating.
- Inflammation - depending on the severity of the strain, the affected area may become inflamed.
- Muscle weakness - strains may limit a muscle or tendon’s ability to exert force or bear weight.
- Muscle cramps/spasms - muscle fibres around the strained area may bunch and knot to protect the injured area from further damage. A cramp or muscle spasm may cause significant pain and reduction in mobility.
- Reduced range of motion - a strain typically results in a reduction in the function of the affected muscle. Depending on the location of the strain, this may lead to a reduction in range of motion.
- Redness and bruising - depending on the severity of the strain and whether the muscle or tendon has been torn, redness or bruising (severe bruising in the case of a torn muscle) may occur.
Symptoms of a Sprain
Sprains are almost exclusively an acute injury so most symptoms have a sudden onset. The symptoms may vary depending on whether the affected ligament was simply overstretched or actually torn but typically include:
- Pain in the affected joint - pain in the affected joint may be constant and sharp, throbbing or an ongoing ache. In most sprains, putting pressure on the joint (walking with a sprained ankle or knee, for example) will cause greater pain.
- Inflammation - swelling around the affected joint.
- Bruising - as sprains are typically caused by impact or torsion, bruising around the affected joint is common.
- Weakness in the affected joint - people with sprains often feel weakness, or a “floppiness” in the sprained joint due to the sprained ligament being unable to properly stabilise a joint. In some cases, such as in the above mentioned complete ACL rupture, this is the most significant symptom.
- Limited range of motion - in addition to weakness in a joint, people with a sprain may also experience either a reduction in range of motion of the affected joint or an inability to properly control the joint.
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What causes a Strain?
Strains may be acute (sudden) or chronic (long term), so may be caused by a number of factors. Acute strains are caused by a single incident, such as lifting an object the wrong way, a sudden stop (whiplash, etc), overstretching in the case of a dancer, accelerating too quickly in the case of a running athlete, or impact.
Chronic strains are caused either by microtraumas resulting from repetitive motions, or improper ergonomics, such as long term poor posture or staying in an awkward position for long periods of time.
Some common risk factors for strains include:
- Racquet sports/throwing - both racquet sports and the action of throwing may strain the muscles and tendons around the elbow (tennis elbow, golfer’s elbow).
- High impact sport or activity - sports or activities that require quick starts, turns or running and jumping increase the risk of straining a muscle or tendon in the back or legs. Such activities may be especially risky to the Achilles tendon (the tendon that connects the heel bone to the calf).
- Poor biomechanics or ergonomics - lifting heavy objects using improper technique, having a poorly designed work area, inappropriate seating, poor posture and the like.
- Failure to warm up before exercise - exercising or playing sports without an adequate, dynamic warmup increases your risk of straining a muscle.
What Causes a Sprain?
Sprains occur when a joint is overextended or otherwise stressed, causing an overextension or tear in the connecting ligament/s. Sprains are acute injuries and may be caused by a number of factors, including:
- Sudden impact/fall - sprained wrists are often caused by the wrist being overextended when someone tries to brace themselves during a fall. Sprains to the digits often result from a sudden impact, such as a skiing collision or ski-pole being torn from the hand, or a hard impact to a racquet in racquet sports. Direct impact on a joint, such as a blow to the knee (accidental or deliberate) may also result in a sprain.
- Sudden rotation - a joint being rotated unexpectedly or suddenly can severely stress the ligaments. These rotations may be caused by awkwardly landing after a jump or slip, walking, running or exercising on uneven ground, or sudden changes in direction. Sprained ankles and knee sprains commonly result from sudden rotation of the joint.
Treatment for Strains and Sprains
First and second grade sprains and strains may be taken care of at home utilising a system of treatment sometimes referred to as R.I.C.E. - R est, I ce, C ompression, E levation.
- Rest - avoiding activities that cause or exacerbate pain in the affected area. This of course doesn’t mean that all physical activity should cease.
- Ice - using an ice pack on the affected area may help reduce inflammation, but is now best understood to be pain relieving. Even if you need medical attention, icing the affected muscle or joint is recommended.
- Compression - a compressive bandage may help reduce or stop inflammation and can also lend stability to an affected joint or muscle.
- Elevation - elevating an injured area above the level of your heart may help reduce or stop inflammation.
Over the counter pain relief medication, such as non-steroidal anti inflammatory drugs (NSAIDs) may also be used for pain relief. Recent research, however, suggests that these should be delayed for the first 48 hours following injury. The body’s natural healing process is the inflammatory process, and shutting this down too early with NSAIDs can be detrimental to long term healing.
Severe soft tissue injuries may require surgery to repair torn muscles, tendons or ligaments.
Tendons and ligament injury may take a long time to heal. Physiotherapy may help in this process utilising a number of techniques, including guided exercises designed to strengthen the muscles around the affected area, taping or binding of the affected area for stability and support, or the use of specialist therapies such as TENS (transcutaneous electronic nerve stimulation), ultrasound or shockwave therapy.
The discomfort and disability caused by a strain or sprain can severely impact your ability to function normally, and a full recovery may take a long time. The fastest and easiest way to book healthcare appointments online is through MyHealth1st.