What are strains and sprains?

Muscle strains and ligament sprains are two of the most common sports injuries. They happen in everyday life as well. These soft tissue injuries (ie, bones are not broken) cause various degrees of pain and swelling, which should prompt appropriate action (R.I.C.E.D. - see below) to protect the injury and promote a full recovery. If at any time you are worried an injury might be severe – or the pain, swelling or function get worse or do not improve within two days – visit a doctor to have it checked.

Sprains

A sprain is a tear in a ligament (a tough fibrous cord that connects a bone to another bone). Sprains are caused by the sudden, forceful twisting of a joint. Symptoms – pain, swelling, bruising and loss of joint function – depend on how badly the ligaments are torn or stretched. If a sprain is not allowed to heal properly, there is a good chance the same injury will recur.

Strains

A strain occurs when a muscle or tendon (a sinewy tissue that connects muscle to bone) is overstretched or torn. Strains are usually caused by putting stress on tight or weak muscles – this can happen if you have not warmed up enough before explosive stop-start exercise or if your muscles become fatigued. If a strain is not allowed to heal properly, or if scar tissue forms, the muscle or tendon can remain weak or painful.

Pain and swelling

The immediate and longer term pain, tenderness and limited movement around an injury is your body’s way of preventing you from further damaging yourself by moving around before it has healed. The swelling and inflammation are caused by the release of chemicals from the damaged tissues. There might also be some bleeding, which may reveal itself later as a bruise.

IMMEDIATE TREATMENT MEANS ‘R.I.C.E.D.’

Rest: Stop the activity as soon as you have become injured. Try not to move or load the injured part – total rest helps prevent further damage.

Ice: Apply ice or a bag of frozen veges wrapped in a damp towel to the injury for 20 minutes as soon as possible after the injury. This should be repeated once every two hours over the next two days. Cold will reduce the pain, bleeding and swelling around the injury.

Compression: A firmly applied elasticated bandage will also reduce pain, bleeding and swelling. If there is any numbness or tingling in the fingers or toes, loosen the bandage.

Elevation: Raise the injured part above the level of your heart if possible, resting it on a chair or cushion. This will help reduce bleeding and swelling.

…Diagnosis: After two days, if the swelling and pain have not eased and function is not returning, it is important you visit a doctor to have the injury checked – it could be a broken bone or an additional injury to the sprain/strain. Further tests, treatment and physical rehabilitation may need to begin right away.

And avoid H.A.R.M. for the first 72 hours: Heat, Alcohol, Running (or any exercise), Massage

Ankle: mild sprains occur when ligaments are stretched or slightly torn.	Ankle: moderate sprains occur when ligaments are partly torn.
Ankle: severe sprains occur when ligaments are completely torn.

Ankle and knee joint strains

Sprains and strains often occur in or near a joint. They result from overloading, overextension or twisting of a joint, or collision with a person or an object.

In mild cases, the force tears a few fibres of the ligament or muscle, causing mild to moderate pain and swelling, which usually subside within a few days. A more forceful injury may completely tear a ligament or muscle (sometimes a ‘pop’ is heard), or it may cause bone damage such as a dislocation or fracture.

The ankle is a vulnerable joint. At times, this complex joint can transmit forces equal to three times your weight. Thus, ankle injuries (usually a ligament strain) are the most common of all joint injuries.

The most common ankle sprain is an inversion sprain – the sole of the foot turns inwards, injuring the ligaments on the outside of the ankle. Any ankle sprain can put you at risk for another since, when it heals, it leaves the ligament weakened and less flexible for some time.

Tearing the anterior cruciate ligament (ACL), which joins bones at the knee, is another common sports injury. It can happen when the knee is suddenly twisted with force. This is a serious injury that needs prompt medical attention by a doctor; it may require surgery as well as physical rehabilitation.

With proper care (R.I.C.E.D.), most ankle and knee sprains and strains heal completely without problems.

Hamstring and calf muscle strains

A muscle can tear without any damage to a joint. The hamstring and calf muscles in the back of the leg are easily torn during sprints or jumps, especially if you have not warmed up properly first. There will be pain, swelling, bleeding in the muscle and bruising. After applying R.I.C.E.D. it is important that the muscle heals completely and is at full strength before returning to sport. Supervised exercises and physiotherapy will help. If not treated properly, scar tissue can form leaving a weak spot and making future injury likely.

Pain relief

You can take over-the-counter pain relievers (analgesics) or anti-inflammatories to treat moderate muscular pain and joint pain. Your doctor can also prescribe stronger analgesics or anti-inflammatory drugs for more severe pain. The best effect from a pain relief or anti-inflammatory medication is obtained only when it is taken regularly and according to advice from your doctor or pharmacist – not just when you feel pain.

Rehabilitation

Once the pain starts to subside, rehabilitation guided by a doctor or physiotherapist may be needed to gain a full recovery. This may include exercises:

• to restore normal movement and flexibility
• to improve strength
• to restore coordination and control
• for balance
• to maintain overall fitness/healthy body weight
• to rebuild confidence
• that are specific to your sport.

A physiotherapist may also use other treatments, such as massage and ultrasound, to assist recovery. It is important, however, to make a 100% recovery before fully testing the injured part in your activity or sport.

A few tips to help avoid another injury

• improve general strength and fitness to protect joints
• improve specific sports skills and technique
• correct any muscle strength imbalances
• always do a gradual warm-up/jog before exercise
• stop if you feel any pain.

For further information on avoiding reinjury visit ACC for Smart Tips on injury prevention and sport-specific training tips.

Original material provided by UBM Medica (NZ) Ltd. Images copyright StayWell/KRAMES. This information was reviewed by the Royal New Zealand College of General Practitioners in August 2003.