Medical Mondays: Sprains & Strains -- January 9, 2012 -- Dr. Jim - | Nashville News, Weather & Sports

Medical Mondays: Sprains & Strains -- January 9, 2012 -- Dr. Jim Johnson

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Monday, January 9, 2012
TOPIC: Sprains and Strains
Jim Johnson, MD: sports medicine physician

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Understanding Sprains and Strains

Sprains and strains are the most common injury experienced by athletes as well as by people in the workplace. Many people use these terms interchangeably to describe everything from a twisted ankle to a pulled hamstring, but they are two specific injuries.

  • A sprain is a stretch or tear in a ligament (the bands of fibrous tissue that connect our bones at the joints).
  • A strain is also a stretch or tear, this time affecting the muscle itself or a tendon (the tissue that connect the muscles to the bones).

Given adequate time and rest, most sprained joints or strained muscles will heal themselves. But severe tearing or complete rupture of the affected tissues usually requires surgical repair. And damage caused by a sprain can leave the bones in the affected joint improperly aligned, or the ligaments so stretched and weakened that the joint is particularly vulnerable to future injury.

How Does a Sprain or Strain Occur?

Anything that places sudden or unaccustomed stress on joints or muscles may cause a sprain or strain. Chronic overuse of a joint can lead to stretching of ligaments, chronic inflammation, or chronic irritation of a muscle tendon. Falls, lifting heavy objects, and the exertion of an unfamiliar sport are common culprits. Being overweight, inactive, or in poor physical condition boosts the likelihood of injury. Improperly warming up and not stretching muscles before intense physical activity can also result in injury.

Sprains usually happen when a person falls, twists, or is hit in a way that forces the body out of its normal position. The most common type of sprain is a sprained ankle; about 25,000 people sprain an ankle every day. Think of a runner who goes over a curb and catches her foot, twisting the ankle; or a baseball player who slides into home plate and twists his knee.

Wrist and thumb sprains are also common, particularly in sports like skiing, where it's not unusual to fall and land on an outstretched palm.

Strains happen when a person twists or pulls a muscle or a tendon. Athletes in contact sports, like football, hockey, and boxing, are at particularly high risk for strains. Frequent repetitive motions, like those used in tennis, rowing, and golf, can lead to strains of the hand and forearm.

In the workplace, people at particular risk for sprains and strains are those who engage in frequent heavy lifting, which can include everyone from construction workers and laborers to warehouse workers, nurses, and physical therapists.

How Can You Detect a Sprain or Strain?

The signs of most sprains or strains are very similar: pain and inflammation, and sometimes bruising, at the injured area. Depending on the severity of the sprain or strain, the pain may be mild, moderate, or severe.

The more severe the sprain or strain, the more difficult it is to use the affected area. Someone with a mild ankle sprain may just favor that ankle slightly, while a more severe ankle sprain may cause much more pain and make it difficult or impossible to walk.

Sprains are graded on a scale of I to III:

  • Grade I is stretching of the ligament or a very mild tear, with little to no instability at the joint.
  • Grade II is a more serious but still incomplete tear.
  • Grade III is a completely torn or ruptured ligament. This is not a broken bone, but can feel like one since it is often impossible to put weight on the joint or use the affected limb.

Most people with mild sprains and strains can treat these injuries at home with the use of RICE care (see below). But more severe sprains and strains should be seen by a doctor. The doctor may take an X-ray to look for a fracture, or other testing to determine the degree of severity of the sprain or strain.

Even if there is no fracture, additional treatment may be required, such as an ankle cast and/or crutches for a severe ankle sprain. In some cases, a sprain or strain is so severe that surgery is necessary to repair the torn ligament or tendon. Physical therapy and rehabilitation exercises are often recommended.

Although the degree of pain and swelling are usually the best indicators of how severe a sprain or strain is, this is not always the case. Some injuries, like Achilles tendon tears, may cause only mild pain at first, but are actually more severe. If the pain and swelling do not begin to subside within 24-72 hours, or if your symptoms actually get worse, see a doctor promptly.

Treating Sprains and Strains

The gold standard of care for sprains and strains is known as RICE therapy. RICE stands for:

Rest: Don't put weight on the injured area (this includes not lifting with an affected wrist or elbow) for 24-48 hours, to guard against aggravating the injury further. If you physically cannot put weight on an injured knee or ankle, see your doctor.

Ice: Put a bag of ice on the injured area for 10 minutes at a time, and then take it off for about 20-30 minutes over the course of the first 24-48 hours. Ice should not be applied directly to the skin. The cold constricts blood vessels and slows down the inflammatory process, easing pain and swelling. Too much time can cause injury, however, so don't leave the bag on too long.

Compression: You can either wrap an injured wrist, ankle, knee or elbow in an elastic bandage, or buy a compression sleeve at any drugstore. Like ice, compression helps to decrease swelling.

Elevation: By placing the injured area on a pillow and elevating it above the level of your heart, you keep fluid from collecting in the area and decrease swelling.

RICE therapy is particularly important during the first 24-72 hours after a sprain or strain occurs. During this time, you can also take medication to alleviate pain if you wish.

As your pain and swelling subsides, you can decrease the RICE therapy, beginning to use the affected area again and applying the ice and compression less frequently (often at the end of the day, as swelling and pain tend to flare up after use).


Orthopaedists often note that many people make the mistake of being either too eager to rush back into athletic activities after a sprain or strain, or resting the injured area too long. If you do too much too soon, you can reinjure the area; if you stay immobile, the scar tissue that forms when any tissue is injured can lead to impaired mobility.

Instead, it is best to pursue a program of gradual rehabilitation. Your doctor or a physical therapist can recommend certain exercises that can help you get back to your normal activities at a measured, safe pace. For example, if you've sprained your ankle, you may begin by walking slowly on a flat treadmill, then move to an incline, then begin to jog. Someone with a sprained wrist may begin with range-of-motion exercises, and then move on to lifting very light weights.

You can expect some discomfort during rehabilitation, but a sudden flare-up of severe pain is a signal to take a step back and move more cautiously. Healing depends a lot on the individual, but for most mild to moderate sprains and strains, you can expect to regain full mobility within three to eight weeks; more severe injuries can take months for a full recovery.


The goal of treatment for sprains and strains is the return to the level of function that the person had before the injury. This means that the expectation is for the injury to completely heal. The time frame for recovery depends on the severity of the injury. It may take just a few days for a slight sprain of an ankle to heal, or it may take months for a knee that has to be surgically reconstructed.

Perhaps the most important therapy for all injuries is rehabilitation. This may be a home exercise program that your doctor outlines, or it may be a formal physical therapy program. You should have an understanding before leaving the office or hospital of what work is expected to rehabilitate the injury. Ask the following questions:

  • What limitations are there for activity and work?
  • What is the time frame for recovery?
  • When is it safe to return to full activity?
  • When should a reevaluation be scheduled?

Preventing Exercise Sprains and Strains

There are many things people can do to help lower their risk of sprains and strains:

  • Avoid exercising or playing sports when tired or in pain.
  • Maintain a healthy, well-balanced diet to keep muscles strong.
  • Maintain a healthy weight.
  • Practice safety measures to help prevent falls (for example, keep stairways, walkways, yards, and driveways free of clutter; anchor scatter rugs; and salt or sand icy patches in the winter).
  • Wear shoes that fit properly.
  • Replace athletic shoes as soon as the tread wears out or the heel wears down on one side.
  • Do stretching exercises daily.
  • Be in proper physical condition to play a sport.
  • Warm up and stretch before participating in any sports or exercise.
  • Wear protective equipment when playing.
  • Run on even surfaces.
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