At one time or another, almost all of us will suffer a strain or a sprain, most often to the “soft tissues” (muscles, tendons,ligaments) of the wrist, ankle or knee. Heavy manual labour and contact sports put you at particular risk of these injuries.
Because the two types of injury have similar names, causes, symptoms and treatments, they are often mistakenly thought to be the same injury, but of different degrees of severity. Actually, the distinction between the two depends on the type of soft tissue that’s been hurt.
Sprain or Strain?
Often, the difference between a sprain and a strain is also the difference between a trip to the doctor and management at home. Knowing what is a sprain and what is a strain helps to know what to do when injury happens.
A strain is an injury to either a muscle (which provides the power to move a joint) or a tendon (the tough, elastic tissue that attaches muscle to bone). The injury itself may be mild, moderate or severe, ranging from a mere overstretched muscle or tendon to a partial or complete tear of their fibres.
Acute strains are often seen in contact sports, typically as the result of forces experienced by a part of the body – for example, undue pressure to the hamstring muscle in the back of the thigh during sports. The muscles of the back are also susceptible to strains caused by twisting while lifting heavy objects, an injury countless numbers of people sustain on Moving Day.
Other frequent injury sites are those experienced by racquet-sport players who sustain a strain to the hand, wrist, forearm, or the elbow (so-called “tennis elbow”), as a result of tightly gripping a racquet handle while repeatedly hitting a shuttlecock or ball. If it isn’t looked after properly, this kind of injury can often become chronic.
A sprain is a stretching or tearing of a ligament (the tough, flexible bands of connective tissue that lash together two or more bones inside joints).
Sprains can occur in both the upper and lower parts of the body. One common sprain of the wrists happens when people try to brace themselves for a fall forward and land with all their weight on their hands with bent wrists. But, by far, the most frequent site is the ankle. In fact, there is no more common injury on the continent. Of the million-plus ankle injuries sustained every year in North America, some 85 percent of them are sprains. An ankle sprain usually involves landing on the side of your foot when stepping off a curb or a stair, or, worse, landing from a jump while you’re playing soccer or basketball.
A sprain may involve one or more ligaments in a joint. Indeed, the severity of the condition is determined both by the extent of injury to a single ligament (whether a tear is partial or complete) and the number of ligaments involved. Athletes are particularly prone. Among the most at risk are basketball, football and hockey players, who often plant a foot and pivot on it, sometimes exerting so much stress on the knee that it puts the knee joint out of place (usually with an audible “pop”), stretching the ligaments beyond their limits.
Signs and Symptoms
In either case – whether the injury is a strain or sprain – the symptoms are likely to be very similar.
The first signs are pain and possibly swelling. There may be bruising around the injury site as well, and in all likelihood it will be difficult to move and use the joint without causing more pain. In a lower-body injury, such as the knee or ankle, severe pain may prevent you from putting weight on the joint.
With a mild sprain or strain, there’s usually relatively little pain and swelling, and perhaps no bruising. You may be able to use the affected joint without wincing from pain, in which case it shouldn’t be necessary to see a doctor or have an x-ray taken, unless the situation is unclear.
There are signs, however, with both sprains and strains that indicate medical attention is appropriate. If you find it almost impossible to walk more than a few steps, or put any pressure on an upper-body joint, or if you can’t move the injured joint, or there’s a great deal of pain, swelling and obvious bruising, these are all indications to see a doctor.
Professional attention should also be sought if the injured area looks odd, apart from the swelling – crooked or lumpy and bumpy – a deformity that isn’t visible on the opposite, uninjured joint.
Finally, if the injured person is anxious or unsure about the seriousness of the injury or if the injury is to a joint that’s been hurt more than once before, it’s best to seek medical attention.
Whether the injury is a strain or a sprain, the treatment approach is likely to be similar. In the first 24 to 48 hours, the goal is to reduce pain and swelling, typically by following a straightforward procedure called RICE (rest, ice, compression and elevation).
Rest means just that. If at all possible, don’t use the injured joint; give it time to heal.
Applying ice (a cold pack or a bag of frozen vegetables) will help to reduce swelling, but you must be careful: Cover the ice or cold pack with a thin towel and apply it to the injured site for no more than 10 minutes at a time, with at least 10-minute intervals between applications to prevent the equivalent of frostbite or freezer burn.
Compression can be applied to the joint with an elastic bandage to help control swelling, though you must make sure the bandage isn’t so tight that it blocks blood circulation.
Elevate the injured joint to drain fluid and reduce swelling, which in turn relieves pain and speeds healing. Elevation should be done as often as possible for the first few days after injury. Ideally the injured joint should be elevated 8 to 12 inches above the level of the heart.
Moderate to severe strains and sprains may require some type of imaging (x-ray, CT scan or MRI) to see if there’s a fracture of one of the bones in the affected joint, or to determine how much the soft tissues have been stretched or torn and whether a cast is needed to stabilize the joint.
People who sustain a very severe, Grade III strain or sprain – which involves a complete soft-tissue tear or rupture – are likely to require a longer period of healing. In some cases, the patient may need to be seen by a specialist and possibly undergo further investigations. In rare cases patients with sprains may require surgery. Air casts, a 3D boot or walking cast are very useful in the treatment of all ankle sprains, including Grade III, and especially during the healing and rehab phase.
All but the mildest strains and sprains will likely require at least some rehabilitation, usually a specific set of stretching and strengthening exercises aimed at returning the injured joint to full functional ability with complete range of motion. The length of time it takes to completely recover will depend on the seriousness of the injury.
Strains and sprains that are treated usually result in a good outcome with a return to normal mobility.