Sprains and strains

A sprain is an injury to a ligament. Ligaments are strong tissues around joints which attach bones together. They give support to joints. A ligament can be injured, usually by being stretched during a sudden pull. The ligaments around the ankle are the ones most commonly sprained. The severity of a sprain is graded into:

Grade I – mild stretching of the ligament without joint instability.

Grade II – partial rupture (tear) of the ligament but without causing joint instability.

Grade III – complete rupture (tear) of the ligament with instability of the joint.

A damaged ligament causes inflammation, swelling, and bleeding (bruising) around the affected joint. Movement of the joint is painful.

What is a strain?

A strain usually means a stretching or tearing of muscle fibres. Most muscle strains occur either because the muscle has been stretched beyond its limits or it has been forced to contract too strongly. The severity of a muscle strain is graded into:

First-degree strain – a mild strain when only a few muscle fibres are stretched or torn. The injured muscle is tender and painful, but has normal strength.

Second-degree strain – a moderate strain with a greater number of injured fibres. There is more severe muscle pain and tenderness. There is also mild swelling, some loss of strength, and a bruise may develop.

Third-degree strain – this strain tears the muscle all the way through. There is a total loss of muscle function.

What is the aim of treatment?

Usually, the damaged ligament or muscle heals by itself over time. Some scar tissue is produced where there has been a tearing of tissues. The main aims of treatment are to keep inflammation, swelling, and pain to a minimum, and to be able to use the joint or muscle normally again as quickly as possible.

What is the treatment of a sprain or strain?

For the first 48-72 hours think of:

Paying the PRICE – Protect, Rest, Ice, Compression, Elevation, and

Do no HARM – no Heat, Alcohol, Running or Massage.

Paying the PRICE

Protect the injured part from further injury. The site of the injury will determine how best to protect it.

R est the affected joint or muscle for 48-72 hours following injury. For example, consider the use of crutches for an ankle, knee or leg injury.

I ce – the cold from the ice is thought to reduce blood flow to the damaged ligament or muscle. This may limit pain and inflammation. Ice should be applied as soon as possible after injury. Wrap the ice in a damp towel and apply it to the injured area for 15-20 minutes. A bag of frozen peas is an alternative. Gently press the ice pack on to the injured part. This should be done every 2-3 hours during the day, for the first 2-3 days after the injury. (Do not put ice directly next to skin, as it may cause ice burn. Also, do not leave ice on while asleep, and do not apply it for more than 30 minutes, or it may damage the skin.)

C ompression with a bandage will limit swelling, and help to rest a joint. A tubular elastic bandage or a simple elasticated bandage is suitable for most joints. A pharmacist will advise on the correct type and size.The bandage should feel snug, but not uncomfortable or tight, and should not stop blood flow. Remove before going to sleep. You may be advised to remove the bandage for good after 48 hours, so that the joint can move. However, sometimes it is advisable to kept the bandage on for longer, to help lessen the swelling and to keep the joint more comfortable.

E levation aims to limit and reduce any swelling. For ankle and knee sprains, keep the foot up on a chair to at least hip level when you are sitting. (It may be easier to lie on a sofa and to put your foot on some cushions.) When you are in bed, put your foot on a pillow. For hand or wrist sprains, use a sling with your hand and wrist higher than your elbow.

Avoid HARM for 72 hours after injury. That is, avoid:

H eat – for example, hot baths, saunas, heat packs. Heat has the opposite effect on the blood flow to ice. That is, it encourages blood flow. So, heat should be avoided when inflammation is developing. However, after about 72 hours, no further inflammation is likely to develop and heat can then be soothing.

Alcohol drinks which can increase bleeding and swelling and decrease healing.

R unning or any other form of exercise which may cause further damage.

M assage which may increase bleeding and swelling. However, as with heat, after about 72 hours, gentle massage may be soothing.

 

Other treatments

Your doctor, nurse or physiotherapist will advise. The advice may include:

For sprains Do not stop moving the affected joint. Don’t do anything that causes much pain, but gently get the joint moving again. Sometimes it means doing gentle exercises several times a day. The aim is to get the joint moving in all normal directions, and to prevent it becoming stiff. Physiotherapy may help for more severe sprains, or if symptoms are not settling. A physiotherapist can advise on exercises and may give heat, ultrasound, or other treatments. However, you should not play sport or do vigorous exercise involving the injured joint for at least 3-4 weeks after the injury.

For strains It is best to immobilise the injured muscle for the first few days after the injury. You may be advised to use crutches in severe injuries. After a few days you can usually gradually start to use the muscle again. Again, this may be under the supervision of a physiotherapist or other health professional.