Strains and sprains are common injuries - a strain affecting a muscle or tendon, and a sprain being to a ligament and joint capsule - usually caused by overstretching, twisting, or trauma to the affected area.
Strains and sprains can be painful and affect mobility, and treatment and healing times can vary depending on the type and severity of the injury.
This blog provides a helpful overview of what sprains and strains are, how they happen, and what you should do about them!
What do the terms ‘Sprain’ & ‘Strain’ mean?
The term sprain and strain are used all the time and both mean a pull or tear in a body structure. The only difference is that a strain refers to a tear or stretch in a muscle, whereas a sprain refers to a tendon, which are taught band like structures that attach muscle to bone.
How do they happen?
Muscle strains usually occur when the muscle is either suddenly overloaded or over stretched. A common example is a strain to a footballer’s hamstring, which often happens when they forcefully kick the ball. Sprains on the other hand will usually occur from a fall or sudden twist or hit that puts the tendon in a sudden unusual position. Take for example a common ankle sprain which usually happens after you twist or put your weight on your ankle in an awkward position.
Muscle strains & sprains - grades
Strain and sprain injuries are graded depending on their severity (1):
Grade 1 - The signs may not be present until after the activity is over. You may feel a muscle cramp or tightness and a slight pain when the muscle is either stretched or contracted. You will have full strength and will be able to move the muscle through all of it’s usual range of motion.
Grade 2 - You will have immediate pain. You will have more pain when stretching or contracting the muscle and it will usually be sore to touch. You will also notice swelling, possible bruising and a decrease in muscle strength.
Grade 3 - This is a very serious injury. There is an immediate burning or stabbing pain. With a grade 3 strain the muscle is completely torn and you will be unable to move the muscle. Bruising will appear below the injury site.
strains & Sprains Treatment
The initial management for both strains and sprains are the same, although, depending on the grade of injury, treatment may vary.
It usually advised that you follow the PEACE & LOVE Protocol (2).
PEACE is used in the first few days, followed by LOVE during your active recovery.
The PEACE stage consists of:
Protection - Protect your muscle or joint. Don’t do any heavy or strenuous activity and try avoid any movements that aggravate the pain.
Elevation - Try to elevate your injured body part, this helps reduce swelling. For example, if you hurt your knee have your leg resting up on a few pillows while you lie in bed or sit on the couch.
Avoid anti-inflammatories - In order to optimise your healing try to avoid taking anti-inflammatories such as ibuprofen or diclofenac. Try to also avoid icing unless you really need it for pain relief.
Compression - You can use taping or a compression bandage around the area to reduce swelling.
Education - Listen to your body and physiotherapist and this will guide you to the optimal treatment.
After a few days you can begin the next part of your recovery, LOVE:
Load - Try to begin using your injured body part as soon as pain allows and return to your usual activities so long as the pain is tolerable.
Optimism - Try to avoid negative thoughts about your injury. Have faith that your body will heal itself with time and you will return to full health and function.
Vascularisation - Do aerobic exercise such as walking or cycling as soon as pain allows. This increases blood flow to the injured tissues and speeds up healing.
Exercise - Doing the correct rehabilitation exercise will restore your full strength and function and reduce the likelihood of the injury happening again.
(3)
When to see a physio
Physiotherapy can be started as soon as 48 hours post injury. Prior to this, the physiotherapist will be limited in treatments that can be safely applied. After 48 hours if you go to your local physio they will be able to provide you with an individual assessment and guide you to a safe recovery with advice, manual therapy and targeted exercises.
Signs to watch out for
If you hurt your ankle and are unable to stand on your leg with the injury and feel excruciating pain deep within your ankle or midfoot you may need to get an x-ray. Also, if you hurt your knee and have pain specifically behind your knee cap, are unable to bend the knee to a 90 degree angle, or are unable to take more than 4 steps even with limping, you may also need an x-ray. If you have these symptoms immediately after your injury you should make your way to the A&E where you can be further assessed (4,5).
Conclusion
In conclusion, if you do get a muscle strain or strain, try to follow the simple PEACE & LOVE protocol. If you have minimal pain and full strength and stability, do not worry and give your body a chance to heal itself for a few days. However, if your injury seems more severe, don’t hesitate to contact a physiotherapist so that they can provide you with appropriate advice and give you an individualised treatment plan.
If you need to get treated for a strain or sprain, you can book an appointment with one of our Chartered Physiotherapists here.
References:
Mueller-Wohlfahrt, H.W., Haensel, L., Mithoefer, K., Ekstrand, J., English, B., McNally, S., Orchard, J., van Dijk, C.N., Kerkhoffs, G.M., Schamasch, P. and Blottner, D., 2013. Terminology and classification of muscle injuries in sport: the Munich consensus statement. British journal of sports medicine, 47(6), pp.342-350.
Dubois, B. and Esculier, J.F., 2020. Soft-tissue injuries simply need PEACE and LOVE.
Bachmann, L.M., Kolb, E., Koller, M.T., Steurer, J. and ter Riet, G., 2003. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. Bmj, 326(7386), p.417.
Emparanza, J.I. and Aginaga, J.R., 2001. Validation of the Ottawa knee rules. Annals of emergency medicine, 38(4), pp.364-368.