Sprains & Strains: What They Are and What to Do About Them
Sprains & Strains: What They Are and What to Do About Them
We have all twisted an ankle or pulled a muscle at some time. but many of us are not sure what to do when this happens. This handout discusses these basic types of injury and information regarding injury first aid and rehabilitation.
A sprain is an injury to a joint ligament. Ligaments are the strong bands of tissue that connect one bone to another at a joint. The severity of the injury can be classified by the amount of tissue tearing, joint stability, pain, and swelling. The mildest sprain (first degree) has little tearing, pain, or swelling and joint stability is good. The second-degree sprain has the broadest range of damage, with moderate instability and moderate-to-severe pain and swelling. The most serious sprain is a third-degree sprain. The ligament is completely ruptured and the joint is unstable. There may be no pain. There will be a lot of swelling with this type of sprain, and often other tissues are damaged.
A strain is damage to muscle fibers and to the fibers that attach the muscle to the bone. Other names for a strain include "torn muscle," "muscle pulls," and "ruptured tendon." Muscle injuries are classified from first- (lease severe) to third- (most severe) degree strains. A first-degree strain has little tissue tearing, mild tenderness, and pain with full range of motion. As with the sprains, the second-degree strain has a wide variability. Muscle or tendon tissue have been torn, resulting in very painful, limited motion. There may be some observable swelling or a depression at the spot of the injury with a second-degree strain. The third-degree strain involves complete rupture of a part of the muscle unit. Motion will be severely decreased or absent. Pain will be severe at first, but the muscle may be painless after the initial injury.
There are several decisions that you must make when you injure yourself. Among the first of these is how serious the injury is and whether you should go to a health care provider. Look for deformities, swelling, and changes in skin color. If there are deformities, significant swelling, or pain, you should immobilize the area and seek medical help. Many fractures will not cause a deformity; thus, if there is any doubt or concern you should get medical attention.
Management of both sprains and strains follows the "PRICE" principle:
P = Protect from further injury
R = Restrict activity
I = Apply ice
C = Apply compression
E = Elevate the injured area
This principle limits the amount of swelling at the injury and improves the healing process. Splints, pads, and crutches will protect a joint or muscle from further injury when appropriately used (usually for more severe sprains or strains). Activity restriction (usually for 48-72 hours) will allow the healing process to begin. During the activity restriction, gentle movement of the muscle or joint should be started. Ice should be applied for 15-20 minutes every hour to hour and a half. Compression, such as an elastic bandage, should be kept on between icing; you may want to remove the bandage while sleeping, though keeping it compressed even during the night is best. Elevating the limb will also keep the swelling to a minimum. Acute treatment is the first stage of rehabilitation.
Following the first 48-72 hours, it is important to start the next stage of rehabilitation. The second stage of rehabilitation focuses on gentle movement of the muscle or joint, mild resistive exercise, joint position training, and continued icing. When you are able to move without pain, you can progress to the next stage of rehabilitation. During this stage you may gradually return to more strenuous activities, such as strengthening. A simple guide to how much you can do is pain. Pain should remain low during rehabilitation; if pain increases it usually means you have attempted to do too much.
Throughout your recovery you can still maintain an aerobic training program. Options for training include stationary bicycling, swimming, walking, or running in water. If the injury is more than a mild sprain or strain, it is best to consult your health care provider.
Important: If you suspect more than a mild injury, cannot put weight on the limb, or it gives way, you should consult a health care provider.
Reprinted with permission from: The American College of Sports Medicine, "Sprains & Strains: What They Are and What to Do About Them," written by Lynn Millar, PhD, PT, FACSM.
Healing time depends on site, severity, and type of injury. for example, a mild ankle sprain may heal in 2-4 weeks, while a fracture of the leg may take 8-12 weeks. However, healing usually proceeds in certain stages.
- Swelling and pain decreases or disappears in the first 24-72 hours.
- Discoloration (bruising) usually subsides within 10-14 days.
- Range of motion increases over 7-14 days, although stiffness and weakness may persist.
When an injury occurs, it may result in weakness due to tissue damage and disuse, in addition to decreased control over the damaged body part. Regaining strength and coordination of the injured body part should be considered part of the rehabilitation and healing process, and an injury should not be considered healed until this process is accomplished. Attempting to return to an activity before proper healing of the injury puts you at risk for reinjury or an additional injury. Consultation with a sports medicine professional may aid in the initial treatment and rehabilitation and the determination of when to return to play.
Reprinted with permission from: The American College of Sports Medicine, "Return to Play: A Common Sense Guide for Coaches," written by Lawrence M. Magee, MD, FACSM.Sprains & Strains: What they are and what to do about them. Altern Med Alert 2006;9(1):S1-S2.
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