Sprain and Strain

Sprains and strains are very common problems which affects almost every individual at least once in a lifetime. An injury to the ligament (a thick fibrous tissue connecting bones) is called sprain whereas, any injury to the muscle or tendon ( a thick fibrous tissue connecting muscles to bone) is termed strain. The severity of both strain and sprain can vary from mild to severe.

In mild cases of sprain also known as first degree sprain, the affected joint is stable while pain and swelling can be there. In moderate or second degree sprain case, there exists some instability in joint along with severe pain and swelling. In third degree sprain or severe cases, the ligament completely ruptures and joint is unstable.

In mild or first degree strain cases, the tissue is torn a little causing pain but motion is not restricted. In second degree or moderate strain cases, the torn muscle or tendon tissue shows depression at the spot of injury along with swelling and problem in motion. In severe or third degree cases of strain, the movement is limited or not possible and the patient experiences severe pain in the start which may become painless afterwards.

In mild to moderate cases, rest can recover the strains and sprains but in severe cases, consult the doctor immediately.

The signs and symptoms of sprain and strain include: 

• Pain while touching the affected area.
• Pain while moving the affected part or inability to move the affected part of the body.
• Swelling due to inflammation
• Bruising 
• Numbness in the affected area.

Causes of sprain and strain vary depending on its type.

The most common type of sprain is that of the ankle joint, which is caused due to a twist in the joint beyond its normal range of motion. This can happen while walking or exercising on an uneven surface. 

Strain in the quadriceps muscle (in the upper thigh near knee joint) is also very common, which results due to quick acceleration while running or walking

Pivoting during an athletic activity, landing on an outstretched hand during a fall thumb, skiing injury or overextension when playing racquet sports, such as tennis can cause injury in the wrist resulting in sprain or strain.

A chronic strain results from prolonged, repetitive movement of a muscle. This may occur on the job or during sports, such as: Gymnastics, Tennis, Rowing Golf etc.

Other than these causes, slipping on ice, running, jumping, throwing, lifting a heavy object or lifting in an awkward position can also cause sprain or strain. 

Making a diagnosis of sprain and strain is done during physical exam and by performing several tests.

Physical inspection by a doctor reveals swelling in the soft tissue, swelling within a joint (effusion), bruising (ecchymosis), and tenderness, inability to use a muscle, or changes in joint stability. In case of sprains some deformity of a joint (third-degree strain) or appearance of a ball or knot under the skin may appear due to complete muscle tears.

Some diagnostic tests as mentioned below are also quite helpful:

1. X-ray may reveal the fracture by muscle pull.
2. Joint space can view by Arthrogram.
3. MRI helps to view integrity of muscle and ligament.

The treatment of sprains and strains will depend upon the severity of injury. In common injury self-care measure is enough but in severe cases medication and therapies are also advised by doctor. Treatments include:

• Medications: In mild cases of sprains and strains, your doctor likely will recommend basic self-care measures and an over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others). 
• Physical Therapy: Apart from medication depending upon severity a physiotherapist can help and advice exercise accordingly that can help in fast recovery of injury.
• RICE Therapy: In cases of a mild or moderate sprain or strain, you should apply ice to the area as soon as possible to minimize swelling. In cases of severe sprain or strain, your doctor may immobilize the area with a brace or splint.
• Surgery: In some cases, such as in the case of a torn ligament or ruptured muscle, surgery may be considered.

A few alternative remedies exist for sprain and strain.

In mild to moderate cases, self-care measures are very effective for recovering from sprains and strains. In first 48-72 hrs avoid heat, alcohol, massage as these promote blood flow which can result into inflammation in the injured part.

The important self care measures which are needed to be followed can be described as RICE practice that is explained below in detail:

• R-rest:   Take rest and avoid any activity that can cause pain and alleviate swelling. Splints, slings, casts, or crutches can be used as a support to the injured area. 
• I – ice:  Apply ice pack at the injured areas. It helps in reducing pain and slowing down the bleeding.
• C - compression: compressing the site of injury is helpful in preventing swelling. Elastic bandage can be used for the purpose of compression.  Use elastic bandage overnight to help in better healing but be careful to not to fold it very tightly to avoid obstruction in the blood flow.
• E - Elevation: Raise the leg (injured part) with help of pillow to heart level. In this position gravity act and help in reduce swelling.

Prevention

Regular exercise like stretching and strengthening, for your sport, fitness or work activity, as part of an overall physical conditioning program helps in minimizing  your risk of getting sprains and strains. You can protect your joints in the long term by working to strengthen and condition the muscles around the joint that has been injured. Ask your doctor about appropriate conditioning and stability exercises. Also, use footwear that offers support and protection.

Lifestyle modifications are necessary in order to cope with sprain and strain.

When you get injured, stay calm and don’t agitate much if you feel sharp pain and are unable to stand.

Follow the rice therapy to get best results in addition to any treatment given by the doctor.

You must consult a doctor to get proper diagnosis, treatment and appropriate advice.

The factors which increase the risk of a person to get sprain or strain includes:

• Participation in sports, lifting and other vigorous physical activities.
• Improper exercise or warm up.
• Walking on  an uneven surface.
• Use of uncomfortable or slippery footwear. 
• Poor muscle conditioning.