Although the terms sprain and strain are used loosely and have no precise clinical definition, a sprain generally refers to an injury to a ligament – one of the tough, fibrous cords within a joint that connects the bones together – and a strain refers to muscle injury.

Sprains and strains often occur together in or near a joint, since joints absorb the stress of movement and are vulnerable to be being twisted or wrenched.  The ankle and the knee are the most common sites of such injuries.  In mild cases, the force of the injury tears a few fibres of the ligament or muscle, causing mild to moderate pain and swelling, which usually subside within a few days.  A more violent injury may completely tear a ligament or muscle and may involve bone damage such as a dislocation or fracture.

With proper care, most mild or moderate sprains and strains heal completely without complication.

The ankles are among the most vulnerable elements of the body.  These complex hinges of bone, ligament, tendon and muscle support the entire body weight and may transmit a force of impact equal to three times your weight.  Thus, ankle injuries, usually the tearing or straining of a ligament, are the most common of all joint injuries. 

The great majority of sprains are inversion sprains.  This happens when the sole of the foot turns inward, injuring the ligaments on the outside of the ankle.  Eversion injuries occur when the foot turns outward, affecting ligaments on the inner side.  Some sprains are minor and can be successfully treated at home, but many need medical attention.  An ankle sprain can put a patient at risk for another because as the injury heals, it leaves the tendon weakened and less flexible and thus more susceptible to injury.  Many sports activities place participants at risk for sprains and strains.  These injuries also often occur in normal everyday activities such as a slip on wet floors, a fall on the wrist, or jamming a finger.  Repetitive activities may also cause a sprain or strain.

Causes and Risk Factors of Sprains and Strains

Sprains and strains occur as a result of an injury, when the joint is subjected to more physical force that it can withstand.  Athletes, dancers and those who perform manual labour commonly suffer such injuries. Previous sprains may so weaken the ligaments such that recurrence is possible with only minor pressure.  The risk of sprains and strains increases with obesity and poor muscular conditioning.

Symptoms of Sprains and Strains

The symptoms of a sprain are typically pain, swelling, and bruising of the affected joint.  Symptoms will vary with the intensity of the injury; more significant ligament tears (Grade III injuries) cause an inability to use the affected joint and may lead to joint instability.   Less serious injuries (Grade I injuries) may only cause pain with movement.

Common Area of Sprains and Strains

Finger Sprain – caused by a violent overstretching of one or more ligaments that hold the finger joints together. 

Wrist Sprain – violent overstretching of one or more ligaments in the wrist joint can cause this common injury.

Knee Sprain – cause by violent stretching of one or more ligaments in the knee.  Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains.

Ankle Sprain – occurs following a sudden sideways or twisting movement of the foot.  An ankle sprain can occur during athletic events or during everyday activities.  All it takes is an awkward step or an uneven surface to cause an ankle sprain – that is why sprained ankles are among the most common orthopaedic injuries.  Orthopaedic doctors see patients for ankle sprains very often, and it is the most common foot and ankle injury.

Back Strain – commonly caused by muscle strains and lumbar sprains.  A low back muscle strain occurs when the muscle fibres are abnormally stretched or torn.  A lumbar sprain occurs when the ligaments – the tough bands of tissue that hold bones together – are torn from their attachments. Differentiating a strain from a sprain can be difficult, as both injuries will show similar symptoms.  Many doctors refer to both injuries as a category called “musculo-ligamentous injuries” of the lumbar spine.

Neck Strain – caused by injury to the muscles or tendons that attach to the vertebral column in the neck, to the skull and to the shoulder.

Groin Strain – caused by an injury to the muscles of the inner thigh.  The groin muscle, called the “adductor muscle” group, consists of six muscles that span the distance from the inner pelvis to the inner part of the femur (thigh bone).  These muscles pull the legs together, and also help with other movements of the hip joint.  The adductor muscles are important to many types of athletes including sprinters, swimmers, soccer players, and football players.

Hamstring (Thigh) Strain – often result from an overload of the muscles or trying to move the muscles too fast or from taking an impact at the back of the leg.

Treatment of Sprains and Strains

First aid measures for a sprain or strain can best be remembered by the acronym RICE – Rest, Ice, Compression, and Elevation:

Rest the injured area.  Try not to move or put pressure on the affected joint. A sling or splint may be recommended to immobilize the joint and allow damaged ligaments or muscles to heal.

Ice the affected area to reduce swelling.  After 24 hours, either ice or heat may be applied to reduce pain. 

Compress the joint by wrapping it in an Ace bandage to help reduce swelling and pain.

Elevate the joint to reduce swelling.

Over-the-counter pain relievers or stronger analgesics may be prescribed, depending on the severity of pain.  After the pain has subsided, a rehabilitation program may be implemented with the help of a physical therapist to help the joint regain strength and mobility.  In severe cases, surgery may be required to repair torn ligaments or muscles.

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