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Ligament and Muscle Damage (Managing Sprains and Strains)

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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Medical Collateral Ligament (MCL)

The medial collateral ligament (MCL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. The four major stabilizing ligaments of the knee are the anterior and posterior cruciate ligaments (ACL and PCL, respectively), and the medial and lateral collateral ligaments (MCL and LCL, respectively).

The MCL spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. The MCL resists widening of the inside of the joint, or prevents “opening-up” of the knee.

MCL Injuries

Because the MCL resists widening of the inside of the knee joint, the ligament is usually injured when the outside of the knee joint is struck. This force causes the outside of the knee to buckle, and the inside to widen. When the MCL is stretched too far, it is susceptible to tearing and injury. This is the injury seen by the action of “clipping” in a football game.

An injury to the MCL may occur as an isolated injury, or it may be part of a complex injury to the knee. Other ligaments, most commonly the ACL, or the meniscus, may be torn along with a MCL injury.

Symptoms of MCL Tears

The most common symptom following an MCL injury is pain directly over the ligament. Swelling over the torn ligament may appear, and bruising and generalized joint swelling are common 1 to 2 days after the injury. In more severe injuries, patients may complain that the knee feels unstable, or feel as though their knee may ‘give out’ or buckle.

Symptoms of a MCL injury tend to correlate with the extent of the injury. MCL injuries are usually graded on a scale of I to III.

  • Grade I MCL Tear
    This is an incomplete tear of the MCL. The tendon is still in continuity, and the symptoms are usually minimal. Patients usually complain of pain with pressure on the MCL, and may be able to return to their sport very quickly. Most athletes miss 1-2 weeks of play.
  • Grade II MCL Tear
    Grade II injuries are also considered incomplete tears of the MCL. These patients may complain of instability when attempting to cut or pivot. The pain and swelling is more significant, and usually a period of 3-4 weeks of rest is necessary.
  • Grade III MCL Tear
    A grade III injury is a complete tear of the MCL. Patients have significant pain and swelling, and often have difficulty bending the knee. Instability, or giving out, is a common finding with grade III MCL tears. A knee brace or a knee immobilizer is usually needed for comfort, and healing may take 6 weeks or longer.

Treatment of MCL Tears

Treatment of an MCL tear depends on the severity of the injury. Treatment always begins with allowing the pain to subside, beginning work on mobility, followed by strengthening the knee to return to sports and activities. Bracing can often be useful for treatment of MCL injuries. Fortunately, most often surgery is not necessary for the treatment of an MCL tear.

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