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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.

CURE YOUR ANKLE LIGAMENT INJURY TODAY. CALL +65 6471 2744 For Appointment or SMS to 92357641

Sprained Ankle

If a sprained ankle is left untreated, if you engage in activities too soon after spraining your ankle or if you sprain your ankle repeatedly, you may experience the following complications:

  • Chronic pain
  • Chronic ankle joint instability
  • Early-onset arthritis in that joint

During the physical exam, your doctor will check for points of tenderness. He or she will move the joint in a variety of ways to check your range of motion and to see if any particular position or movement causes pain.

If the injury is severe, your doctor may recommend one or more of the following imaging scans to rule out a broken bone or to more precisely evaluate the soft tissue damage:

  • X-ray. During an X-ray, a small amount of radiation passes through your body to produce images of your internal structures. This test is good for evaluating bones, but is less effective at visualizing soft tissues. Tiny cracks or stress fractures in bones may not show up, especially at first, on regular X-rays.
  • Bone scan. For a bone scan, a technician will inject a small amount of radioactive material into an intravenous line. The radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas show up as bright spots on an image taken by a scanner. Bone scans are good at detecting stress fractures.
  • Computerized tomography (CT). CT scans are useful because they can reveal more detail about the bones of the joint. CT scans take X-rays from many different angles and combine them to make cross-sectional images of internal structures of your body.
  • Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed images of internal structures. This technology is exceptionally good at visualizing soft tissue injuries.

Treatment for a sprained ankle depends on the severity of your injury. Many people simply treat their injury at home.

Medications
In most cases, over-the-counter pain relievers — such as ibuprofen are enough to handle the pain caused by a sprained ankle.

Therapy
A few days after your injury, after the swelling has gone down, you may want to see a physical therapist and start performing exercises to restore your ankle’s range of motion, strength, flexibility and balance.

Balance and stability training is especially important to retrain the ankle muscles to work together to support the joint. These exercises may involve various degrees of balance challenge, such as standing on one leg.

If you sprained your ankle while exercising or participating in a sport, talk to your doctor about when you can begin your activity again. You may need to wear an ankle brace or wrap your ankle to protect it from re-injury.

Surgical and other procedures
If your ankle joint is unstable, your doctor may refer you to a joint specialist for evaluation. You may need a cast or walking boot to immobilize your joint so that it can heal properly. In rare cases of severe ligament tears, or if you are an elite athlete, you may need surgery to repair the damage.

For immediate self-care of an ankle sprain, try the R.I.C.E. approach:

  • Rest. Avoid activities that cause pain, swelling or discomfort. But don’t avoid all physical activity. Instead, give yourself relative rest. With an ankle sprain, you can usually still exercise other muscles to prevent deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on a footrest. That way you still exercise three limbs and keep up your cardiovascular conditioning.
  • Ice. Even if you’re seeking medical help, ice the area immediately. Use an ice pack or slush bath for 15 to 20 minutes and repeat every two to three hours while you’re awake, for the first 48 to 72 hours. Cold reduces pain, swelling and inflammation in injured muscles, joints and connective tissues. It also may slow bleeding if a tear has occurred. If the area turns white, stop treatment immediately. This could indicate a cold injury. If you have vascular disease, diabetes or decreased sensation, talk with your doctor before applying ice.
  • Compression. To help stop swelling, compress the ankle with an elastic bandage until the swelling stops. Don’t wrap it too tightly or you may hinder circulation. Begin wrapping at the end farthest from your heart. Loosen the wrap if the pain increases, if the area becomes numb or if swelling occurs below the wrapped area.
  • Elevation. To reduce swelling, elevate your ankle above the level of your heart, especially at night. Gravity helps reduce swelling by draining excess fluid.

Prevention

Take the following steps to help prevent a sprained ankle:

  • Warm up before you exercise or play sports.
  • Be careful when walking, running or working on an uneven surface.
  • Wear shoes that fit well and are made for your activity.
  • Don’t wear high-heeled shoes.
  • Don’t play sports or participate in activities for which you are not conditioned.
  • Maintain good muscle strength and flexibility.
  • Practice stability training, including balance exercises.

CURE YOUR ANKLE SPRAINED TODAY. CALL +65 6471 2744 OR SMS TO +65 92357641 FOR APPOINTMENT

Don’t Ignore Ankle Sprained

Ankle sprain is a common injury in Singapore athletes as well as the active adult. Most of the time, the ankle heals with a little care (rest, taping, ice). But one rare complication of lateral ankle sprains is a condition called peroneal tendon instability.

A lateral ankle sprain means the side of the ankle away from the other leg is sprained. The two peroneal tendons go down the leg and around the back of the ankle bone. The tendons set down inside a tunnel formed by bone and connective tissue called the retromalleolar groove. A fibrous band (the superior peroneal retinaculum) goes across the tendon to hold them in the groove.

When this fibrous retinaculum is ruptured, the tendons can dislocate or pop out of the groove. The result is persistent pain along the outside aspect of the ankle bones. There may be a painful popping or snapping sensation.

Swelling may mask the symptoms of tendon displacement at first. It’s only weeks to months later when the painful symptoms don’t go away that the additional tendon damage is recognized. Early MRIs may not show peroneal tendon instability, especially if the tendon pops in and out of the groove spontaneously.

A relaxed tendon is more likely to remain in the groove. Any active movement of the ankle will force the tendon out of its protective tunnel. If the ankle is relaxed and the tendon is repositioned correctly at the time of the imaging study, then diagnosis can be delayed. Dynamic ultrasound tests are the best diagnostic tests because they will reveal the movement of the unstable tendon.

Since this problem is rare, not much is known about the best way to treat it. Conservative (nonoperative) care is only possible when the unstable tendons can reposition inside the retromalleolar groove. A cast or boot placed on the lower leg will give the tendon a chance to heal.

If conservative care is unable to achieve a stable gliding tendon or if the tendon displacement is unstable from the start, then surgery is necessary. There are several different surgical options to consider. The fibrous protective sheath (retinaculum) can be reinforced or reconstructed. The groove can be reshaped (deepened) and rebuilt. The surgeon must be careful not to destroy or disrupt the smooth gliding surface of the bone that helps form the retromalleolar groove.

The retinaculum is repaired or reconstructed depending on the severity of the damage. Incision shape, drill holes, suture type and placement, and method for protecting the groove surface are discussed. Photos of each step in the surgical procedure are provided.

In summary, traumatic displacement of the peroneal tendons is a rare but painful complication of some lateral ankle sprains. Pain and swelling may mask the presence of this problem at the time of the injury with a delayed diagnosis. A careful examination with tenderness palpated over the torn retinaculum is the best way to accurately identify the injury. Treatment is usually surgical with the surgeon’s own preferred treatment presented.

Treat Your Ankle Sprained today! Call +65 6471 2744 for Appointment or SMS to +65 9235 7641

Sprained Ankle

A sprained ankle occurs when a ligament is injured through stretching or a sharp pull. Ligaments are strong bands of tissue that connect one bone to another and help to hold joints together.

A sprained ankle, or twisted ankle, is the most common type of soft tissue injury. Soft tissue means any tissue in your body that isn’t bone. Around 1.5 million people go to UK accident and emergency departments each year with severe sprained ankles.

A minor sprain is when a ligament is stretched or partially torn. In severe sprains the ligament is completely torn. Sometimes the end of the bone to which a ligament is attached can crack or be pulled off. This is called an avulsion fracture.

Symptoms of Sprained Ankle

When you sprain your ankle there is sometimes a snapping or popping sound and a feeling of ‘giving way’ – this could be a ligament tearing or a bone cracking. A sprain can be very painful with the pain getting worse when you move your ankle. With a severe sprain you may not be able to put weight on your leg.

You may have swelling and bruising. Swelling happens soon after the injury but bruising can take up to 24 hours to fully develop. The swelling around your ankle can make it difficult to move your foot and your ankle may feel unstable.

Causes of a sprained ankle

The most common type of ankle sprain is when the sole of your foot turns inwards, overstretching the ligaments on the outside of your ankle and squeezing those on the inside. This is called an inversion sprain.

Ankle sprains make up about a quarter of all sporting injuries. They are especially common in sports that involve running and jumping, landing from a jump, changing direction quickly, or lots of stop-starts.

Other causes include:

  • walking on irregular surfaces
  • your foot slipping off the edge of a kerb
  • slipping while going up or down stairs
  • losing your balance while wearing high heels

You’re more likely to sprain your ankle if it has happened before.

Treatment of a sprained ankle

The treatment you receive will depend on how severe your injury is.

Self-help

Follow the PRICE procedure as soon as possible after injuring your ankle. PRICE stands for the following.

  • Protection. Protect your ankle from further harm, for example, by using a support or high-top, lace-up shoes.
  • Rest. Try to rest your injury for the first 48 to 72 hours. Use crutches to help you get around if you need to. After this time, gradually re-introduce movement to the affected area.
  • Ice. Apply ice packs or ice wrapped in a damp towel for 15 to 20 minutes every two to three hours. Never apply ice directly to your skin as it can give you an ‘ice burn’ – always place a cloth between the ice and skin. If you have no ice to hand, you could also use a bag of frozen peas or immerse the area in iced water. This will help to reduce any swelling and bruising. You should try to apply ice for the first 48 to 72 hours after your injury but only when you’re awake – never leave ice on while you sleep. Also, don’t use ice if you have skin disorders that make your skin sensitive.
  • Compression. Compress the area by bandaging it to support the injury and help decrease swelling. You can use a simple elastic bandage to do this or an elasticated tubular bandage. It should fit snugly but not be too tight. Make sure you remove the bandage before going to sleep.
  • Elevate. Elevating your ankle above the level of your heart will help to control the swelling. Use a pillow to keep the area raised. Try to keep it elevated as much as possible until the swelling goes down.

It’s important to begin gentle flexibility exercises within 48 to 72 hours of injury as long as it doesn’t cause excessive pain – this will help your injury to heal more quickly. It will also help you regain the full range of motion in your ankle.

You could try the following exercises.

  • Move your foot up and down as though pressing on a car pedal.
  • Make circles with your foot, both clockwise and anti-clockwise.
  • In either a sitting or a standing position, shift your weight from front to back and from the inside to the outside of your foot.
  • Stretch your Achilles tendon (without putting weight on it) – you can do this by using a belt to pull your toes up towards you.

It’s important to see your GP or a physiotherapist if:

  • you can’t walk more than four steps on the affected ankle immediately after you injure it
  • your ankle remains extremely painful or swollen after four days of self-treatment
  • you have a lot of pain, redness or swelling over a bony area of your foot
  • you have lumps and bumps that aren’t usually there
  • your ankle feels numb

If possible, see a physiotherapist who can advise you on exercises to restore the range of movement in your ankle. Your risk of injuring your ankle again is very high if you don’t get the correct treatment.

Medicines

You can take paracetamol to help reduce pain and swelling. However, don’t take tablets that contain a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, or use creams or gels that contain NSAIDs until 48 hours after you injure your ankle. These will reduce inflammation, which is an important part of the healing process.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Surgery

Surgery to treat a sprained ankle is rare and usually only done if your ankle remains unstable. Surgery can repair torn ankle ligaments, but there isn’t enough evidence to say whether this is better than keeping your ankle in a cast, or keeping your ankle moving and wearing a support brace. Your doctor may recommend surgery for torn ankle ligaments that aren’t getting better.

After your treatment

Following a sprain or a strain, the length of time that it takes for you to recover will depend on how severe your injury was. The pain and swelling should begin to subside after a few days. At this point, try to move your ankle more than you have been able to. If you’re using a brace or taping, take this off after two days because it limits movement. Instead use a compression bandage that doesn’t restrict movement as much.

Exercises to strengthen your muscles are important because they will help your recovery. They will also make your ankle more stable, helping to prevent another injury. Try to increase how far you move your ankle each day but take care not to cause more pain.

There is evidence suggesting that a below-knee cast or brace worn for 10 days for a severe sprain may speed up the healing process compared with an elasticated bandage that allows movement.

The time it takes for you to recover fully will depend on the severity of your injury.

Prevention of a sprained ankle

There are measures you can take to help reduce your risk of spraining your ankle again.

  • A brace or taping can support your ankle in the short term if your injury is severe but try to strengthen the muscles around your ankle through exercise to give it more long-lasting support. See a physiotherapist as soon as possible after injuring your ankle to get advice about the sort of exercises that will help.
  • Wear footwear that supports your ankle.
  • Don’t wear shoes that are worn on one side and take care when wearing high heels.
  • Try to keep stairs and hallways clear.
  • Don’t exercise if you’re tired – your muscles will be tired too and offer less support to your joints. Injuries can occur as a result of being tired from playing sport or doing strenuous activity.
  • Do strength and endurance training before the season begins if you’re a competitive sportsperson.
  • A recent study showed that doing balancing exercises can cut your risk of spraining your ankle again. A physiotherapist can advise you on these and how to advance them as your ankle gets stronger.

To schedule an appointment to treat your ankle sprained / for second opinion / to get your ankle checked, please call us at +65 6471 2744 or SMS to +65 9235 7641