The terms sprain and strain are typically used interchangeably to describe common musculoskeletal injuries that occur around the joints as a result of a variety of activities. Common causes include improper lifting techniques, repetitive movements at work, home or school and traumatic injuries (e.g., abrupt falls with twisting or pivoting movements, etc.).
Sprain/Strain Symptoms
The common symptoms of sprains and strains are similar, which is how they are so easily confused.
-
Sprain
- Bruising
- Pain around the injured joint
- Edema (swelling)
- Limited flexibility and range of motion due to pain
Strain
- Muscle spasms
- Pain around the injured joint
- Edema (swelling)
- Limited flexibility and range of motion due to pain
The major difference with the symptoms is that there is bruising around the injured joint on a sprain, and with a strain, muscle spasms occur.
Sprains and Strains Are Different Injuries
A sprain is an overstretching or tearing of one or more ligaments and/or joint (articular) capsules. Ligaments are crisscross bands of fibrous tissue that connect one bone to another and stabilize joints. A joint capsule surrounds the synovial joint and seals the joint space. It also provides passive stability by limiting movements and active stability via its proprioceptive nerve endings.1
Sprains are classified as:
- Grade 1 (mild): slight over-stretching and a little damage to the ligament fibers.
- Grade 2 (moderate): partial tearing of the ligament with abnormal looseness (laxity) in the joint when moved in certain ways.
- Grade 3 (severe): complete ligament tear, which causes severe instability and makes the joint nonfunctional.
A strain is the tearing of muscle fibers or a tendon. Muscle fibers are the individual units that make up your muscles. Tendons are fibrous cords of tissue that connect muscles to bones.
Muscle and tendon strains are classified as:
- Grade 1 (mild): a mild disruption of the muscle fibers. There may be mild swelling, mild tenderness, and it may be painful to stretch and use the injured muscle.
- Grade 2 (moderate): moderate muscle fiber damage. The pain is moderate to severe, it definitely hurts to use and stretch the injured muscle, and ecchymosis may be present. Ecchymosis (commonly called bruising) indicates that there was internal damage to blood vessels that resulted in bleeding within and around the muscle. This bleeding is often visible under the skin as a purple, blue, red, yellow, and even green in color.
- Grade 3 (severe): complete tearing of a muscle into two pieces, or separation of the muscle from its associated tendon. There is severe pain, complete loss of muscle strength, swelling is normally present with ecchymosis, and there may be a palpable "indentation" where the muscle is torn. Medical intervention is usually necessary. Typically, an orthopaedist (musculoskeletal specialist) will evaluate your condition and surgical repair may be necessary.
Treatment for Sprains and Strains
Directly after a sprain or strain, control the swelling with RICE for 24 to 48 hours:
- Rest the injured joint/extremity and use a sling for an arm or shoulder injury or crutches for a leg or foot injury.
- Ice for 20 minutes every hour.
- Compress with an elastic Ace bandage or brace for an ankle or knee, a splint for an injured finger or buddy-taping for an injured toe.
- Elevate above the heart, if possible.
An over-the-counter acetaminophen, such as Tylenol® or non-steroidal anti-inflammatory drug (NSAID), such as Advil® may help with reducing the swelling and pain/ pressure relief. After this home treatment, be sure to have the injury evaluated by your doctor to rule out a fracture or a severe sprain or strain.
Most mild sprains and strains heal with a few days to a week. Seeing a physical therapist can also help you regain range of motion. Your physical therapist can also show you injury prevention techniques to help prevent future sprains and strains.
Moderate sprains and strains may require bracing for a period of time, followed by physical therapy to help regain normal function and range of motion. Severe sprains and strains may require surgery to repair the tear, followed by physical therapy to rehabilitate the injury.
Resource:
- Ralphs JR, Benjamin M. The joint capsule: structure, composition, ageing and disease. J Anat. 1994;184 ( Pt 3)(Pt 3):503-509.
