Sprains and strains
Sprains and strains are very common injuries that affect muscles and ligaments.
They often occur if you change direction or speed suddenly, fall and land awkwardly or collide with an object or person – such as when playing sports.
A sprain occurs when one or more of your ligaments have been stretched, twisted or torn, usually as a result of excessive force being applied to a joint.
Ligaments are strong bands of tissue around joints that connect bones to one another.
Common locations for sprains include the knees, ankles, wrists and thumbs.
Symptoms of a sprain can include:
pain around the affected joint
being unable to use the joint normally or being unable to put weight on it
The swelling from a sprain will often occur soon after the injury, but the bruising may not show until later or it may not show at all. Bruising can sometimes occur some distance from the affected joint, as blood from the damaged tissue seeps along the muscles and around the joint before coming close to the skin.
A strain occurs when muscle fibres stretch or tear. They usually occur when the muscle has been stretched beyond its limits or it has been forced to contract (shorten) too quickly.
Muscle strains are particularly common in the legs and back, such as hamstring strains and lumbar (lower back) strains.
Symptoms of a muscle strain can include:
pain in the affected muscle
muscle spasms (when the muscles contract tightly and painfully)
loss of some, or all, of the function in the affected muscle
blood collecting under the skin at the site of the strain – this is known as a haematoma, and it may look like a large, dark-red bruise
When to seek medical help
Most sprains and strains are relatively minor and can be cared for at home (see below).
However, you should visit a minor injuries unit (MIU) or your GP if you think you have a sprain or strain and:
the pain is particularly severe
you cannot move the injured joint or muscle
you cannot put any weight on the injured limb, or it gives way when you try to use it
the injured area looks crooked or has unusual lumps or bumps (other than swelling)
you have numbness, discolouration or coldness in any part of the injured area
the symptoms have not started to improve within a few days of self-treatment
These cases should be assessed by a doctor because they may indicate that your sprain or strain is severe or that you have another serious injury, such as a fracture.
How sprains and strains are treated
Minor sprains and strains can usually be treated with self-care techniques, such as PRICE therapy (protection, rest, ice, compression and elevation).
Generally, you should try to start moving a sprained joint as soon as it is not too painful to do so, whereas a strained muscle should normally be immobilised for at least a few days.
Ordinary painkillers such as paracetamol can be used to help ease any pain, although stronger medication can be prescribed if the pain is more severe.
Most people will regain full use of the affected body part within six to eight weeks, although severe injuries may take longer to heal and some people may experience persistent problems lasting several months or longer.
Preventing sprains and strains
There are a number of ways you can help to prevent sprains and strains, including:
wearing the correct footwear for different activities
warming up properly before exercise
stretching or "warming down" after exercise
doing regular strengthening and flexibility exercises
Sprains and strains often occur when playing sports
Driving after an injury
If you have a sprained ankle, avoid driving until strength and mobility has returned.
The length of time you are unable to drive for will depend on the severity of the sprain and how quickly it recovers. Your GP or physiotherapist can give you more advice.
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Causes of sprains and strains
The main causes of sprains and strains are sporting activities or accidents that involve a fall or collision.
Sprains or strains are most likely to occur if you:
change direction or speed suddenly
fall and land awkwardly
collide with an object or person
Ankle sprains can occur if you lean onto the outside of your foot. This causes your whole body weight to press down suddenly on the outer ligament of your ankle, which can stretch or tear it. Ankle sprains sometimes occur when walking or running over rough or uneven ground.
Sprains and strains often occur when playing sports, due to the physical contact and sudden acceleration and deceleration involved.
Sports injuries often occur when someone begins to take part in a sport for the first time and their muscles are not used to the physical stresses involved.
Alternatively, experienced athletes may injure themselves when they are at the peak of their training, because the increased demands on their muscles can suddenly cause them to become strained.
Competitive athletes such as sprinters, long-distance runners, gymnasts and footballers have a high risk of recurring muscle strains, due to the intense nature of their training and the overuse of specific muscle groups.
Children are also at risk of getting sports injuries because they are still developing physically. However, while there is an increased risk of injury when playing sports, it is important to remember that they also have important health benefits and can help increase a child’s confidence and self-esteem.
There are a number of things that make you more likely to develop an injury. These include:
poor conditioning – a lack of regular exercise can make your joints and muscles weaker and less flexible, which can mean they are more likely to become injured
poor technique – the way you distribute your weight when walking or running, or the way you land after jumping can increase your risk of injuring your knee or ankle
inadequate warm up – warming up before exercise helps loosen your muscles and increases your range of joint movement, thereby lowering your risk of sustaining a ligament injury; not warming up properly before exercising increases your risk of injury
fatigue – when your muscles are tired, they are less likely to provide good support for your joints, and when you are tired,
Diagnosing sprains and strains
When diagnosing a strain or sprain, your doctor will ask how you injured yourself and will perform a physical examination. In severe cases, an X-ray may be needed.
Your doctor will want to know about treatments you have already tried, as well as any medication you are currently taking that could affect the injury, such as anticoagulants (medication that reduces the ability of the blood to clot).
The affected joint or muscle will be examined to assess how severe your injury is. Your doctor will check for:
pain, discomfort and tenderness in the injured area
swelling and inflammation
any lumps and bumps not usually present
bruising or bleeding in the joint or muscle
They will also assess how much you can move the injured joint or muscle and whether you are able to put your weight on it.
If you have a severe sprain, your doctor may check whether the ligaments are loose. This is sometimes called joint instability, mechanical instability or ligamentous laxity.
Most people with sprains and strains do not need to have X-rays.
However, an X-ray may be recommended if:
you are unable to put any weight on your ankle, foot or leg
there is tenderness of the bones at specific points on your ankle, foot or leg
you have difficulty moving your knee
An X-ray may also be recommended if you are over 55 years of age and have injured your knee, because people over 55 have a higher risk of developing a fracture after this type of injury.
Treating sprains and strains
Most sprains and strains can be managed at home, using over-the-counter painkillers to ease any pain.
If the injury is only minor, you can look after yourself by "avoiding HARM" and using "PRICE therapy". These are described below.
PRICE stands for:
Protection – protect the injured area from further injury by using a support or (in the case of an ankle injury) wearing shoes that enclose and support your feet, such as lace-ups.
Rest – stop the activity that caused the injury and rest the injured joint or muscle. Avoid activity for the first 48 to 72 hours after injuring yourself. Your GP may recommend you use crutches.
Ice – for the first 48 to 72 hours after the injury, apply ice wrapped in a damp towel to the injured area for 15 to 20 minutes every two to three hours during the day. Do not leave the ice on while you are asleep, and do not allow the ice to touch your skin directly, because it could cause a cold burn.
Compression – compress or bandage the injured area to limit any swelling and movement that could damage it further. You can use a simple elastic bandage or elasticated tubular bandage available from a pharmacy. It should be wrapped snuggly around the affected area, but not so tightly that it restricts blood flow. Remove the bandage before you go to sleep.
Elevation – keep the injured area raised and supported on a pillow to help reduce swelling. If your leg is injured, avoid having long periods of time where your leg is not raised.
For the first 72 hours after a sprain or muscle strain, you should avoid HARM. This means you should avoid:
Heat – such as hot baths, saunas or heat packs.
Alcohol – drinking alcohol will increase bleeding and swelling, and slow healing.
Running – or any other form of exercise that could cause more damage.
Massage – which may increase bleeding and swelling.
Moving sprained joints
Most healthcare professionals recommend you should not stop using a sprained joint, because the injury will heal quicker if you begin to move the joint as soon as you are able to do so without experiencing significant pain.
Your doctor may be able to teach you a range of exercises that will help you improve the joint's functionality.
However, an exception may be made in cases of severe ankle sprains, because studies have found people whose ankle joint was immobilised for 10 days with a short cast recovered normal ankle function quicker than those who were treated using exercise soon after the injury occurred.
Immobilising strained muscles
The advice for muscle strains can be different. Depending on your injury, you may be advised to keep your injured muscle still for the first few days. Your doctor may arrange for a brace, cast or splint, to help keep it as still as possible.
The aim of immobilising the muscle is to allow it to start healing, so you can move it without tearing or pulling it again in the same place. After a few days you will probably be advised to start using the muscle again.
Paracetamol is usually recommended for painful sprains or strains. If this does not help, you may need an additional stronger painkiller – such as codeine – that is only available on prescription.
Your GP may also prescribe a non-steroidal anti-inflammatory drug (NSAID) cream or gel, such as ketoprofen, to help treat pain. You should gently apply the cream or gel to the injured area and wash your hands immediately afterwards.
Ketoprofen can make your skin sensitive to light (this is known as photophobia). Avoid exposing treated areas of skin to direct sunlight or artificial sources of light, such as sunlamps or sun beds, during treatment and for two weeks afterwards.
Oral NSAIDs, such as ibuprofen tablets, can also help reduce swelling and inflammation. However, they should not be used in the first 48 hours after the injury, because they may delay healing.
For more severe injuries, particularly muscle strains, your doctor may consider referring you for physiotherapy.
Physiotherapy involves carrying out exercises designed to improve the range of motion and return the normal function of injured area.
This may reduce your risk of experiencing long-term problems or injuring the area again.
The length of time it takes to recover from a sprain or strain depends on how severe it is.
Generally, after an ankle sprain you will probably be able to walk a week or two after the injury. You may be able to use your ankle fully after six to eight weeks, and you will probably be able to return to sporting activities after eight to 12 weeks.
In cases of muscle strains, the time it can take to recover can vary considerably. Some people can recover within a few weeks, whereas others may not be able to return to their normal activities for several months.
Some people may experience continued problems – such as pain, intermittent swelling or instability – for months, or even years, after the original sprain or strain.
You should contact your GP if your injury does not improve as expected or your symptoms get worse. If this happens, your GP may consider referring you to an orthopaedic specialist for further assessment and treatment.
It's uncommon for surgery to be carried out to repair sprains or strains.
Surgery is usually only required for severe muscle strains, particularly those in professional sports people. This is because, without surgery, it is likely the affected muscle will not fully regain its former strength, and the person’s performance may be affected.
For non-sports professionals and those with more minor strains, the loss of muscle strength is usually too mild, or the risk of repeated injuries too low, to justify the risks of surgery.
Surgery is rarely carried out for sprains, because it is unclear whether it is any more effective than less invasive treatments.
Preventing sprains and strains
There are several ways you can help prevent sprains and strains, such as warming up properly before exercising and wearing suitable footwear.
Strengthening and conditioning
Regular stretching and strengthening exercises as part of an overall physical conditioning programme can help reduce your risk of sprains and strains, by helping your joints stay strong and flexible.
If you are prone to sprains and strains, taping, strapping or wrapping your knees, ankles, wrists or elbows can help while you are recovering from injury and when you first get back into regular activities.
However, for most people, taping, strapping or wrapping should only be a short-term protective measure. You can protect your joints in the long-term by strengthening and conditioning the muscles around them.
Wearing appropriate footwear
You should always make sure you wear footwear that supports and protects your feet and ankles, whether you are at work, home or doing sport.
The specific type of shoe you should wear will depend on the activity you are doing, but you should make sure that all the shoes you do wear are in good condition. For example, you should avoid shoes that have a worn heel on one side, as they may increase your risk of injury.
If you wear high-heeled shoes, you are more likely to sprain your ankle than if you wear flat shoes.
You can help prevent sprains and strains by following the advice listed below:
Warm up properly before you exercise, and cool down properly afterwards
Avoid exercising or doing sporting activities when you are tired
Take precautions against falling – keep stairs, walkways, gardens and driveways free of clutter, and in winter put sand or salt on icy spots outside your home
Avoiding running or walking on uneven surfaces
Eat a healthy, balanced diet to help keep your muscles strong