Sprains and strains

Sprains and Strains are common ailments which many people don’t completely understand.

A SPRAIN is any injury to a ligament, which is the fibrous tissue that joins the end of one bone with another. Ligaments stabilize and support the joints of the body. (The ACL supports the upper leg to the lower leg). In a sprain, one or more ligaments are stretched or torn. A STRAIN is classified as any injury to a muscle and/or tendon, which is the fibrous tissue that connects muscle to bone (The Achilles tendon attaches the calf muscle to the foot bone). In a strain, a muscle or tendon is stretched or torn. Strains and sprains are classified as Grade I, Grade II, or Grade III.

SPRAINS occur due to direct, and occasionally indirect trauma, which forces a joint out of its normal position and causes overstretching and/or rupture of the supporting ligaments. Many things can cause a sprain and force a joint out of its normal position, such as automobile accidents, twisting the ankle or a sudden blow to the knee. The usual signs and symptoms of a sprain are: inflammation, pain, swelling, bruising and sometimes the loss of joint function. Occasionally patients feel a pop or tear when the injury occurs. With a grade I sprain, the fibers of the ligament are stretched, but still intact. A grade II sprain involves tearing, which can involve one third to almost all of its fibers. Third degree sprains involve complete rupture of the ligament, sometimes avulsing a piece of bone as well.

STRAINS are caused by over stretching and tearing of the muscle fibers. Strains can happen suddenly in athletes or it may take days or sometimes even weeks to develop. An example of this is a rotator cuff injury. Strains are typically associated with lifting heavy objects incorrectly and  athletes overstressing the muscles (weekend warriors). Strains are more likely to happen to a muscle that is weak, inflexible, tired, or one that has not been properly warmed up before exercise. A Grade I strain involves mostly stretching and limited tearing of the muscle fibers. There is some discomfort when you use the muscle, but there is usually little loss of strength. A person with a mild strain can often continue activity, but may have some limitation. A grade III strain is a complete rupture of the muscle, which is usually accompanied by a “snap.” The injured person will not be able to continue activity or use the muscle at all.  The most common sites for a strain are the back and the hamstring muscles. Symptoms of a muscle strain depend on the severity of the injury, but may include: pain, muscle spasms, weakness, swelling, cramping, bruising and difficulty moving the muscle. If a muscle or tendon is torn completely, it is often very painful and hard to move.

Treatments for grade I sprains and strains are typically the same and begin with cessation of the activity that caused it. Ice packs should be applied to the area. It is recommend that you initially ice the injury for 20 minutes; once an hour, two to three times a day. As the injury heals, you can ice it less. It is a good idea to rest after the initial injury, but do not rest for too long. You should begin to move the joints and the muscle as soon as possible to prevent stiffness, atrophy, and weakness. Once you can stretch and move without pain, you can begin light stretching and muscle movement. In a study of people with ankle sprains, researchers compared chiropractic joint manipulation with an anti-inflammatory medication. They found that joint manipulation worked as well as the anti-inflammatory medication in improving pain and flexibility. It worked better than the medication in improving range of motion. When you feel ready, you can gradually resume activities in moderation, but you should start slowly. Grade II injuries are treated similarly, but may require some immobilization of the injured area to allow healing. Grade III sprains and strains usually require immobilization and possibly surgery to restore function.

Prevention steps for sprains and strains involve: 1) Avoid exercising or playing sports when tired or in pain. 2) Eat a well-balanced diet to keep muscles strong. 3) Maintain a healthy weight. 4) Wear shoes that fit well. 5) Exercise every day. 6) Be in proper physical condition to play a particular sport. 7) Warm up (light walking or jogging) and stretch before playing a sport. Medical studies have shown that a warm muscle is less likely to be strained. Flexibility is achieved by stretching and is a key factor in the prevention of injury or the re-injury of an already strained muscle. Although there are no scientific studies which show that stretching prevents injury to muscles, most doctors believe that stretching is beneficial. Stretching can be done before or after exercise, but it is best done once you are warmed up.