Overview
A sprain is an injury to a ligament, the strong band of tissue that connects bones at a joint. A strain is an injury to a muscle or to a tendon, which joins muscle to bone. A strain is also called a pulled muscle.
Both range from a mild stretch to a partial or complete tear. Sprains are common in the ankles, wrists, thumbs and knees, and strains in the back, legs and feet. Mild and moderate injuries often heal with simple care at home.
Symptoms
Sprains and strains cause similar problems:
- Pain, tenderness or weakness around the injury
- Swelling or bruising
- Trouble putting weight on the injured part or using it normally
- Stiffness, and muscle spasms or cramping, especially with a strain
- A pop or tear felt at the moment of injury, in some sprains
A bad sprain, a dislocation and a broken bone can look alike, so an X-ray is sometimes needed.
When to see a doctor
See a doctor soon if the pain is very bad or getting worse, swelling or bruising is large or growing, you cannot put weight on it or walk more than a few steps, the area is very stiff, or you have a very high temperature or feel hot, cold or shivery. Also see a doctor if it is not getting better after treating it yourself.
Causes
A sprain usually happens when a joint is forced out of position, for example by a fall, a twist or a blow. A strain can happen the same way, or build up when a movement is repeated again and again, as in some sports.
Risk factors
- Playing sport, especially without warming up
- Tired muscles, poor technique, or increasing exercise too quickly
- Running or jumping on hard surfaces
- Shoes with poor support, or the wrong equipment
- A previous injury to the same part, or poor flexibility
- Certain (fluoroquinolones), which are linked to tendon injury
Complications
Most people recover well, but some problems can follow:
- Severe injuries can take months to recover fully
- Further damage if hard exercise, such as running, starts too early
- Stiffness, if the part is kept still for too long
Prevention
Sprains and strains cannot always be prevented, but these steps lower the risk:
- Warm up before exercise and keep the muscles flexible
- Build up the amount and intensity of exercise gradually
- Use correct technique and the right equipment
- Wear supportive shoes, and avoid running or jumping on hard surfaces where you can
- Rest when your muscles are tired
Diagnosis
A doctor asks how the injury happened and examines the injured part. Injuries are graded from a mild stretch to a complete tear. An X-ray may be done to check for a broken bone.
Treatment
For the first 2 to 3 days, a common approach is PRICE: protection (a support or supportive footwear), rest (stop exercise and avoid weight on the injury), ice (wrapped in a cloth, for up to 20 minutes every 2 to 3 hours), compression (a bandage during the day) and elevation (keep it raised on a pillow). Avoid heat, alcohol and massage for the first couple of days.
When the pain allows, start moving the injured part gently so it does not stiffen. Paracetamol can ease pain, and ibuprofen gel or spray can help with swelling. Ibuprofen tablets do not suit everyone, so check with a doctor or pharmacist.
Most sprains and strains feel better after about 2 weeks. Avoid strenuous exercise such as running for up to 8 weeks to prevent further damage. Physiotherapy can help if recovery is slow. Severe injuries may need a brace or cast.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A hot oil massage or a hot compress straight away will take the swelling out.”What is true?
Fact
In the first couple of days, avoid heat, alcohol and massage, because they can increase the swelling. Protect the injury, rest it, put ice wrapped in a cloth on it, support it with a bandage and keep it raised. Gentle movement can start once pain allows.
Myth“If I can still walk on it, it is only a sprain.”What is true?
Fact
A bad sprain, a dislocation and a broken bone can look alike, especially in the wrist and ankle. An X-ray is sometimes needed to tell them apart. If you heard a crack, the part is out of shape or numb, or you cannot put weight on it, see a doctor.
Myth“I should rest the injury completely until the pain has gone.”What is true?
Fact
Rest and protection help in the first days, but keeping the part completely still for too long can make it stiff. Once you can move it without pain stopping you, try to keep moving it gently.
Myth“Once the pain has eased I can go straight back to sport.”What is true?
Fact
Most sprains and strains feel better after about 2 weeks, but the tissue is still healing. Strenuous exercise such as running is best avoided for up to 8 weeks to prevent further damage, and severe injuries can take months to recover fully.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
What is the difference between a sprain and a strain?
A sprain is an injury to a ligament, which joins bones at a joint, such as a twisted ankle. A strain is an injury to a muscle or tendon, such as a pulled muscle in the back or leg. The first aid and recovery are very similar.
How do I know whether it is a sprain or a break?
You cannot always tell. A bad sprain, a dislocation and a broken bone can look alike. If you heard a crack, the part has changed shape, it is numb, or you cannot put weight on it, see a doctor, and expect to need an X-ray.
Should I use ice or heat?
Use ice, wrapped in a cloth, for the first 2 to 3 days. Avoid heat, alcohol and massage for the first couple of days, as they can increase swelling. A pharmacist or doctor can advise you on anything further.
When can I start exercising again?
Start gentle movement as soon as the pain allows. Avoid hard exercise such as running for up to 8 weeks, and go back to sport only after rehabilitation exercises. A doctor or physiotherapist can guide you.