Sprain, Strain; Causes, Symptoms, Diagnosis, Treatment

A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connect the end of one bone with another. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect the thighbone with the shinbone, enabling people to walk and run.

The areas of your body that are most vulnerable to sprains are your ankles, knees, and wrists. A sprained ankle can occur when your foot turns inward, placing extreme tension on the ligaments of your outer ankle. A sprained knee can be the result of a sudden twist, and a wrist sprain can occur when falling on an outstretched hand.

Sprains are classified by severity:

• Grade 1 sprain (mild): Slight stretching and some damage to the fibers (fibrils) of the ligament.
• Grade 2 sprain (moderate): Partial tearing of the ligament. There is abnormal looseness (laxity) in the joint when it is moved in certain ways.
• Grade 3 sprain (severe): Complete tear of the ligament. This causes significant instability and makes the joint nonfunctional.

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. The most common locations for a sprain to occur are:

• the knee – which can become strained when a person turns quickly during sports or other physical activities
• the ankle – which can become strained when walking or running on an uneven surfac
• the wrist – which can become strained when a person falls onto their hand
• the thumb – which can become strained during intense and repetitive physical activity, such as playing a racquet sport.

 Symptoms of Foot  Sprain, Strain

• pain,
• swelling,
• bruising,
• instability of the joint, and
• decreased range of motion.

Strains

A strain is an injury to a muscle and/or tendons. Tendons are fibrous cords of tissue that attach muscles to the bone. Strains often occur in your foot, leg (typically the hamstring) or back.

Similar to sprains, a strain may be a simple stretch in your muscle or tendon, or it may be a partial or complete tear in the muscle-and-tendon combination. Typical symptoms of a strain include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping.

The severity of a muscle strain is graded into

• First-degree strain – a mild strain when only a few muscle fibers are stretched or torn. The injured muscle is tender and painful but has normal strength.
• Second-degree strain – a moderate strain with a greater number of injured fibers. There are more severe muscle pain and tenderness. There is also mild swelling, some loss of strength, and a bruise may develop.
• Third-degree strain – this strain tears the muscle all the way through. There is a total loss of muscle function.

Soccer, football, hockey, boxing, wrestling, and other contact sports put athletes at risk for strains, as do sports that feature quick starts, such as hurdling, long jump, and running races. Gymnastics, tennis, rowing, golf and other sports that require extensive gripping, have a high incidence of hand sprains. Elbow strains frequently occur in racquet, throwing, and contact sports.

The recommended treatment for a strain is the same as for a sprain: rest, ice, compression and elevation. This should be followed by simple exercises to relieve pain and restore mobility. Surgery may be required for a more serious tear.

Contusions (Bruises)

A contusion is a bruise caused by a direct blow or repeated blows, crushing underlying muscle fibers and connective tissue without breaking the skin. A contusion can result from falling or jamming the body against a hard surface. The discoloration of the skin is caused by blood pooling around the injury.

Most contusions are mild and respond well with the RICE protocol. If symptoms persist, medical care should be sought to prevent permanent damage to the soft tissues.

Causes of Strains

Strains can be caused by the following:

•     Slipping on slick surfaces.
•     Running, jumping or throwing during sports and activities.
•     Lifting heavy objects.
•     Participating in sports or activities without proper conditioning (muscles are not strong enough and flexibility may be limited; therefore you are more likely to sustain injury).
•     Fatigue (tired muscles are less likely to provide support for the joints).
•     Insufficient or improper warm-up (warming up before vigorous physical activity loosens the muscles and increases range of motion, making you less vulnerable to strains).

Signs and symptoms of strains include

• pain,
• inflammation,
• muscle spasm,
• muscle cramping,
• muscle weakness, and
• bruising may occur but may be delayed for several days.

Diagnosis of Foot  Sprain, Strain

Strain injury (SI) may be diagnosed when symptoms develop after a repetitive task and fade when the task is stopped.

Your GP will examine the area where you have pain and ask about your symptoms and medical history.

If your symptoms suggest you have swollen and inflamed tissue, you may have an underlying medical condition, such as:

Bursitis

Bursae are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid and are positioned between bones and soft tissues, acting as cushions to help reduce friction.

Bursitis is inflammation of a bursa. Repeated small stresses and overuse can cause the bursa in the shoulder, elbow, hip, knee or ankle to swell. Many people experience bursitis in association with tendinitis.

Nerve entrapment, such as carpal tunnel syndrome

Dupuytren’s contracture – a thickening of the tissues in the hand, which causes one or more fingers to bend into the palm

Epicondylitis – inflammation of the area where bone and tendon join, such as the elbow

Rotator cuff syndrome – inflammation of the tendons and muscles around the shoulder

Tendonitis – inflammation of a tendon

Tenosynovitis – inflammation of the sheath that covers the tendons, most commonly in the hand, wrist or forearms

Trigger finger – were swelling in a tendon running along one of the fingers makes it difficult to either bend or straighten the affected finger

Ganglion cyst – a sac of fluid that forms around a joint or tendon, usually on the wrist or fingers

Raynaud’s phenomenon – a condition where the blood supply to extremities such as the fingers is interrupted, especially when exposed to cold

Thoracic outlet syndrome – compression of the nerves or blood vessels that run between the base of the neck and the armpit

Writer’s cramp (a type of dystonia) – a condition that occurs from overuse of the hands and arms

If your symptoms don’t immediately suggest one of the above conditions, you may be referred for further tests

Treatment for sprains and strains

Most soft tissue injuries take a few weeks to heal, depending on the severity of the sprain or strain, any subsequent injuries or issues such as weakness, stiffness, poor balance or function, and the general health of the person.

First aid for sprains or strains

Suggestions for immediate treatment of acute sprains or strains include:

• Stop your activity.
• Rest the injured area.
• Use ice packs every two hours, applied for 15 minutes and separated from the skin by wet toweling.
• Compressor bandage the injured site firmly, extending the wrapping from below to above.
• Elevate (raise) the injured area above heart height whenever practical.
• Avoid exercise, heat, alcohol, and massage, which can exacerbate swelling.
• If symptoms get worse in the first 24 hours, see your doctor for further medical investigation.

PRICE

• Protect from further injury (for example, protect the ankle by support or high-top high-lace shoes).
• Rest the joint for 48-72 hours following injury. For example, consider the use of crutches when wanting to be mobile. You need to protect the injured ankle from further injury. For example, use a bandage and/or ankle support, or a boot with high sides. It is important that the ankle is not rested for too long as this may delay recovery. In most cases, early controlled weight-bearing with the ankle well supported is preferable to complete rest.
• Ice should be applied as soon as possible after injury, for 10-30 minutes. (Less than 10 minutes has little effect. More than 30 minutes may damage the skin.) Make an ice pack by wrapping ice cubes in a plastic bag or towel, or by using a bag of frozen peas. Do not put ice directly next to skin, as it may cause ice burn. Gently press the ice pack on to the injured part. The cold is thought to reduce blood flow to the damaged ligament. This may limit pain, inflammation and bruising.
• Compression with a bandage will limit swelling and help to rest the joint. A tubular compression bandage or an elastic bandage can be used. The bandage should not be too tight – mild pressure that is not uncomfortable and does not stop blood flow is the aim. A pharmacist will advise on the correct size. Remove the bandage before going to sleep. You may be advised to remove the bandage for good after 48 hours so that the joint can move.
• Elevation aims to limit and reduce any swelling. For example, keep the foot up on a chair to at least hip level when you are sitting. (It may be easier to lie on a sofa and to put your foot on some cushions.) When you are in bed, put your foot on a pillow

Avoid HARM for 72 hours after injury

That is, avoid

• Heat – for example, hot baths, saunas, heat packs. Heat encourages blood flow which will tend to increase bruising and inflammation. So, heat should be avoided when inflammation is developing. However, after about 72 hours, no further inflammation is likely to develop and heat can then be soothing.
• Alcohol, which can increase bleeding and swelling and decrease healing.
• Running, which may cause further damage.
• Massage, which may increase bleeding and swelling. However, after 72 hours, gentle massage may be soothing.

Treatment may include

• exercises, under the guidance of your doctor or another health professional, to promote healing, strength, and flexibility
• manual techniques, such as mobilization and massage
• electrotherapy
• gradually introducing activities to back-to-normal levels.

Pain-relieving medication (talk to your doctor or pharmacist before taking any medications, as they can sometimes disrupt the healing of soft tissue injuries)

• medication – including short-term use of anti-inflammatory painkillers (such as ibuprofen) or pain receptor-blocking medications, such as some forms of antidepressants, if you’re getting severe symptoms or interrupted sleep
• cold packs, elastic supports or a splint
• physiotherapy – including advice on posture and stretches or exercises to help strengthen or relax your muscles
• steroid injections to reduce inflammation in an affected area (these are only recommended if an area has definite inflammation caused by a specific condition, such as carpal tunnel syndrome)
• surgery to correct specific problems with nerves or tendons (for example, if you are diagnosed with carpal tunnel syndrome or Dupuytren’s contracture) if other treatments haven’t helped

Physical and complementary therapies

“Hands-on” therapies, including physiotherapy, massage or osteopathy, may be available after a referral from your GP, but in some cases, there may be a long wait for an appointment.

If you’re thinking about private treatment, make sure your therapist is registered with a professionally recognized organization.

Many long-term sufferers of RSI try other types of complementary therapies and relaxation techniques to help relieve the symptoms of RSI, such as:

• yoga
• acupuncture
• the Alexander technique

Severe injuries, where the tissue has completely ruptured, may need surgery to put the torn pieces back together. Surgically repaired grade III injuries will require significant treatment to regain strength and function. Whether you have surgery, or immobilization and physical therapy, as the treatment for a grade III injury, medium to long-term success is similar for either treatment.