Sprains and strains

Soft tissue injuries may be sudden (acute) or long-standing (chronic). and tendons. in the body. A strain is an injury to muscles or tendons. Healing depends on various factors including the type of tissue and severity of injury, treatment undertaken, previous injuries, and the age and general health of the person.

Soft tissue structures are made from bundles of fibres. Muscles and tendons contain specialised cells that monitor the degree of contraction and stretch. With general use, muscles gently contract to resist overstretching.

However, sudden twists or jolts can apply greater force than the tissue can tolerate, resulting in a tear or rupture of the fibres. The damage to these fibres triggers an immune reaction called inflammation. Inflammation is a complex cascade of biological processes that results in the classic swelling, redness and tenderness associated with sprains and strains.

In higher-grade injuries, bleeding from broken blood vessels increases the degree of swelling. Injuries to soft tissues such as ligaments, muscles and tendons can come on suddenly, and occasionally be recurrent or get worse over time (usually due to suboptimal treatment and rehabilitation). A sudden injury is often related to a specific incident and is termed an acute soft tissue injury.

Acute usually means the injury has occurred within the previous 72 hours. An injury that has been present for at least 3 months is often referred to as a chronic soft tissue injury. Joints are stabilised by a joint capsule and supported by tough bands of connective tissue called ligaments.

These structures are often called passive or non-contractile supports. The entire joint is enclosed inside a membrane filled with lubricating synovial fluid, which helps to nourish the joint and provide extra cushioning against impact. A sprain is an injury that involves tearing of the ligaments or joint capsule or both.

Common sites for sprains include the thumb, ankle and knee. Muscles traverse across joints and are anchored to bones via tendons. Muscles can cross either one joint (single-joint muscles) or 2 or more joints (multi-joint muscles).

Muscles contract (or shorten) and pull on their tendon insertion into the bone and thus produce movement of a joint. Multi-joint muscles (like the hamstrings, quadriceps and our main calf muscle called the gastrocnemius) are injured at much higher rates than single joint muscles. Injury to these tendons or the muscles themselves is called a strain.

Common sites for strains include the calf, groin and hamstring.

The symptoms of a sprain or strain may include: reduced function

Acute soft tissue injuries can be graded according to their severity. The classic grading system for ligaments is from grade I to grade III: localised pain with palpation (pressing).

Grading of muscle injuries classically follows this same formula of grade I to grade III.

However, there are new grading systems that expand upon this for further depth and nuance: localised tenderness with palpation. widespread tenderness with palpation. limited loss muscle power. moderate functional limitation.

significant functional limitation

significant functional limitation

Suggestions for immediate treatment of acute sprains or strains include: Stop your activity.

Rest the injured area

Put icepacks on the area for 20 minutes every 2 waking hours, separated from the skin by wet towelling. Compress or bandage the injured site firmly, extending the wrapping from below to above. Elevate (raise) the injured area above heart height whenever practical.

If symptoms get worse in the first 24 hours, see your doctor for further medical investigation. 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.

Hamstring strains (the most common strain) have an average return to play time of 3 weeks. Lateral ankle sprains (one of the most common ligament sprains) have an average return to play time of 2.5 weeks.

However, the variation can be large with some studies citing return to play times of over 100 days for some hamstring strains and ankle sprains.

It’s important to get the correct treatment as soon after the injury as possible to help faster recovery. See your doctor or physiotherapist if you don’t have full function of the area, or if the pain and swelling don’t subside after a couple of days. Treatment may include:

• exercises – under the guidance of your doctor or other health professional
• to promote healing strength
• flexibility bracing
• external supports – to help protect the injured area
• allow greater participation in normal daily activities whilst the injury heals pain-relieving medication – talk to your doctor or pharmacist before taking any medications
• as they can sometimes disrupt the healing of soft tissue injuries gradually introducing activities to back-to-normal levels

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 a period of immobilisation and physical therapy as the treatment for a grade III injury, medium to long-term functional outcomes is similar for either treatment.

Need treatment today? Need treatment today, but it’s not life-threatening and you can’t get a GP appointment, there are services available: – provide care for conditions that require treatment today but not an emergency response (extended hours) Tel. About sprains and strains Soft tissues include ligaments, muscles A sprain is an injury to the ligaments and capsule of a joint Causes of sprains and strains Sprains Strains Symptoms of sprains and strains pain swelling stiffness Degrees of severity of a sprain or strain Grade I – Injury to some ligament fibres Signs and symptoms minimal function limitation normal range of motion minimal swelling Grade II – Injury to a considerable portion of the ligament fibres Signs and symptoms significant pain with palpation considerable swelling Grade III – Complete rupture of ligament Signs and symptoms audible ‘pop’ may have been heard at time of injury considerable swelling and bleeding Grade 0a – Focal muscle injury with normal MRI Signs and symptoms ‘awareness’ of muscle with use Grade 0b – Generalised muscle soreness with normal MRI Signs and symptoms no trauma or moment in time muscle pain usually starts 24 to 48 hours after an unaccustomed bout of exercise Grade 1 – Small local tears to muscle Signs and symptoms noticeable moment in time immediate onset of pain localised tenderness with palpation no loss of range of motion Grade 2 – Moderate localised tears to muscle Signs and symptoms noticeable moment in time immediate onset of pain localised tenderness with palpation no loss of range of motion moderate loss of muscle power Grade 3 – Extensive tears to muscle Signs and symptoms noticeable moment in time immediate onset of pain localised tenderness with palpation can have some loss of range of motion significant loss of muscle power Grade 4 – Complete tears to muscle belly or tendon, or between junction of muscle and tendon Signs and symptoms noticeable moment in time immediate onset of pain localised tenderness with palpation can have visible deformity to muscle can have some loss of range of motion significant loss of muscle power First aid for sprains or strains Avoid heat, alcohol , running Treatment for sprains and strains manual techniques – such as mobilisation and massage electrotherapy Where to get help Your GP (doctor) Physiotherapist Urgent Care Clinics Nurse-on-Call (616) 555-0024 – for expert health information and advice (24 hours, 7 days) Emergency care In an emergency, always call 911 Emergency department of your nearest hospital More information American Physiotherapy Association (616) 555-0200.

Key Points

• Common sites for sprains include the thumb, ankle and knee
• Common sites for strains include the calf, groin and hamstring
• symptoms of a sprain or strain may include: reduced function
• Suggestions for immediate treatment of acute sprains or strains include: Stop your activity
• If symptoms get worse in the first 24 hours, see your doctor for further medical investigation